POS1492-HPR BARRIERS AND FACILITATORS TO THE IMPLEMENTATION OF A BEHAVIOUR CHANGE-INFORMED EXERCISE PROGRAMME (SPLIT.OA) FOR PEOPLE WITH OSTEOARTHRITIS: A QUALITATIVE STUDY WITH PHYSIOTHERAPISTS AND PATIENTS’ PERSPECTIVES
Authors: N. Gomes, F. Gonçalves, A. Moniz, M. Curto, S. Duarte, C. Caeiro, R. Fernandes, E. B. Cruz, D. Costa
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Osteoarthritis is the most common type of arthritis and is currently one of the leading and increasing causes of disability worldwide, representing a major public health issue. Exercise programmes appear to be effective in reducing pain and improving physical function and quality of life in people with hip and/or knee osteoarthritis (HKOA). However, the literature reveals a gap between recommendations for OA and the current clinical practice of physiotherapists, as well as a low adoption of exercise practice by people with HKOA. Split.OA is a structured and tailored exercise programme, informed by behaviour change strategies, to promote the adoption of regular exercise and prevent functional decline in people with HKOA. For a successful implementation of Split.OA, it is crucial to explore and understand the perspectives of physiotherapists and people with HKOA about the programme. <h3>Objectives:</h3> This study aimed to identify and explore barriers and facilitators to the implementation of Split.OA by physiotherapists and the barriers and facilitators to the adoption of regular exercise practice by people with HKOA. <h3>Methods:</h3> In total, five focus groups were conducted, three with physiotherapists (n=18) and two with HKOA patients (n=12). The Capability, Opportunity, Motivation – Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) were used to inform the development of the semi-structured interview guides. All focus groups were held via videoconference and were audio and video recorded for posterior <i>verbatim</i> transcription. For data analysis, a deductive content analysis approach was employed using a developed coding matrix informed by the COM-B and TDF. The analysis was carried out by two independent researchers. When necessary, a third researcher was approached to settle arising disagreements and reach a consensus. <h3>Results:</h3> The analysis of the physiotherapists' focus groups found 13 barriers (4 COM-B components; 6 TDF domains) and 17 facilitators (5 COM-B components; 11 TDF domains) to the implementation of the Split.OA programme by physiotherapists. Barriers such as lack of knowledge on behaviour change, lack of ability to promote exercise and program adherence and current organisation of healthcare were identified. Knowledge of recommendations for OA management, the use of exercise in interventions and high levels of confidence in their abilities to implement the Split.OA programme were highlighted by physiotherapists. Regarding the patients' focus groups, 18 barriers (6 COM-B; 11 domains of TDF) and 28 facilitators (6 COM-B; 14 TDF) were found to influence the adoption of regular exercise practice by patients with HKOA. On one hand, the presence of symptoms, difficulty exercising without an action plan and needing the presence of a physiotherapist, were commonly reported by participants as obstacles to regularly exercising. On the other hand, patients found that positive experiences with exercise, believing in their abilities to adopt exercise in the long term and generally enjoying it, were important facilitators. <h3>Conclusion:</h3> Multi-domain barriers and facilitators to the implementation of the Split.OA programme by physiotherapists were found, that will inform the future training of physiotherapists. Together with the perspectives for the adoption of regular exercise by patients, the Split.OA intervention will be optimised, with effective behaviour change strategies that will be included in the programme. Overall, the results of this study contribute to a deeper understanding of the determinants for the implementation of an exercise-based intervention and long-term adoption of exercise from the perspectives of physiotherapists and people with HKOA, respectively. <h3>REFERENCES: NIL.Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>