Table 3 Study outcomes

Implementation outcomes (site level)

 Penetration (primary)

Average number of patients enrolling in the EBP monthly

Administrative and VA electronic health record (VA Corporate Data Warehouse)

6 months, 12 months (primary)

 Adoption (dichotomous)

Delivery of Group PT as a clinical service (at least 1 class) and enrollment of at least 5 patients

 Fidelity

Average number of sessions attended by patients who enroll in the EBP

Effectiveness outcomes (patient level)

 30-s chair rise

Number of times patient can stand up from a chair and sit back down within a 30-s period

Collected by clinicians at time of patient visit via electronic or paper survey and stored in the VA electronic health record (VA Corporate Data Warehouse)

Every Group PT class

Note: patient satisfaction and ability to deal with daily problems regarding knee pain are asked after the first class

 Pain experienced during chair rise

Patient-reported pain experienced during chair rise (0–10 numeric scale)

 Patient-reported physical function

PROMIS Short form 4a

 Patient-reported pain interference

PROMIS Short form 4a

 Patient satisfaction

Patient’s response to: “How satisfied are you with the Group PT program?” on a numeric rating scale (0–10)

 Ability to deal with knee pain

Patient’s response to: “Compared to before you before you started the Group PT program, how would you rate your ability to deal with daily problems with knee function and pain now?” on a 5-point Likert (from much worse to much better)

Implementation context and experience

 Program adaptations (using Wiltsey Stirman’s FRAME framework) [47]

Sites report changes to program staffing, delivery, equipment, education, and documentation

Site self-report

Baseline, 6 months, and 12 months

 Qualitative interviews

Implementation process and experience

Key informant semi-structured interviews

Baseline (all sites), 6 months (all sites), and 12 months (sites that receive enhanced support)

 Organizational Readiness for Implementing Change (ORIC) [48]

Used to determine organizational members’ change commitment and efficacy. Each item includes a Likert scale from 1 (disagree) to 5 (agree).

Staff-reported

Baseline

 Organizational resilience^a [49]

Measure of the capacity of an organization to anticipate, prepare for, respond, and adapt to both incremental changes and sudden disruptions to survive and thrive.

Baseline and 12 months

 Challenging and helpful implementation factors

Using a list of items developed through previous work by the Function QUERI team, respondents are asked to select how challenging or helpful resources and other factors (e.g., patient awareness) will be or were when implementing Group PT at their facility on a scale of 1 (not at all) to 5 (very).

Baseline and 12 months

 Implementation Climate Scale (ICS) [50]

Captures six dimensions of the organizational context that indicate to employees the extent to which their organization prioritizes and values the successful implementation of Group PT.

Baseline

 Implementation process and experience

Questions regarding the use of the different Group PT implementation resources and activities. Respondents are asked to indicate, whether their facility used the tool, how much, and how helpful it was for supporting implementation of Group PT.

12 months

 Program Sustainability Index^b [51]

A measure of a program’s capacity for sustainment over time. Using a list of statements related to common program attributes (e.g., leadership competence and staff involvement and integration), respondents are asked to what extent the statements are reflective of their facility on a scale of 0 (not at all) to 4 (to a very great extent).

12 months

 COVID-19 impact question

What impact do you think the COVID-19 pandemic and its effects had on your facility's ability to implement the Group PT program?

Baseline and 12 months

 Enhanced support experience^c

How helpful were the enhanced support sessions with Function QUERI staff? From 1 (not at all helpful) to 5 (very helpful).

12 months

What, if anything, would you change about the enhanced support sessions? [free text response]

 Demographic measures

Questions related to job title, years at the VA, age, gender, etc

Baseline and 12 months

Cost

 Clinical delivery team costs

How much time did each delivery team member spend conducting the following tasks for each Group PT class?

• Time entering data in the EHR

• Time spent with patients on clinical issues outside of class

• Time spent outside of class assisting patients with technical issues

• Other time associated with preparing for delivery of Group PT

Site self-report

After sites host their first Group PT class

 Implementation strategy costs

During the month before Group PT launched, on an average week how much time did each team member spend planning for and/or supporting your Group PT program?

Site self-report