Research Protocol Adaptations During the COVID-19 Pandemic: A Process Evaluation.

In general, COVID-19-related adaptations that transitioned in-person assessments and interventions to a virtual format were not routinely evaluated. We aimed to conduct a process evaluation to examine the impact of COVID-19-related adaptations on a behavior change intervention designed to increase exercise adherence among Veterans with mobility difficulty. We used secondary data from a nonrandomized study to complete a process evaluation examining the intervention's reach, recruitment, fidelity, dose delivered by physical therapists, and the dose received by the 14 participating Veterans. The physical therapist delivered 95% (133/140) of the study's 10 sessions. Sessions with the lowest delivery dose included Sessions 1 and 10 (86%; n = 12/14). The elements with the lowest dose received included using an exercise journal and developing a postintervention plan (86%; n = 12/14). Our COVID-19 adaptations allowed us to provide our intervention to the majority (67%) of eligible participants without a negative impact on fidelity, dose delivered, or dose received.

Community-Dwelling Older Adults and Physical Activity Recommendations: Patterns of Aerobic, Strengthening, and Balance Activities.

Though it is known that most older adults do not meet the recommended physical activity (PA) guidelines, little is known regarding their participation in balance activities or the full guidelines. Therefore, we sought to describe PA patterns among 1,352 community-dwelling older adult participants of the Adult Changes in Thought study, a longitudinal cohort study exploring dementia-related risk factors. We used a modified version of the Community Healthy Activities Model Program for Seniors questionnaire to explore PA performed and classify participants as meeting or not meeting the full guidelines or any component of the guidelines. Logistic regression was used to identify factors associated with meeting PA guidelines. Despite performing 10 hr of weekly PA, only 11% of participants met the full guidelines. Older age, greater body mass index, needing assistance with instrumental daily activities, and heart disease were associated with decreased odds of meeting PA guidelines. These results can guide interventions that address PA among older adults.

Physical Therapist and Patient Perspectives on Mobile Technology to Support Home Exercise Prescription for People With Arthritis: A Qualitative Study.

Introduction Mobile applications (apps) for exercise prescription may enhance communication between healthcare providers and patients while addressing common barriers to exercise among people with osteoarthritis. However, little is known about preferences and barriers to the use of mobile apps by physical therapists or people aging with osteoarthritis. Therefore, we aimed to examine physical therapist and patient perspectives on mobile apps to support physical therapist-prescribed home exercise for people with osteoarthritis. Methods Eighteen physical therapists and 17 individuals with a history of physical therapy for osteoarthritis participated in the study. Focus groups (n = 6, three each with physical therapists and patients) were conducted to gather perspectives on three commercially available mobile apps designed for physical therapy exercise prescription. Semi-structured questions assessed feature preferences, ease of use, exercise completion support, clinical feasibility, and potential barriers and facilitators to using the apps. Recordings of the focus groups were transcribed verbatim. The study team iteratively coded transcripts using thematic analysis. Results Perspectives of patients and physical therapists intersected but differed on the mobile apps. All patients preferred video exercise prescription over traditional methods and both patients and therapists predicted challenges and opportunities with mobile communication. Four themes emerged: accountability, data-driven, communication boost, and duality of technology. Facilitators of home exercise through mobile apps included exercise tracking, feedback loop, personalization, and the potential for reduced in-person visits. Barriers included technological challenges, complex interface design, lack of universal applicability, and security concerns. Conclusion Mobile app technology has the potential to support exercise adherence for people with osteoarthritis. However, patients' and therapists' perspectives differ and highlight numerous challenges that limit the universal clinical adoption of this technology. While physical therapists acknowledged the potential to improve the rehabilitation experience with mobile apps, there was concern about reimbursement and time constraints in the current fee-for-service environment.

Exploring physical therapists' approach to addressing home exercise program-related low self-efficacy: knowledge, strategies, and barriers.

