Accepted for/Published in: JMIR Aging
Date Submitted: Sep 22, 2023
Open Peer Review Period: Sep 22, 2023 - Oct 9, 2023
Date Accepted: Dec 18, 2023
(closed for review but you can still tweet)
“It gives you more independence”: experiences of older people, physiotherapists and aged care staff in the TOP UP telephysiotherapy program
ABSTRACT
Background:
Telehealth provides opportunities for older people to access health care. However, limited research exists on the utilisation of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older people, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP Study, a hybrid type 1 hybrid effectiveness-implementation randomised control trial in aged care, employed a supported multidisciplinary telehealth physiotherapy model to motivate older people to engage in exercises to improve mobility and reduce falls.
Objective:
This qualitative sub-study aimed to achieve two primary objectives: 1) to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists and aged care support workers and managers; and 2) to gain an in-depth understanding of program implementation.
Methods:
A purposive recruitment strategy was employed to select 18 older people who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographical location, and cognitive levels. Additionally, seven physiotherapists, eight aged care support workers, and six managers from seven different aged care provider partners participated in the study. Semi-structured interviews were conducted to explore stakeholders’ experiences with the TOP UP program, gather suggestions for improvement, and obtain insight for future implementation of similar telehealth physiotherapy programs. The interview framework and coding processes were informed by behaviour change and implementation frameworks. Data were analysed using an abductive approach, informed by two behavioural change theories (COM-B, Self Determination Theory) and the NASSS framework (Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies).
Results:
All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. Thematic analysis generated six main themes: (1) Telehealth physiotherapy expands opportunity, (2) Tailored physiotherapy care with local support enhances motivation, (3) Engaging, senior-friendly educational resources build capability, (4) Flexible reablement approach fosters autonomy, (5) Telehealth physiotherapy is safe, effective and acceptable for many, and (6) Organisational commitment is required to embed telehealth. Motivation to exercise was enhanced by Zoom’s convenience, use of tailored online exercise resources, and companionable local support.
Conclusions:
This study highlights the inherent value of telehealth physiotherapy in aged care, emphasising the need for investment in staff training, local support and senior-friendly resources in future telehealth physiotherapy iterations. TOP UP represents a convenient and flexible virtual care model that empowers many older people to receive sustainable, high-quality care precisely when and where they need it. Clinical Trial: ACTRN 1261000734864
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