Physiotherapy Practice in Flemish Nursing Homes

Overall adherence of physiotherapy sessions in Flemish nursing homes to IAGG-GARN recommendations. Adherence is assessed through structured direct observation of the routine physiotherapy sessions. The secondary outcomes are operationalize adherence to the guideline (frequency, exercise intensity, exercise duration, exercise type and personalization)

Narrative description of each exercise performed during a physiotherapy sessions.

Type of equipment, aids or materials used during each exercise.

Whether the exercise is performed individually or in a group setting.

Number of participants involved in group-based exercises.

Level of supervision provided by the physiotherapist during exercises (none, intermittent, continuous)

Start and end time of each exercise performed during physiotherapy sessions

Rest periods during physiotherapy exercises, recorded separately as (1) rest periods instructed or allowed by the physiotherapist and (2) rest periods actually taken by the resident during exercise.

Category of each exercise performed during physiotherapy sessions (strength, endurance, mobility/flexibility, balance/coordination, or other)

Number of repetitions per exercise, recorded separately as (1) repetitions prescribed by the physiotherapist and (2) repetitions actually performed by the resident during the exercise.

Intensity of each exercise performed during physiotherapy sessions, including whether intensity was explicitly determined during the exercise, the method used to determine intensity, the recorded intensity value, and the observer's interpretation (high, medium or low intensity).

Parameters during walking or treadmill exercises (incline and speed).

Parameters recorded during cycling exercises (rounds per minute, resistance and distance)

Speed of movement during exercises, classified according to the observed execution pace (slow, controlled or fast).

External load applied during exercises (kg).

Contextual elements influencing physiotherapy sessions, such as disturbances (e.g., noise, interruptions) and other relevant observations.

Age, gender, year of graduation, specialization, number of years of experience as a physiotherapist, educational level (e.g., bachelor, master…), employment regime (full-time, part-time, other appointment), number of years working within the nursing home and continuing education participation

This information is pseudonymously linked to the observation data with the aim of identifying interpersonal differences in therapy approach.

In addition, the physiotherapeutic interventions will be linked to residents' background information to determine the extent to which the physiotherapists adapt their therapy to the specific needs of the patient. The following information will be used:

• Age category: 65-70, 71-75, 76-80, 81-85, 86-90, 91-95, 96-100 and 100+
• Gender: male / female / other
• Stable medical status: yes/no
• Cognitive status (MMSE score): 25-30 (normal), 21-24 (mild cognitive impairment), 10-20 (moderate cognitive impairment), 0-9 (severe cognitive impairment)
• Ability to walk (maximum achievable level for resident): independent, independent with walking aid, with assistance from caregiver, wheelchair-bound, bedridden
• Ability to transfer (maximum achievable level for resident): independent, with aid, with assistance from caregiver, with hoist
• Following physiotherapy: yes/no
• With which (main) physiotherapist: physiotherapist ID

Step 1: Center-specific After completion of the observations, a center-specific feedback session will be held at each nursing home. These sessions (60-90 minutes, 2-8 therapists) present and discuss the results with physiotherapists, focusing on their work context, its influence on care delivery, and the reasoning behind their choices.

Step 2: Validation Following the feedback sessions, a validation focus group will be organized at a neutral location (UHasselt), including 1-2 representatives per center and additional physiotherapists (10 participants, 60-90 minutes). Results from the observations and all feedback sessions will be presented anonymously. The discussion will focus on validating and deepening findings, identifying key themes and patterns, and determining priorities for further development

Digital recordings of the focus groups will be made during the session. At the end of the focus groups, the recordings will be transcribed and anonymized for analysis.