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Implementing Live Long Walk Strong: Practice-based evidence on adapting a physical therapy program across diverse

Addie Middleton¹, Rebekah Harris^2,3, Caroline Madrigal⁴

¹Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

PM & R : the Journal of Injury, Function, and Rehabilitation

|June 19, 2026

Summary

This summary is machine-generated.

Adapting the Live Long Walk Strong physical therapy program across diverse settings identified common and unique barriers. These adaptations enhance program effectiveness and accessibility for older adults, improving mobility outcomes.

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Area of Science:

Geriatric physical therapy
Health services research
Implementation science

Background:

The Live Long Walk Strong program is a physical therapy intervention designed to enhance mobility in older adults.
Program adaptation is crucial for expanding reach and effectiveness across varied healthcare environments.
This study focuses on adapting an age-friendly physical therapy program for diverse clinical settings.

Purpose of the Study:

To document the adaptation process of the Live Long Walk Strong program.
To analyze adaptations made across four distinct clinical settings within the Veterans Health Administration.
To identify barriers and facilitators influencing program implementation in different contexts.

Main Methods:

A process evaluation was conducted using the Consolidated Framework for Implementation Research (CFIR).
Data were collected on barriers and adaptations during program implementation across urban outpatient, rural outpatient, skilled nursing, and virtual telehealth settings.
Physical therapists and physical therapist assistants (n=11) delivering the program were involved.

Main Results:

Barriers were identified across CFIR domains (Innovation, Outer Setting, Inner Setting, Individuals), with common themes related to Design, Partnerships, and Access to Knowledge.
Shared barriers led to central adaptations benefiting all sites, while context-specific barriers prompted tailored modifications.
Facilitators, primarily related to Design, Relative Advantage, Relational Connections, and Mission Alignment, supported program spread without requiring further adaptation.

Conclusions:

Practice-based evidence demonstrates successful adaptation of an age-friendly physical therapy program across diverse settings.
Findings offer practical insights for improving the efficiency of future program implementations by proactively addressing potential barriers.
Adaptations enhance program fit, ensuring it effectively meets patient needs in various clinical contexts.