Development of a Coaching Protocol to Enhance Self-efficacy Within Outpatient Physical Therapy.

Objective: To describe the development of the Specific, Measurable, Action-Oriented, Realistic, and Timed (SMART) Coaching Protocol to increase exercise self-efficacy in middle-aged and older adults participating in Live Long Walk Strong (LLWS) Rehabilitation Program. LLWS Rehabilitation Program is an innovative physical therapist (PT) delivered outpatient intervention for middle- and older-aged adults with slow gait speed.

Design: Phase II randomized controlled trial (RCT) with masked outcome assessment. We applied the Knowledge to Action Framework to develop and implement the LLWS SMART Coaching Protocol within an RCT for the LLWS Rehabilitation Program. Data will be collected at baseline and post intervention at 2, 8 and 16 weeks.

Setting: Outpatient; VA Boston Healthcare System.

Participants: Community-dwelling veterans (N=198) (older than 50 years) with slow gait speed (<1.0 m/s).

Interventions: Participants will be randomized to the LLWS Rehabilitation Program, an 8-week (10-session) PT-delivered intervention, or wait-list control group. Each study visit will introduce a new SMART Coaching module focused on goal setting, exercise adherence, and addressing internal and external barriers to meeting exercise goals.

Main Outcome Measures: Primary outcome is gait speed and secondary outcome is the Self-Efficacy for Exercise Scale.

Conclusions: Incorporating cognitive behavioral tools in physical therapy intervention research is critical for targeting motivational processes needed for exercise behavior change.