Acceptability of therapist training and delivery of a psychological informed gait rehabilitation intervention for people with early rheumatoid arthritis

Sekhon, M; Godfrey, E; Amirova, A; Hendry, G; Foster, N; Hider, SH; van der Leeden, M; Mason, H; McConnachie, AA; McInnes, I; Patience, A; Sackley, C; Steultjens, M; Williams, AE; Woodburn, J; Bearne, L

Abstract

Purpose: GREAT-Strides is a novel gait rehabilitation intervention with an embedded psychological component aimed at improving walking ability in people with early rheumatoid arthritis. As part of the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study, physiotherapists and podiatrists received two days of bespoke training delivered by psychologists, physiotherapists and podiatrists on (i) the Great-Strides exercise programme (six walking exercises), (ii) aspects of motivational interviewing (MI) and (iii) delivery of key behaviour change techniques (BCTs) to facilitate motivation and adherence to the intervention. The aim of this study was to explore therapists’ acceptability of: (1) the bespoke training and (2) GREAT-Strides within the GREAT feasibility study.

Methods: Nine therapists (four physiotherapists, five podiatrists) participated in semi-structured telephone interviews. The topic guide was informed by the Theoretical Framework of Acceptability (TFA). Interviews were audio recorded, professionally transcribed, and a deductive thematic analysis was applied. Data were coded into six TFA constructs (Affective Attitude; Burden; Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy).

Results: Barriers and facilitators to the acceptability of the training and intervention were identified.

Training: Therapists liked the supportive training environment (affective attitude) and reported that role play exercises aided their confidence in applying MI and BCTs (self-efficacy). Therapists also understood the purpose of the training sessions (intervention coherence) and reported the training sessions were vital preparation for delivering the intervention (perceived effectiveness). The lack of time available from clinicians usual practice to attend training was considered unacceptable (opportunity costs).

Delivery: All therapists valued the opportunity to provide individualised care (intervention coherence)and enjoyed applying MI techniques and BCTs to encourage patients to adhere to completing the gair exercises (affective attitude). Barriers associated with acceptability included the use of trial-related materials (e.g. checklist) during intervention delivery (burden), the time delay between receiving training and intervention delivery (perceived effectiveness) and impact of delivering GREAT-strides on routine clinical workload (opportunity costs).

Conclusion(s): The bespoke training and GREAT-Strides delivery was acceptable to most therapists. Findings have guided refinements (e.g. timing of training in relation to intervention delivery, remote access to training, development of example audio and recordings of intervention delivery) for the GREAT trial.

Impact: The refinements to training and the GREAT-Strides intervention will optimise the acceptability of training and delivery in the GREAT trial and may influence future implementation into practice. The GREAT-Strides will potentially transform the management of Foot disability and pain in people with RA.

Citation

Sekhon, M., Godfrey, E., Amirova, A., Hendry, G., Foster, N., Hider, S., …Bearne, L. (2022). Acceptability of therapist training and delivery of a psychological informed gait rehabilitation intervention for people with early rheumatoid arthritis. Physiotherapy, 114(Sup. 1), e120-e121. https://doi.org/10.1016/j.physio.2021.12.072

• Journal Article Type: Conference Paper
• Conference Name: Physiotherapy UK 2021 Conference
• Conference Location: Virtual
• End Date: Nov 6, 2021
• Publication Date: Feb 16, 2022
• Deposit Date: Feb 22, 2022
• Journal: Physiotherapy
• Publisher: De Gruyter
• Volume: 114
• Issue: Sup. 1
• Pages: e120-e121
• DOI: https://doi.org/10.1016/j.physio.2021.12.072
• Publisher URL: https://doi.org/10.1016/j.physio.2021.12.072
• Related Public URLs: https://www.journals.elsevier.com/physiotherapy/
• Additional Information: Access Information : This is a published conference poster abstract.; Event Type : Conference; Projects : Health Technology Assessment Programme