PURPOSE: Self-efficacy is the strongest predictor of completing home exercise programs (HEPs). How physical therapists address low levels of self-efficacy is unknown. Our objectives were to determine (1) knowledge and confidence in addressing patients' self-efficacy; (2) strategies used to address low self-efficacy; and (3) barriers. MATERIAL AND METHODS: Licensed physical therapists who are actively treating patients in the United States participated in our mixed-methods study consisting of: (1) a survey on knowledge, barriers, and confidence; and (2) interviews on strategies used to address low self-efficacy. Descriptive statistics were calculated on all quantitative data. Braun and Clarke's 6-phase thematic analysis was used for the qualitative data. RESULTS: All 37 participants believed that self-efficacy impacts HEP completion. The majority (72.9%) reported addressing low self-efficacy. Barriers that impacted the ability to address low self-efficacy (Theme 1) included lack of knowledge, confidence, tools, guidance, and community resources, patients' past experiences and complexities, inability to follow-up with patients, and reimbursement. Due to these barriers, participants primarily addressed patients' low self-efficacy via communication (Theme 2) and ensuring successful exercise completion (Theme 3). CONCLUSION: Instead of using Bandura's fours sources of self-efficacy (i.e., mastery experiences, verbal persuasion, vicarious experiences, physiological state), participants verbalized addressing low self-efficacy via communication and successful exercise completion. Thus, implementation studies evaluating strategies to overcome the identified barriers are needed.

Self-efficacy is the strongest predictor of completing home exercise programs (HEPs) as prescribed.Instead of using evidence-informed strategies, physical therapists primarily address low self-efficacy via communication and ensuring that patients complete exercises successfully by simplifying the exercises and repeating the exercises until able to do them without cues.Barriers that keep physical therapists from using evidence-informed strategies include lack of knowledge, confidence, tools, guidance, and community resources, patients' past experiences and complexities, inability to follow-up with patients, and reimbursement.Physical therapists' ability to address low self-efficacy and increase HEP completion, can be improved by resolving clinical barriers (i.e., lack of knowledge) with implementation strategies (i.e., training).

Integrating STEADI for Falls Prevention in Outpatient Rehabilitation Clinics: An Outcomes Evaluation Using the RE-AIM Framework.

BACKGROUND AND OBJECTIVES: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe the implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (2018-2021) for screening and assessing all older adults ≥65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system. RESEARCH DESIGN AND METHODS: We described the Implementation process and strategies. Using Electronic Health Records (EHRs), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults. RESULTS: STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs; 94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed an FOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1%-10% annually between 2018 and 2021. DISCUSSION AND IMPLICATIONS: STEADI screening and FOMs were implemented systemwide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation.

Associations of Cognitively Active Versus Passive Sedentary Behaviors and Cognition in Older Adults.

BACKGROUND: Cognitively stimulating sedentary behavior (SB) may positively impact cognition. This study aimed to (1) describe participation across types of SB among older adults with and without cognitive impairment and (2) examine how baseline SB participation impacts cognition, longitudinally. METHODS: We used National Health and Aging Trends Study data from rounds 6 to 11 for cross-sectional and longitudinal analyses. Participants were 2244 community-dwelling older adults who were selected for the SB module in round 6. The SBs were categorized as active (eg, hobbies) and passive (eg, television). Participants were also categorized as having intact or impaired orientation, memory, and executive function based on tests of orientation, recall, and the clock-drawing test. We calculated descriptive statistics characterizing SB by cognitive status. Aim 2 involved competing risks proportional hazard models of participants with intact cognition (n = 1574) to identify associations between baseline SB and changes in cognition, moves to institutional care, and death over 6 years. RESULTS: Participants (40% ≥ 80 years, 55% female, 77% White non-Hispanic) averaged 8.75 (SD = 4.42) hours of daily SB, including 4.05 (SD = 2.32) hours of passive SB and 4.75 (SD = 3.13) hours of active SB. Active SB >3 hours per day was associated with a lower risk of impaired orientation (subdistribution hazard models = 0.60; P = .048) and memory (subdistribution hazard models = 0.62; P = .02). Baseline participation in passive SB did not impact the risk of having a change in cognition during rounds 7 to 11. CONCLUSION: Cognitive decline was lower among older adults who participated in more active SB. Thus, type of SB should be considered in examining the impact on cognition.

