Implementing Live Long Walk Strong: Practice-based evidence on adapting a physical therapy program across diverse contexts.

Abstract

Adapting programs to fit the needs of different contexts allows for greater reach. Live Long Walk Strong is a physical therapy program designed to improve mobility among older adults. To describe adaptation of Live Long Walk Strong, an age-friendly physical therapy program, across four different clinical settings. Process evaluation. Urban outpatient, rural outpatient, skilled nursing facility, and virtual (telehealth) settings within the Veterans Health Administration. Physical therapists and physical therapist assistants delivering Live Long Walk Strong (n = 11). Not applicable. Barriers encountered and adaptations made to the program as it was implemented across settings. We used the Consolidated Framework for Implementation Research (CFIR) to organize and analyze collected data. We identified barriers across the Innovation, Outer Setting, Inner Setting, and Individuals domains of the CFIR. Several barriers were encountered across all contexts. These barriers related to CFIR constructs Design, Partnerships & Connections, and Access to Knowledge & Information. The shared barriers led to central adaptations beneficial to all current and future sites. We also identified barriers unique to specific contexts, which resulted in adaptations to improve fit and allow the program to best meet the needs of patient populations in those settings. Facilitators were similar across settings and did not result in further adaptation of the program; however, they likely contributed to the program's successful spread across different contexts. Facilitators fell under the Design and Relative Advantage constructs of the Innovation domain, as well as under the Relational Connections and Mission Alignment constructs of the Inner Setting domain. We present practice-based evidence on adaptations to an age-friendly physical therapy program implemented across diverse settings. Our findings provide practical information that may improve the efficiency of implementation of future programs, as potential barriers can be addressed during the planning phase.