title: Physical Therapists, Telephone Coaches, and Patients With Knee Osteoarthritis: Qualitative Study About Working Together to Promote Exercise Adherence.
abstract: BACKGROUND
  Integrated models of care are recommended for people with knee osteoarthritis (OA). Exercise is integral to management, yet exercise adherence is problematic. Telephone-based health coaching is an attractive adjunct to physical therapist-prescribed exercise that may improve adherence. Little is known about the perceptions and interpretations of physical therapists, telephone coaches, and patients engaged in this model of care.
  
  
  OBJECTIVE
  The purpose of this study was to explore how stakeholders (physical therapists, telephone coaches, and patients) experienced, and made sense of, being involved in an integrated program of physical therapist-supervised exercise and telephone coaching for people with knee OA.
  
  
  METHODS
  A cross-sectional qualitative design drawing from symbolic interactionism was used.
  
  
  METHODS
  Semistructured interviews with 10 physical therapists, 4 telephone coaches, and 6 patients with painful knee OA. Interviews were audiorecorded, transcribed, and analyzed using thematic analysis informed by grounded theory.
  
  
  RESULTS
  Four themes emerged: (1) genuine interest and collaboration, (2) information and accountability, (3) program structure, and (4) roles and communication in teamwork. Patients reported they appreciated personalized, genuine interest from therapists and coaches and were aware of their complementary roles. A collaborative approach, with defined roles and communication strategies, was identified as important for effectiveness. All participants highlighted the importance of sharing information, monitoring, and being accountable to others. Coaches found the lack of face-to-face contact with patients hampered relationship building. Therapists and coaches referred to the importance of teamwork in delivering the intervention.
  
  
  CONCLUSIONS
  The small number of physical therapists and telephone coaches who delivered the intervention may have been biased toward favorable experiences with the intervention and may not be representative of their respective professions.
  
  
  CONCLUSIONS
  Integrated physical therapy and telephone coaching was perceived as beneficial by most stakeholders. Programs should be structured but have some flexibility to give therapists and coaches some freedom to adjust treatment to individual patient needs as required. Opportunities for visual communication between telephone coaches and patients could facilitate relationship building.
authors: R.S. Hinman, BPhysio(Hons), PhD, Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia 3010. ranash@unimelb.edu.au.
authors: Rana S
authors: RS
authors: Hinman
authors: C.M. Delany, BPhysio, MHlth&MedLaw, MPhysio, PhD, Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne.
authors: Clare M
authors: CM
authors: Delany
authors: P.K. Campbell, BAppSci(FoodSci&Nutr), Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne.
authors: Penelope K
authors: PK
authors: Campbell
authors: J. Gale, BA(Psych Hons), MCommerce, MCHP, HealthChange Australia, Kangaroo Valley, Australia.
authors: Janette
authors: J
authors: Gale
authors: K.L. Bennell, BAppSci(Physio), PhD, Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne.
authors: Kim L
authors: KL
authors: Bennell
mesh_terms: D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005081:Exercise Therapy; D005260:Female; D066296:Grounded Theory; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010349:Patient Compliance; D059825:Physical Therapists; D024382:Professional Role; D013689:Telephone