Assessing older adult physical activity levels in clinical settings: The modified PAVS for older adults.

BACKGROUND: Participating in recommended levels of physical activity (PA) is critical for preventing functional decline, falls, and frailty, making it essential to identify older adults not meeting national PA guidelines. However, guidance on assessing older adult PA levels, particularly in clinical settings, is lacking. This article presents an overview of clinically feasible PA assessment tools for older adults, identifies gaps in current tools, and provides recommendations on addressing these gaps. METHODS: We conducted a literature review on clinically feasible PA assessment tools, suggested modifications to an existing PA assessment for older adult patients, and highlighted opportunities for integrating the modified PA assessment tool in clinical settings. RESULTS: We identified 16 PA assessment tools used in clinical settings. The most widely used tool is the Physical Activity Vital Sign (PAVS), which has been successfully integrated into several electronic health records (EHR) and clinical practices. Most tools, including the PAVS, primarily focus on aerobic activities, with limited consideration for strength and balance. We recommend the use of a Modified PAVS for Older Adults that includes items on muscle-strengthening and balance activities to better align with national PA guidelines. We then identified several existing opportunities for broad implementation of the Modified PAVS for Older Adults within clinical settings. CONCLUSIONS: Widespread integration of the Modified PAVS for Older Adults will better support healthcare providers in identifying individuals not meeting national PA recommendations, assisting them in prescribing tailored PA prescriptions and better connecting their patients to appropriate resources and professionals for further support.

Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation.

Purpose: Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation. Patients and Methods: Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire. Results: Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors. Conclusion: Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.

Electronic health record data extraction: Physical therapists' documentation of physical activity assessments and prescriptions for patients with chronic low back pain.

BACKGROUND: Despite physical activity being a major component of managing chronic low back pain, < 50% of patients receive physical activity interventions. Electronic Health Records can deepen our understanding about this clinical gap. OBJECTIVE: We aimed to: 1) develop and test a data abstraction form that captures physical activity documentation; and 2) explore physical therapists' documentation of physical activity assessments and interventions. METHODS: We developed a data abstraction form using previously published practice guidelines. After identifying the forms' inter-rater reliability, we used it to explore physical therapists' documentation related to physical activity assessments and interventions for patients with chronic low back pain. RESULTS: The final data abstraction form included information about physical activity history, assessments, interventions, general movement discussion, and plan. Our inter-rater reliability was high. Of the 18 patients, 66.7% had documentation about their PA history. Across the 56 encounters, 14 (25.0%) included an assessment, 18 (32.1%) an intervention, 18 (32.1%) a general movement discussion, and 12 (21.4%) included a plan. CONCLUSION: Using our reliable data abstraction form we identified a lack of documentation about physical activity assessments and interventions among patients with chronic low back pain. A larger study is needed to examine the generalizability of these results.

Incorporating Physical Activity Assessments and Behavior Change Techniques Into Geriatrics.

Ninety-one percent of adults 65 years and older do not perform the recommended levels of physical activity (PA), resulting in increased risk of disability, morbidity, and mortality. Despite knowing the benefits of PA and acknowledging the importance of assessing and addressing inadequate PA levels, 50%-75% of health care providers do not incorporate behavior change techniques into clinical practice. This clinical gap can be explained by a lack of knowledge or confidence in (1) assessing PA levels; (2) addressing inadequate PA levels; and (3) justifying the time needed to use these techniques in clinical practice. In this special communication, we address this gap by providing a 3-step theoretical-based clinical decision pathway that guides health care providers on how to identify older adults with inadequate PA levels, determine readiness to increase PA, and empower patents to develop an action plan that will increase their PA levels. We also provide a conceptual model that supports the use of techniques that assess and address inadequate PA by tying PA to the Age-Friendly Health System's 4Ms (ie, What Matters to the older adult, Mentation, Mobility, and Medications).

