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    2020-08-18


    3. Results
    A total of ten themes for potential barriers and five themes for facil-itators to intervention adherence emerged (see Table 1). The responses indicated factors that inhibit intervention adherence, as well as strate-gies that facilitated participation in the prescribed walking and lower extremity exercise program. Representative patient and FCG comments from each theme are provided in Tables 2 and 3.
    3.1. Barriers to Intervention Adherence
    3.1.1. Theme 1: Comorbid Conditions, Procedures, and Injuries
    Multiple comorbid conditions were frequently noted by both pa-tients and FCGs as an intrapersonal barrier to intervention adherence. Several ailments and injuries were cited, with the majority of partici-pants reporting cardiovascular, pulmonary, and arthritis related comor-bid conditions as barriers. For some, other recent surgical procedures and lower extremity injuries limited participants' ability to engage in physical activity. Among others, allergies and medication sensitivity prohibited participation in walking outdoors.
    Physical symptoms secondary to comorbid conditions were fre-quently endorsed by participants as a key barrier to physical activity
    Table 1
    Barriers and facilitators of adherence from physical therapy/occupational therapy (PT/OT) assessment and session notes.
    Themes
    Barriers 1. Comorbid conditions, procedures, and injuries
    2. Physical symptoms
    3. Functional limitations/history of falls
    4. Anxiety/feeling overwhelmed
    5. Other roles and responsibilities
    6. Other engagements/unexpected life events
    8. Lack of motivation
    9. Not accustomed to physical activity
    10. Physical environment/weather
    Facilitators 1. Physical activity as part of routine
    2. Coping strategies
    3. Setting goals for motivation
    4. Social/family support
    5. Seeing benefits from walking
    Exemplars: barriers to adherence.
    Theme Patient Caregiver
    Comorbid conditions, “Since his 444890-41-9 surgery in ‘08, there has been functional limitations “Has co-morbidities of COPD.”
    procedures, and injuries and a decrease in engagement in meaningful activities.” “Has been arthritis and trauma to her right knee from previous injury
    “Patient states her activity at home is limited from COPD.” so is limited with her walking for exercise.”
    “She also stated that she does not do the exercises in the manual “Left ankle fracture and will be on walking restrictions for the next 6
    because Semiconservative replication aggravates her arthritis.” weeks.”
    “History of left ankle injury with instability since the past year.” “Unsure if she will be able to walk with him due to allergies.”
    “Patient states she is limited in walking second to allergies.”“Patient
    used to enjoy fishing and hunting however he has not engaged in this
    activities over the past year due to medication which does not allow
    for sun exposure.”
    Physical symptoms “Patient states that his primary barrier to increasing physical activity is “Caregiver states that due to right knee pain there may be days she
    his back pain.” will be unable to walk with him.”
    “History of right knee pain which is limiting her from being more “Hip pain with walking.”
    active.”
    “Pt reported pain at the surgical site when attempting to stand straight
    while walking.”
    “Worsening neuropathy in bilateral feet.”
    “Patient has been mostly housebound in the past year and limited
    community ambulation due to shortness of breath.”
    “Fatigue prevent him from walking more.”
    “She stated she was also feeling nauseous which has discouraged her
    from being active.”
    “Patient has also been complaining of dizziness with ambulation.”
    “Limited and poor sleep due to frequent bathroom breaks (very
    important).”
    Functional limitations/history “He reported the following functional deficits: SELF-CARE: fatigue after
    of falls showers, difficulty with lower body dressing due to balance issues,
    limited endurance affecting functional mobility (very important), and no
    longer driving due to problems with hearing.”
    “Patient is independent with ADLs but needs extra time to complete,
    ambulates with SPC in the house for short distances.”
    “Multiple falls in the past 3 years. She fell in the past and fractured her
    pelvis and lower spine.”
    Anxiety/Feeling Overwhelmed “Patient stated that as he approaches his surgery date he feels more