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. 2017 Jul 27;42(3):E1–E16. doi: 10.1519/JPT.0000000000000140

Table 1. Description of the Coach2Move Strategy and Usual Care Physical Therapy, and the Implementation Strategy for Older Adults (≥70 Years) Visiting the Physical Therapist With Mobility Problems.

Subject Coach2Move Strategy Usual Care Physical Therapy
Provider Physical therapist with (a) additional education in physical therapy in geriatrics at master's level, (b) experienced in working with older adults, and (c) trained in the Coach2Move strategy and measurement instruments and standardized reporting in medical records. Physical therapist with (a) experience in working with older adults, and (b) trained in using the measurement instruments and standardized reporting of medical records.
Primary focus (Re)gaining roles and physical activity focused on empowerment of abilities, self-management, and using the context in the exercises focused on barriers related to impairment, activity, and participation levels. Exercises focused on impairment, activity, and participation levels.
Therapy elements Key elements added to the steps in clinical reasoning (90 min):
  1. History taking concerning the start and course of the complaints, exploring the question of help, with added motivational interviewing techniques addressing barriers and facilitators (physical, social, and environmental) in relation to physical activity, and exploring needs and beliefs; questions focus on both disabilities and abilities.

  2. Using the HOAC-II for problem analysis and diagnostics, eg, testing muscle force, joint mobility, endurance, pain, fatigue, skill performance, coordination, etc, guided by the disabilities found, with a strong focus on task manipulation to test abilities and to set priorities.

  3. Shared decision making on meaningful treatment goals to abrogate barriers and increase physical activity.

  4. Coaching on self-management and self-efficacy to perform exercise in daily activities at home and goal setting on being physically active at home.

  5. Repeated measurements to monitor the outcome and increase adherence and motivation.

  6. Focus on meaningful activities at home with help from family, friends, and/or professionals.

  7. Three tailored intervention profiles defined by the number (4/9/18 sessions) of intervention sessions needed, based on expected recovery potential, baseline level, coping style, and availability of environmental support.

  8. Increasing physical and social activity levels and exercise interventions based on the physical therapy diagnosis, including training in strength, endurance, balance, flexibility, functional training, etc.

Steps in usual care physical therapy clinical reasoning (30 min):
  1. History taking concerning the start and course of the complaints, exploring the issue of help, with a strong emphasis on disabilities.

  2. Using the HOAC-II for problem analysis and diagnostics, eg, testing muscle force, joint mobility, endurance, pain, fatigue, skill performance, coordination, etc, guided by the disabilities found.

  3. Defining treatment goals.

  4. Supervised training combined with exercise advice at home.

  5. Monitoring through observation (less objective measurements).

  6. Less focus on environmental social support.

  7. Open-ended: number of sessions to be determined during ongoing treatment.

  8. Exercise interventions depending on the physical therapy diagnosis, including training of strength, endurance, balance, flexibility, functional training, etc, and increasing physical activity level.

Implementation
  1. Two-day training in Coach2Move strategy (motivational interviewing, HOAC-II with video cases, strong emphasis on task manipulation [what to change for enablement], shared decision making and SMARTI goal setting, and how to organize self-management).

  2. Explanation of and training in the measurement instruments used.

  3. Explanation of the use of Coach2Move supportive medical records with decision aids.

  4. Feedback and coaching during the RCT by the researcher (NdV).

  5. Three follow-up meetings to discuss problems encountered.

  6. Payment for the extra time to perform the intake.

  1. One day training on the HOAC-II (same patient video cases).

  2. Explanation of and training in the measurement instruments used.

  3. Explanation of medical recording guidelines.

Abbreviations: HOAC-II, Hypothesis Oriented Algorithm for Clinicians II; RCT, randomized clinical trial.