Exploring the implementation potential of physical activity assessment and prescription tools in physical therapy practice: a mixed-method study.

BACKGROUND: Despite the benefits of physical activity (PA), especially related to aging, physical therapists do not perform regular PA prescriptions secondary to various barriers, including lack of tools. Therefore, we developed the Inventory of Physical Activity Barriers (IPAB). OBJECTIVE: Explore potential solutions that could address the current lack of PA prescription among United States-based physical therapists treating patients 50 years and older. METHOD: A convergent parallel mixed-method design consisting of focus groups and self-report questionnaires. Descriptive statistics were used for all quantitative variables. Focus groups were thematically coded. RESULTS: The 26 participants had 8.6 years (SD = 6.4) of clinical experience, 88.4% (n = 23) reported they regularly have PA conversations with patients, 65.4% (n = 17) regularly assess PA levels, and 19.2% (n = 5) regularly provide PA prescriptions. We identified three themes: 1) opportunities and challenges related to PA prescriptions; 2) lack of standardization in PA assessments and interventions; and 3) implementation potential for innovative solutions that address the current informal PA assessments and interventions. CONCLUSION: Physical therapists are amenable to incorporating innovative solutions that support physical activity prescription behavior. Therefore, we recommend the continued development and implementation of PA assessment and prescription tools.

Physical activity for patients with chronic low back pain: What are physical therapists prescribing?

BACKGROUND: Despite the extensive evidence supporting physical activity (PA) for managing chronic low back pain (CLBP), little is known about PA prescription by physical therapists treating patients with CLBP. OBJECTIVE: 1) Explore how PA prescriptions provided by outpatient physical therapists treating patients with CLBP align with PA guidelines. 2) Examine the barriers and facilitators of PA prescription among physical therapists working with patients with CLBP. METHODS: We conducted a qualitative study with outpatient physical therapists who treat CLBP. Semi-structured interviews provided an understanding of physical therapist experience with PA prescription among patients with CLBP. The interviews were transcribed, coded, and analyzed thematically. RESULTS: The 18 participants had an average of 13.4 (6.4) years of clinical experience in outpatient physical therapy. Thematic analysis revealed: 1) Physical therapists' articulate knowledge of PA guidelines and importance of physical activity; 2) Patient factors take priority over the PA guidelines for people with CLBP; and 3) The importance of building and maintaining a strong patient-therapist relationship influences physical therapist prescription of PA for patients with CLBP. CONCLUSION: When providing PA recommendations for patients with CLBP, general movement recommendations are emphasized in place of explicit PA prescriptions. Our findings highlight factors for consideration when prescribing movement and PA for patients with CLBP.

Screening for Osteoporosis Risk Among Community-Dwelling Older Adults: A Scoping Review.

