远程医疗步行自我管理在截肢患者中的应用：基于治疗师视角的采用定性研究。

Telehealth Walking Self-Management for Individuals With Amputation: A Qualitative Study of Therapist Perspectives on Adoption.

机构信息

Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA.

Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA.

出版信息

Phys Ther. 2024 Feb 1;104(2). doi: 10.1093/ptj/pzad155.

DOI:10.1093/ptj/pzad155

PMID:37944092

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10902556/

Abstract

OBJECTIVE

The aim of this study was to understand therapist-identified factors influencing clinical adoption of a telehealth walking self-management intervention for individuals with lower limb amputation.

METHODS

Semi-structured focus groups were completed with actively practicing physical and occupational therapists treating populations that are medically complex. A qualitative explorative design was employed with conventional content analysis and iterative independent parallel coding using 2 analysts. Themes and subthemes were generated with a consensus building process identifying patterns and collapsing codes to represent participant perspectives.

RESULTS

Thematic saturation was met after 5 focus groups (24 therapists). Therapists were on average 34 years old and predominantly female (n = 19; 79%) physical therapists (n = 17; 71%). Three primary facilitator and barrier themes were identified for intervention adoption: system, therapist, and person. System considerations included telehealth support and interprofessional care coordination. Therapist facilitators included self-management programming that overlapped with standard of care and personalization methods. However, limited behavioral theory training was a therapist level barrier. Finally, person factors such as patient activation could influence both positively and negatively. Person facilitators included social support and barriers included the complex health condition.

CONCLUSION

System, therapist, and person facilitators and barriers must be considered to maximize the adoption of similar telehealth walking self-management interventions and prior to larger scale implementation of the current intervention for individuals with lower limb amputation.

IMPACT

A telehealth walking self-management intervention has potential impact for individuals with lower limb amputation and must be considered in terms of optimizing system, therapist, and person level facilitators and barriers to implementation.

摘要

目的

本研究旨在了解治疗师确定的影响下肢截肢患者远程健康步行自我管理干预临床应用的因素。

方法

与积极治疗医疗复杂人群的在职物理治疗师和职业治疗师进行半结构式焦点小组讨论。采用定性探索性设计，使用两名分析师进行常规内容分析和迭代平行独立编码。通过共识建立过程生成主题和子主题，以代表参与者的观点对模式进行分类并合并代码。

结果

5 个焦点小组（24 名治疗师）后达到主题饱和。治疗师的平均年龄为 34 岁，女性居多（n=19；79%），其中物理治疗师（n=17；71%）居多。确定了三个促进和阻碍干预措施采用的主要因素：系统、治疗师和人。系统考虑因素包括远程健康支持和跨专业护理协调。治疗师的促进因素包括与标准护理重叠的自我管理计划和个性化方法。然而，行为理论培训有限是治疗师层面的障碍。最后，患者激活等个人因素可能会产生积极和消极的影响。个人促进因素包括社会支持，而障碍则包括复杂的健康状况。