Coach2Move: a person-centered physical therapy approach to pain-related functional decline in older adults

Pain and physical inactivity are closely connected in older adults. Pain can restrict activity and participation, while inactivity contributes to deconditioning, disability, and persistent pain. Physical therapy is well positioned to interrupt this cycle, but care may insufficiently address factors shaping daily activity. In this Perspective, we describe Coach2Move, a person-centered approach aligned with the Age-Friendly Health Systems framework for older adults with mobility limitations and chronic conditions. Coach2Move operationalizes recommended geriatric physical therapy principles by integrating comprehensive assessment, clinical reasoning, motivational interviewing, shared decision-making, meaningful goals, and progress monitoring. Its contribution is the integration of these components into a defined process connecting impairment-level treatment with meaningful activity and self-management. Dutch randomized and pragmatic cluster-randomized trials found improvements in physical activity, functional mobility, and frailty with fewer sessions than usual physical therapy. We also describe adaptation to US outpatient care, including explicit content addressing pain-related fear, catastrophic interpretations, and beliefs that restrict activity. Coach2Move provides a structured method for integrating person-centered coaching with physical therapy for pain-related functional decline. Its pain-specific effectiveness and implementation in the United States remain to be established.