BACKGROUND AND PURPOSE: Due to potential health-related consequences of osteoporosis (OP), health care providers who do not order imaging, such as physical therapists, should be aware of OP screening tools that identify individuals who need medical and rehabilitation care. However, current knowledge and guidance on screening tools is limited. Therefore, we explored OP screening tools that are appropriate and feasible for physical therapy practice, and evaluated tools' effectiveness by examining their clinimetric properties. METHODS: A systematic search of the following databases was performed: PubMed, PEDro, PsycINFO, CINAHL, and Web of Science. Articles were included if the study population was 50 years and older, had a diagnosis of OP, if the screening tool was within the scope of physical therapy practice, and was compared to either a known diagnosis of OP or bone densitometry scan results. Included articles underwent multiple reviews for inclusion and exclusion, with each review round having a different randomly selected pair of reviewers. Data were extracted from included articles for participant demographics, outcome measures, cut-off values, and clinimetric properties. Results were categorized with positive and negative likelihood ratios (+LR/-LR) based on the magnitude of change in the probability of having or not having OP. RESULTS: +LRs ranged from 0.15 to 20.21, with the Fracture Risk Assessment Tool (FRAX) and Study of Osteoporotic Fractures (SOF) having a large shift in posttest probability. -LRs ranged from 0.03 to 1.00, with the FRAX, Male Osteoporosis Risk Estimation Scores, Osteoporosis Self-Assessment Tool (OST), and Simple Calculated Osteoporosis Risk Estimation having a large shift in posttest probability. CONCLUSION: Tools with moderate-large shift for both +LR and -LR recommended for use are: (1) OST; (2) FRAX; and (3) SOF. The variability in cut-off scores and clinimetric properties based on gender, age, and race/ethnicities made it impossible to provide one specific recommendation for an OP screening tool. Future research should focus on OP risk prediction among males and racial and ethnic groups.

Examining physical activity participation barriers among adults 50 years and older: a scoping review.

Background: Addressing physical activity (PA) barriers is essential for increasing PA levels in middle-aged and older adults. However, there are no recommendations on selecting PA barrier assessment tools. Objectives: Thus, we aimed to identify and provide clinimetric properties on PA barrier assessment tools that healthcare providers, exercise experts, and public health officials can use to examine potential barriers faced by community-dwelling adults 50 years and older. Methods: We performed a systematic search of the following databases: PubMed, PsycINFO, CINAHL, and Web of Science. Articles were included if they presented clinimetric data on a PA participation barrier assessment tool for community-dwelling participants with a mean age of 50 years and older. The 561 identified articles underwent multiple rounds of blinded reviews. Included articles underwent data extraction for participant characteristics, scoring, constructs, reference tests, and clinimetric properties. Results: The 35 included articles reported on 33 different PA participation barrier assessment tools. Eighteen articles reported on participants with cardiovascular, musculoskeletal, or neurological diagnoses, diabetes, hemodialysis, history of cancer, or mobility limitations. Tools with two or more supporting publications included the Exercise Benefits/Barrier Scale (EBBS), Episode-Specific Interpretations of Exercise Inventory (ESIE), and Inventory of Physical Activity and Barriers (IPAB). Due to differences in methodologies, across-tool comparison was not possible. Conclusion: The EBBS, ESIE, and IPAB are promising tools for community-dwelling adults 50 years and older. However, additional research is warranted to identify the best PA barrier assessment tool among adults 50 years and older.

The Inventory of Physical Activity Barriers for Community-Dwelling Adults 50 Years of Age and Older: Development and Preliminary Validation.

BACKGROUND: Health care providers, including physical therapists, need to identify the reasons for insufficient physical activity (PA) to assist the 56% to 73% of community-dwelling adults 50 years of age and older who are not performing the recommended 150 minutes of moderate to vigorous PA. Currently, there is no feasible, multifactorial tool to assess PA barriers among this population. Without a tool, health care providers must either rely on self-generated questions or collate results from multiple assessments to identify PA barriers related to personal, social, and environmental factors, which can be time-consuming and incomplete. PURPOSE: To develop the Inventory of Physical Activity Barriers (IPAB), an assessment tool that examines personal, social, and environmental PA barriers. METHODS: We developed and psychometrically evaluated the IPAB using a 3-phase process. For phase 1, we used a deductive method to develop the initial scale. During phase 2, we refined the scale and explored its psychometric properties by collecting cross-sectional pilot data on community-dwelling adults 50 years of age and older. We used descriptive statistics, item-scale correlations, construct validity via Mann-Whitney U test, and internal consistency via Cronbach α to analyze the data from phase 2. After identifying the scale's potential for being valid and reliable, we implemented phase 3, a modified Delphi technique. RESULTS: Using item-scale correlations, descriptive statistics, and consensus among PA experts, we refined the initial scale from 172 items to 40 items. The 40-item IPAB demonstrated good construct validity (determined by the scale's ability to differentiate between individuals who did and did not meet 150 min/wk of moderate to vigorous PA; P = .01) and internal consistency (Cronbach α of 0.97). CONCLUSION: Our preliminary results suggest that the IPAB is valid and reliable. Using the IPAB, health care providers will be able to identify patients' PA barriers and thus develop individualized PA prescriptions, an evidence-based method of increasing PA.

