title: Development of a Theory-Based Intervention to Increase Clinical Measurement of Reactive Balance in Adults at Risk of Falls.
abstract: BACKGROUND
  Effective balance reactions are essential for avoiding falls, but are not regularly measured by physical therapists. Physical therapists report wanting to improve reactive balance assessment, and theory-based approaches are recommended as the foundation for the development of interventions. This article describes how a behavior change theory for health care providers, the theoretical domains framework (TDF), was used to develop an intervention to increase reactive balance measurement among physical therapists who work in rehabilitation settings and treat adults who are at risk of falls.
  
  
  METHODS
  We employed published recommendations for using the TDF-guided intervention development. We identified what health care provider behavior is in need of change, relevant barriers and facilitators, strategies to address them, and how we would measure behavior change. In this case, identifying strategies required selecting both a reactive balance measure and behavior change techniques. Previous research had determined that physical therapists need to increase reactive balance measurement, and identified barriers and facilitators that corresponded to 8 TDF domains. A published review informed the selection of the Balance Evaluation Systems Test (Reactive Postural Responses Section) as addressing the barriers and facilitators, and existing research informed the selection of 9 established behavior change techniques corresponding to each identified TDF domain.
  
  
  RESULTS
  The TDF framework were incorporated into a 12-month intervention with interactive group sessions, local champions, and health record modifications. Intervention effect can be evaluated using health record abstraction, questionnaires, and qualitative semistructured interviews.
  
  
  CONCLUSIONS
  Although future research will evaluate the intervention in a controlled study, the process of theory-based intervention development can be applied to other rehabilitation research contexts, maximizing the impact of this work.Video Abstract is available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A123).
authors: Toronto Rehabilitation Institute-University Health Network and Department of Community Health Sciences (K.M.S.), University of Manitoba, Winnipeg, Canada; Department of Physical Therapy (D.B.), University of Toronto, Toronto, Canada; Department of Health Sciences (P.G.), Brock University and Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare-Sinai Health System, Toronto, Canada; Respiratory Medicine (T.J.-F.), West Park Healthcare Centre and Department of Physical Therapy, University of Toronto, Toronto, Canada; Toronto Rehabilitation Institute-University Health Network (M.M.), Toronto, Canada; West Park Healthcare Centre (S.O.), York, Canada; Sunnybrook Health Sciences Centre (S.M.), Toronto, Canada; Department of Physical Therapy (N.M.S., S.B.J.), University of Toronto and Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Sunnybrook Health Sciences Centre-St. John's Rehab (J.S.), Toronto, Canada; Bridgepoint Active Healthcare-Sinai Health System (P.S.), Toronto, Canada; and Li Ka Shing Knowledge Institute (S.E.S.), St. Michael's Hospital and Department of Geriatric Medicine, University of Toronto, Toronto, Canada.
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mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D006801:Humans; D010808:Physical Examination / Q000379:methods*; D059825:Physical Therapists; D004856:Postural Balance / Q000502:physiology*; D018570:Risk Assessment