Physiotherapy Practice in Flemish Nursing Homes

Physiotherapy in Flemish Nursing Homes: Insights Into Practice, Barriers, and Facilitators

The goal of this observational study is to evaluate the extent to which physiotherapy sessions in Flemish nursing homes adhere to the IAGG-GARN guidelines and to explore factors influencing clinical practice among physiotherapists.

The study targets multiple nursing homes across Flanders, with 3 to 5 centers in each of the provinces of Limburg, Antwerp, and Flemish Brabant. This selection ensures variation in geographic location and organizational context. The participants in this study are physiotherapists working in the participating nursing homes.

The main questions it aims to answer are:

• To what extent do the physiotherapy sessions align with the IAGG-GARN guidelines?
• Are there differences in physiotherapy session content and volume according to physiotherapist characteristics and resident characteristics?
• What barriers and facilitators do physiotherapists experience when implementing guideline-based practice in Flemish nursing homes?

Researchers will observe physiotherapy sessions delivered as part of routine care and document session content and duration using structured observation diaries. Participating physiotherapists will also take part in focus groups discussing experiences with guideline implementation, barriers, facilitators, and clinical decision-making.

Study Overview

• Status: Recruiting
• Conditions: Physiotherapy; Nursing Homes; Guideline Implementation; Focus Group
• Intervention / Treatment: Other: Mapping therapy sessions

• Study Type: Observational
• Enrollment (Estimated): 40

Contacts and Locations

• Study Contact: Name: Maxine Claes, Msc; Phone Number: +3211268443; Email: maxine.claes@uhasselt.be
• Study Contact Backup: Name: Joke Spildooren, Prof.dr; Phone Number: +3211269178; Email: joke.spildooren@uhasselt.be

Study Locations

• Belgium
  • Antwerpen
    • Deurne, Antwerpen, Belgium
      • Not yet recruiting
      • Nursing home
    • Zoersel, Antwerpen, Belgium
      • Recruiting
      • Nursing home
  • Limburg
    • Tongeren, Limburg, Belgium
      • Recruiting
      • Nursing home

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of licensed physiotherapists working in Flemish nursing homes who provide physiotherapy to older residents

Description

Inclusion Criteria:

• None beyond being a licensed physiotherapist working in a Flemish nursing home and willing to participate.

Exclusion Criteria:

• None

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Guideline Adherence to IAGG-GARN Recommendations	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)	2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exercise Description	Narrative description of each exercise performed during a physiotherapy sessions.	2 weeks
Use of Equipment, Aids or Materials	Type of equipment, aids or materials used during each exercise.	2 weeks
Exercise format	Whether the exercise is performed individually or in a group setting.	2 weeks
Group Size	Number of participants involved in group-based exercises.	2 weeks
Level of supervision	Level of supervision provided by the physiotherapist during exercises (none, intermittent, continuous)	2 weeks
Exercise Start and End Time	Start and end time of each exercise performed during physiotherapy sessions	2 weeks
Rest Periods During Exercises	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.	2 weeks
Exercise Category	Category of each exercise performed during physiotherapy sessions (strength, endurance, mobility/flexibility, balance/coordination, or other)	2 weeks
Exercise Volume - Repetitions	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.	2 weeks
Exercise Intensity	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).	2 weeks
Walking or Treadmill parameters	Parameters during walking or treadmill exercises (incline and speed).	2 weeks
Cycling Parameters	Parameters recorded during cycling exercises (rounds per minute, resistance and distance)	2 weeks
Speed of movement	Speed of movement during exercises, classified according to the observed execution pace (slow, controlled or fast).	2 weeks
External Load (Resistance)	External load applied during exercises (kg).	2 weeks
Contextual Factors	Contextual elements influencing physiotherapy sessions, such as disturbances (e.g., noise, interruptions) and other relevant observations.	2 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Background information physiotherapists	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.	baseline
Background information residents	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	baseline
Focus groups with physiotherapists	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.	2 days

Collaborators and Investigators

• Sponsor: Hasselt University
• Investigators: Principal Investigator: Joke Spildooren, Prof.dr, UHasselt

Study record dates

Study Major Dates

• Study Start (Actual): March 23, 2026
• Primary Completion (Estimated): January 1, 2028
• Study Completion (Estimated): December 1, 2028

Study Registration Dates

• First Submitted: April 2, 2026
• First Submitted That Met QC Criteria: May 4, 2026
• First Posted (Actual): May 8, 2026

Study Record Updates

• Last Update Posted (Actual): May 8, 2026
• Last Update Submitted That Met QC Criteria: May 4, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Physical therapy; Older adults; Geriatrics; Focus groups; Long-term care; Clinical practice; Guideline implementation
• Other Study ID Numbers: B1152025000037; BOF25OWB11 (Other Grant/Funding Number: Bijzonder Onderzoekfonds (BOF))

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No