The Relationship Between Mental and Physical Health and Walking During the COVID-19 Pandemic.

INTRODUCTION: COVID-19 policies such as quarantining, social isolation, and lockdowns are an essential public health measure to reduce the spread of disease but may lead to reduced physical activity. Little is known if these changes are associated with changes in physical or mental health. METHODS: Between September 2017 and December 2018 (baseline) and March 2020 and February 2021 (follow-up), we obtained self-reported demographic, health, and walking (only at follow-up) data on 2042 adults in primary care with multiple chronic health conditions. We examined whether the perceived amount of time engaged in walking was different compared with prepandemic levels and if this was associated with changes in Patient-Reported Outcomes Measurement Information System-29 mental and physical health summary scores. Multivariable linear regression controlling for demographic, health, and neighborhood information were used to assess this association. RESULTS: Of the 2042 participants, 9% reported more walking, 28% reported less, and 52% reported the same amount compared with prepandemic levels. Nearly 1/3 of participants reported less walking during the pandemic. Multivariable models revealed that walking less or not at all was associated with negative changes in mental (ß = -1.0; 95% CI [-1.6, -0.5]; ß = -2.2; 95% CI [-2.9, -1.4]) and physical (ß = -0.9; 95% CI [-1.5, -0.3]; ß = -3.1; 95% CI [-4.0, -2.3]) health, respectively. Increasing walking was significantly associated with a positive change in physical health (ß = 1.3; 95% CI [0.3, 2.2]). CONCLUSIONS: These findings demonstrate the importance of walking during the COVID-19 pandemic. Promotion of physical activity should be taken into consideration when mandating restrictions to slow the spread of disease. Primary care providers can assess patient's walking patterns and implement brief interventions to help patients improve their physical and mental health through walking.

Evaluation of Electronic and Pen-and-Paper Formats of the Inventory of Physical Activity Barriers: A Randomized Crossover Study.

BACKGROUND: The Inventory of Physical Activity Barriers (IPAB) assesses physical activity participation barriers. Development, refinement, and psychometric evaluation of the IPAB occurred via an electronic format. However, various circumstances may require using a pen-and-paper format. As instrument formats are not always interchangeable, the authors aimed to establish whether 2 different formats (electronic and pen and paper) can be used interchangeably for the IPAB. METHODS: This randomized crossover study included 66 community-dwelling adults aged 50 years and older (mean age = 73 [SD = 7.6]). Half the sample completed the electronic format of the IPAB first and the pen-and-paper format second, and the other half completed them in reverse order. Tests of equivalence and a Bland-Altman plot were performed. RESULTS: The intraclass correlation coefficient between formats was .94, and kappa was .68. The mean difference between the 2 administration forms of the IPAB was 0.002 (P = .96). Both administration formats had high internal consistency (Cronbach alpha = .92 and .93) and illustrated construct validity (P ≤ .001 for both administration formats). CONCLUSION: Pen-and-paper and electronic formats of the IPAB are equivalent and, thus, can be used interchangeably among non-Hispanic whites who are highly educated. The format should be used consistently if completing preintervention and postintervention evaluations or comparing scores.

Physical Activity and Physical Activity Participation Barriers Among Adults 50 Years and Older During the COVID-19 Pandemic.

