Facilitators of and Barriers to Physical Activity Promotion among Physical Therapists who Treat Clients with Neurological Conditions: A Qualitative Study Informed by the Theoretical Domains Framework

Abstract

Healthcare provider communications about physical activity (PA) lead to meaningful and sustained increases in PA, but physical therapists (PTs) do not consistently promote PA for clients with neurological conditions (NC). The purpose of this qualitative study was to understand factors that could support implementation strategies related to PTs promoting PA for clients with NC. The Theoretical Domains Framework (TDF) was used to develop a semi-structured interview guide. One-on-one online interviews were conducted in 2022 with 10 physical therapists licensed to practice in the United States whose caseloads include clients with NC. Responses were first sorted into a priori factors derived from previous research (TDF codebook), then reappraised to ensure other factors were not overlooked (inductive analysis). Responses about facilitators corresponded to three factors: Personal (e.g., sense of responsibility, personal connections to community opportunities); Professional (e.g., a specific PT course on PA promotion); and Client-related (e.g., highly motivated). Barriers corresponded to two factors: Professional (e.g., limited continuing education, lack of guidance/communication from PT-associations), and Client-related (e.g., lack of low-cost/free services to offer, provider safety concerns). There are opportunities for PTs to increase PA promotion when treating clients with NC, as outlined in PT education. PTs should also utilize and advocate for community-based partnerships and expand education/resources from PT associations beyond traditional communication channels.