Barriers and facilitators for physical fitness training in orthopedic geriatric rehabilitation. A qualitative study

PurposeThe aim of this explorative, qualitative study is to identify factors that potentially influence the execution of physical fitness training in inpatient orthopedic geriatric rehabilitation (GR), from the perspectives of patients, their relatives and professionals.Materials and methodsIn GR wards of skilled nursing facilities in the Netherlands, semi-structured interviews were held with triads of patients, their relatives and responsible nurses, and focus groups with members of the multidisciplinary teams. Verbatim reports were analyzed according to the framework method.ResultsWe found twelve categories of barriers and facilitators related to characteristics of the patients, their family, staff, training program and organization.ConclusionsThe barriers and facilitators found largely correspond with those found for participation in exercise in related settings, but also show important differences. This overview of barriers and facilitators enables multidisciplinary teams to design improvements at the level of the organization and interventions, as well as at the level of the individual training program, tailoring it to the patient's circumstances and needs. Further research should focus on weighing these barriers and facilitators to develop a feasible guidance for daily practice, as well as testing their effect on the adherence to existing physical fitness training guidelines. Physical fitness training is important in reaching functional goals in orthopedic geriatric rehabilitation.Practicing outside of therapy can be stimulated by clarity about expectations, proper training equipment and tailored stimulation/assistance.Training volume and intensity should meet the guidelines, but be tailored to the patient.Characteristics of the program, staff and organization need to be considered as they impact the physical fitness training.