OBJECTIVE: We examined changes in physical activity from pre-COVID-19 to during the COVID-19 pandemic and the factors associated with reduced physical activity levels among adults 50 yrs and older. DESIGN: Participants of a validation study were stratified into being "less active than before" or "equally or more active than before" COVID-19. Multivariable manual backward analyses were used to identify self-reported barriers associated with the reduction in physical activity. RESULTS: Reduced physical activity levels during COVID-19 were reported among 244 of 503 participants (43%). After adjusting for demographics and health conditions, factors that increased the odds of reduced physical activity levels during COVID-19 were lacking access to workout places, feeling too anxious, and difficulty committing to physical activity. Factors that decreased the odds of reduced physical activity levels during COVID-19 were self-identifying a heart- or lung-associated diagnosis that impacts physical activity and having a 12-mo retrospective history of falling. CONCLUSIONS: The physical activity participation barriers identified to be associated with a reduction in physical activity can be used as a starting point for a conversation regarding physical activity participation during COVID-19. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe the changes in physical activity levels among adults 50 yrs and older from pre-COVID-19 to during the COVID-19 pandemic; (2) Differentiate between the COVID-19 related factors associated with reduced physical activity levels among adults 50 yrs and older and younger adults; and (3) Identify the physical activity-related factor that decreased the odds of reduced physical activity levels during COVID-19 among adults 50 yrs and older. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation.

BACKGROUND AND OBJECTIVES: Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, health care providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing PA participation barriers can be done through the Social Ecological Model-based Inventory of Physical Activity Barriers Scale (IPAB). This study aimed to refine the initial 40-item IPAB and determine its reliability and validity. RESEARCH DESIGN AND METHODS: Five hundred and three community-dwelling adults 50 years and older completed a demographic and health questionnaire, the Physical Activity Vital Sign, the IPAB, and a feedback questionnaire. For scale refinement, half of the data were used for exploratory factor analysis and the other half for confirmatory factor analysis. The refined scale underwent reliability and validity assessment, including internal consistency, test-retest reliability, and construct validity. RESULTS: The refined scale contains 27 items consisting of 7 factors and 1 stand-alone item: (a) environmental, (b) physical health, (c) PA-related motivation, (d) emotional health, (e) time, (f) skills, (g) social, and (h) energy (a stand-alone item). The 27-item IPAB has good internal consistency (alpha = 0.91) and high test-retest reliability (intraclass correlation coefficient = 0.99). The IPAB's mean scores were statistically different between those who met the recommended levels of PA and those who did not (p < .001). DISCUSSION AND IMPLICATIONS: The information gathered through the IPAB can guide discussions related to PA participation barriers and develop individualized PA prescriptions that incorporate solutions to the identified barriers.

Examining physical activity participation barriers among adults 50 years and older: a scoping review protocol.

Background: Despite the benefits of physical activity (PA), 61% of adults 50 years and older do not meet the recommended levels of PA. One method of increasing PA participation is assessing and addressing PA participation barriers. Currently, no guidance on methodologies for assessing PA participation barriers exist. Objective: The primary objective of this scoping review is to map the methodologies used to examine potential PA participation barriers faced by community-dwelling adults 50 years and older. A secondary objective is to evaluate the clinimetric properties of these methodologies. Methods: This scoping review protocol is registered with Open Science Framework (https://osf.io/wd2hx). A systematic search of the following databases will be performed: PubMed, PsycINFO, CINAHL, Web of Science, and PEDro. Included studies will 1) present either a) data on development or clinimetric properties of PA participation barrier tool (s); or b) relative risk or odds ratios of PA participation barrier(s); 2) compare PA participation barriers or PA participation barrier tool(s) to either subjective or objective measures of PA; and 3) comprise of community-dwelling participants with a mean age of 50 years and older. A two-phase blinded independent screening process will be conducted to select the included publications. Data will be extracted using a standardized form and cross-checked by the first author. A narrative summary will accompany the results presented in tables and figures. Conclusion: This scoping review will provide a comprehensive understanding of current literature and gaps related to PA participation barrier methodologies used with adults 50 years and older.