Exploring Facilitators and Barriers to Physiotherapists’ Delivery of a Falls Prevention Program with Brief Action Planning Counseling in Community-Dwelling Older Adults with a History of Falls

Objectives Falls are a leading cause of injury and hospitalization among older adults, including those with rheumatic conditions that can increase falls risk.[1] The Otago Exercise Program (OEP) can reduce falls by 35%,[2] but sustained participation remains challenging. Structured self-management approaches can improve adherence, yet little is known about physiotherapists’ experiences delivering these approaches in community-based falls prevention. This qualitative study explored facilitators and barriers influencing physiotherapists’ delivery of OEP+ (home-based OEP with Brief Action Planning [BAP] and a Fitbit-compatible app) in community-dwelling older adults with a history of falls.

Methods A qualitative study using directed content analysis guided by the Theoretical Domains Framework (TDF),[3] was conducted. Semi-structured Zoom interviews (30-60 minutes) were completed with 13 physiotherapists purposively sampled after delivering OEP+ to community-dwelling older adults for 12 months. OEP+ combined OEP with BAP, a structured approach to support self-management which involves goal setting, action planning, and feedback, plus a Fitbit-compatible app. Interviews were audio-recorded, transcribed verbatim, and analyzed using the TDF, which integrates constructs from behavior change theories to identify factors influencing implementation. Three researchers (CP, ST, EW) independently coded transcripts and reached consensus.

Results Thirteen physiotherapists participated (7 private, 6 public), aged 20-64 years (31% aged 20-34, 54% aged 35-49, 15% aged 50-64), with a median of 15 years of experience (IQR=6-22). Two had prior exposure to using OEP in practice, and 7 had home-care experience. Facilitators and barriers to delivery were categorized using the TDF (Table 1). Facilitators included prior knowledge of OEP components, structured session planning, use of BAP support materials, context-sensitive application of BAP, ability to adapt exercises for home environments, and prior home care experience. External support (eg, patient family involvement, app-based cues) reinforced program delivery, while minimal equipment needs enhanced accessibility. Barriers included time gaps between training and delivery, rigidity of BAP structure, difficulty recalling exercise progressions, scripted follow-up calls limiting conversation flow, unclear communication about time expectations, scheduling and workload challenges, time-intensive home visits, and technical app issues. Some physiotherapists reported low confidence delivering follow-up phone visits and frustration with scheduling delays, though several planned to continue applying BAP skills in future practice. These factors collectively influenced physiotherapists’ ability to integrate OEP+ effectively into community practice.

Conclusion Modifiable factors, including practical supports and program design, shape physiotherapists’ ability to deliver OEP+ effectively in community falls prevention. Findings can support development of theory-informed strategies to enhance uptake, engagement, and sustainability of community falls prevention.

References [1.] Stanmore EK. Arthritis Care Res 2013;65:1251-8. [2.] Robertson MC. J Am Geriatr Soc 2002;50:905-11. [3.] Cane J. Implement Sci 2012;7:37.