Coach2Move: Physical Therapy to Improve Physical Activity in Individuals With Chronic MSK Conditions

Leveraging Physical Therapy to Improve Physical Activity in Older Adults With Chronic MSK Conditions.

Chronic musculoskeletal conditions (chronic low back pain, knee osteoarthritis, hip osteoarthritis) are the most common causes of long-term disability resulting in a loss of quality-of life for affected individuals and high costs for society. Regular physical activity can reduce disability and improve quality-of-life but can be challenging in the presence of pain and impaired function. This proposal addresses an urgent need for interventions that support physical activity in this population by leveraging the physical therapy intervention to address symptoms of chronic musculoskeletal conditions and support long-term physical activity engagement.

Coach2Move is a patient-centered physical therapy intervention that has demonstrated success in changing physical activity in adults with chronic medical conditions. Coach2Move has only been delivered in the Netherlands with older adults at risk of frailty. It is unclear if it is feasible to deliver this intervention within a U.S. health system and if it would be effective for older adults with chronic MSK conditions. The objective of this research is to adapt and implement the Coach2Move intervention among mid-life and older adults with chronic MSK conditions in a U.S. health care system.

The investigators will do this through the following specific aims:

Aim 1: Adapt the Coach2Move intervention for mid-life and older adults with chronic MSK conditions.

Using a systematic process, intervention mapping, investigators will adapt the Coach2Move training, patient and provider materials to incorporate best evidence for chronic low back pain, and hip/knee osteoarthritis. The investigators will use the logic model from the original Coach2Move program to identify changes necessary for delivery to this population and in the U.S. health system. The adaptation team will include the Coach2Move developers, 2 physical therapists and 2 patient-representatives.

Aim 2: Assess the impact of implementing Coach2Move on patient-level physical activity and function.

With a single group clinical cohort of 104 patients, investigators will examine the impact of the adapted Coach2Move on PA and function 6-months after initiating PT. Investigators will measure implementation with fidelity, dose and reach. Investigators will examine the association between Coach2Move fidelity and dose on PA using regression models and examine reach descriptively across clinics and patient demographics.

Aim 3: Identify Coach2Move implementation barriers and facilitators from both clinician and patient perspectives.

Investigators will evaluate patient and clinician experiences with Coach2Move through semi-structured patient interviews and a clinician focus group. Using interviews with 30 patients receiving the Coach2Move intervention, we will explore the patient experience, perceived burden of the program, and health beliefs. With clinician interviews we will examine barriers and facilitators to implementing Coach2Move.

Inclusion Criteria:

• Scheduled for physical therapy with a Coach2Move trained physical therapist for chronic hip, knee, or back pain (3 months or more).
• Able to walk around home independently.
• Current hip, knee, or back pain is limiting physical activity

Exclusion Criteria:

• Medical provider determines increasing physical activity is not appropriate.