Anecdotal evidence informed practice change
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Clinicians, predominantly, considered the practice-based evidence they observed through participating in the RCT was sufficient to support using SUp in usual care. In particular, they drew on observations of individual residents, referring to changes in (1) residents’ capabilities: “one of the ladies walked all the way up from the downstairs wing and walked back - previously she was using a wheelchair to get to and from the class” (FAC#4); (2) increased fitness and balance: “I was very pleasantly surprised how rapidly I could get them up to 60 minutes of exercise and how far I could get in the difficulty of exercises challenging their balance” (FAC#8); and (3) resident engagement: “residents had asked for more exercises” (FAC#6). Some physical therapy participants built on this, adding classes to usual care where previously none were available or increasing the number of classes offered and applying concepts from SUp within these: “It’s hard to teach an old dog new tricks, but we have learnt some… it has made us realise that we can push them” (FAC#2). The engagement of the physical therapists themselves was seen as positive and convinced some management participants to support practice change, with one reflecting: “physios don’t change stuff without good evidence” (Mgmt#5), while another requested the physical therapist run more classes. While physical therapy SUp facilitators could see changes in individual residents’ functional abilities, management participants needed to measure the change across all those who took part in the SUp program and were specifically focused on the falls prevention outcome. Observing changes in participants and perceiving the program produced better outcomes for residents resulted in clinicians being more open to change. However, this resulted in clinicians incorporating concepts of SUp into usual care rather than management looking for additional funding to continue the SUp program.