Applying a theoretical framework to assess the acceptability of therapist training and delivery of the Gait Rehabilitation in Early Rheumatoid Arthritis Trial intervention (GREAT Strides): a qualitative analysis

Background/Purpose: GREAT Strides is a novel gait rehabilitation intervention with an embedded psychological component aimed at improving walking ability in people with early rheumatoid arthritis. Therapists received two days of gait rehabilitation training, motivational interviewing (MI) and behaviour change techniques (BCTs). This study explored therapists’ acceptability of: (1) the training received and (2) delivering GREAT Strides within a feasibility study. Methods: Nine therapists (four physiotherapists, five podiatrists) participated in semi-structured interviews. The topic guide was informed by the Theoretical Framework of Acceptability (TFA). Interviews were professionally transcribed, and a deductive thematic analysis was applied. Data were coded into six TFA constructs (Affective Attitude; Burden; Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Results: Key barriers and enablers with regards to the acceptability of the training and intervention delivery were identified. Training: Therapists liked the supportive training environment (affective attitude) and reported that role play exercises aided their confidence in applying MI and BCTs (self-efficacy). The lack of time available to attend training was considered unacceptable (opportunity costs). Delivery: All therapists valued the opportunity to provide individualised care (intervention coherence). Barriers associated with acceptability included the use of trial-related materials (e.g. checklist) during intervention delivery (burden) and the time delay between receiving training and intervention delivery (perceived effectiveness). Conclusions and implications: The bespoke training and Great Strides delivery was acceptable to most therapists. Key refinements (e.g. timing of training in relation to intervention delivery) have the potential to improve aspects of the training and delivery of the intervention, maximising efficiency and potential for effectiveness