“It’s all about the money”: An interpretive description of embedding physical therapy-led falls prevention group exercise in long-term care

Background: Fall prevention interventions are effective for community dwelling older adults however, the same cannot be said for older adults living in long-term care (LTC). The Staying UpRight (SUp) randomized controlled trial was designed to test the effectiveness of a progressive strength and balance group exercise program delivered to LTC residents. This paper explores what impacts on LTC providers’ decisions to continue the program on completion of the funded trial period. Methods: : A qualitative study using an Interpretive Description approach. Semi-structured interviews and focus groups were conducted with 15 LTC staff who had been involved in the randomized controlled trial. Data were analysed using conventional content analysis. Results: : Practice change occurred following participation in the trial with some facilities starting exercise groups, some increasing the number of exercise groups offered and physical therapists selecting elements of the program to adopt into their practice. Continuing with SUp as designed was constrained by organizational decisions on the use of funding and resources. Three factors were identified which informed decision-making: business models and philosophies, requirements for evidence, and valuing physical therapy. Conclusions: : Managers and facilitators demonstrated effective adaptation of the SUp in response to the changes they had observed in residents taking part in the program. However, our findings highlight that while SUp was valued, the tight financial environment created by the current funding model in New Zealand does not support delivery of falls prevention in LTC by a physical therapist. This study may provide policy makers with important information on changes needed to support falls prevention service delivery in LTC. Trial registration: This study is a sub-study of a randomized controlled trial which was registered to the Australian New Zealand Clinical Trials Registry ACTRN12618001827224 on 09/11/2018. Universal trial number U1111-1217-7148.