Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework

Jackie Chu; Hannah G. Withers; Joanne V. Glinsky; Hueiming Liu; Matthew D. Jennings; Ian J. Starkey; Blake Palmer; Rachel Parmeter; Jackson J. Cruwys; Max Boulos; Ian Jordan; Maggie Duong; Kitty Duong; David Wong; Tara E. Lambert; Barbara R. Lucas; Deborah Taylor; Christopher G. Maher; Catherine Sherrington; Joshua R. Zadro; Lisa A. Harvey

doi:10.1136/bmjopen-2024-097770

Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework

Jackie Chu, Hannah G. Withers, Joanne V. Glinsky, Hueiming Liu, Matthew D. Jennings, Ian J. Starkey, Blake Palmer, Rachel Parmeter, Jackson J. Cruwys, Max Boulos, Ian Jordan, Maggie Duong, Kitty Duong, David Wong, Tara E. Lambert, Barbara R. Lucas, Deborah Taylor, Christopher G. Maher, Catherine Sherrington, Joshua R. ZadroLisa A. Harvey

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: The objectives of this process evaluation were to explain the results of the REFORM (REhabilitation FOR Musculoskeletal conditions) trial and identify potential facilitators and barriers to the future rollout of a remotely delivered physiotherapy model of care.

Setting: Outpatient physiotherapy units in five government-funded public hospitals in Sydney, Australia.

Design: This process evaluation was run alongside the REFORM trial. The REFORM trial (n=210) set out to determine whether remotely delivered physiotherapy (with one initial face-to-face session with a physiotherapist) was as good or better than a course of face-to-face physiotherapy. The process evaluation was informed by The UK Medical Research Council Process Evaluation Guidance. It was also based on the Realist Evaluation and the dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework. Qualitative and quantitative data were collected. The qualitative data included semistructured interviews. The quantitative data included audits of screening logs and participants’ self-reported satisfaction with service delivery. A thematic analysis using both inductive and deductive approaches was used for qualitative analysis. Multiple data were used to triangulate the process evaluation findings.

Participants: Quantitative data were collected on 210 participants. Qualitative interviews were conducted with 20 participants, 15 physiotherapists and 5 stakeholders.

Results: Some participants valued the convenience and accessibility of remotely delivered physiotherapy. It was also deemed to have the potential of improving the efficiency in the way physiotherapy is delivered. The findings from the RE-AIM framework were mixed. For example, the Reach was limited, and the Adoption and Maintenance were inconsistent across sites.

Original language	English
Article number	e097770
Number of pages	14
Journal	BMJ Open
Volume	15
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2024-097770
Publication status	Published - 28 Aug 2025
Externally published	Yes

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Chu, J., Withers, H. G., Glinsky, J. V., Liu, H., Jennings, M. D., Starkey, I. J., Palmer, B., Parmeter, R., Cruwys, J. J., Boulos, M., Jordan, I., Duong, M., Duong, K., Wong, D., Lambert, T. E., Lucas, B. R., Taylor, D., Maher, C. G., Sherrington, C., ... Harvey, L. A. (2025). Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework. BMJ Open, 15(8), Article e097770. https://doi.org/10.1136/bmjopen-2024-097770

@article{a6c974d562ac491f9831391bb2be24f3,

title = "Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework",

abstract = "Objectives: The objectives of this process evaluation were to explain the results of the REFORM (REhabilitation FOR Musculoskeletal conditions) trial and identify potential facilitators and barriers to the future rollout of a remotely delivered physiotherapy model of care.Setting: Outpatient physiotherapy units in five government-funded public hospitals in Sydney, Australia.Design: This process evaluation was run alongside the REFORM trial. The REFORM trial (n=210) set out to determine whether remotely delivered physiotherapy (with one initial face-to-face session with a physiotherapist) was as good or better than a course of face-to-face physiotherapy. The process evaluation was informed by The UK Medical Research Council Process Evaluation Guidance. It was also based on the Realist Evaluation and the dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework. Qualitative and quantitative data were collected. The qualitative data included semistructured interviews. The quantitative data included audits of screening logs and participants{\textquoteright} self-reported satisfaction with service delivery. A thematic analysis using both inductive and deductive approaches was used for qualitative analysis. Multiple data were used to triangulate the process evaluation findings.Participants: Quantitative data were collected on 210 participants. Qualitative interviews were conducted with 20 participants, 15 physiotherapists and 5 stakeholders.Results: Some participants valued the convenience and accessibility of remotely delivered physiotherapy. It was also deemed to have the potential of improving the efficiency in the way physiotherapy is delivered. The findings from the RE-AIM framework were mixed. For example, the Reach was limited, and the Adoption and Maintenance were inconsistent across sites.",

author = "Jackie Chu and Withers, {Hannah G.} and Glinsky, {Joanne V.} and Hueiming Liu and Jennings, {Matthew D.} and Starkey, {Ian J.} and Blake Palmer and Rachel Parmeter and Cruwys, {Jackson J.} and Max Boulos and Ian Jordan and Maggie Duong and Kitty Duong and David Wong and Lambert, {Tara E.} and Lucas, {Barbara R.} and Deborah Taylor and Maher, {Christopher G.} and Catherine Sherrington and Zadro, {Joshua R.} and Harvey, {Lisa A.}",

year = "2025",

month = aug,

day = "28",

doi = "10.1136/bmjopen-2024-097770",

language = "English",

volume = "15",

journal = "BMJ Open",

issn = "2044-6055",

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Chu, J, Withers, HG, Glinsky, JV, Liu, H, Jennings, MD, Starkey, IJ, Palmer, B, Parmeter, R, Cruwys, JJ, Boulos, M, Jordan, I, Duong, M, Duong, K, Wong, D, Lambert, TE, Lucas, BR, Taylor, D, Maher, CG, Sherrington, C, Zadro, JR & Harvey, LA 2025, 'Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework', BMJ Open, vol. 15, no. 8, e097770. https://doi.org/10.1136/bmjopen-2024-097770

Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework. / Chu, Jackie; Withers, Hannah G.; Glinsky, Joanne V. et al.
In: BMJ Open, Vol. 15, No. 8, e097770, 28.08.2025.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy

T2 - process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework

AU - Chu, Jackie

AU - Withers, Hannah G.

AU - Glinsky, Joanne V.

AU - Liu, Hueiming

AU - Jennings, Matthew D.

AU - Starkey, Ian J.

AU - Palmer, Blake

AU - Parmeter, Rachel

AU - Cruwys, Jackson J.

AU - Boulos, Max

AU - Jordan, Ian

AU - Duong, Maggie

AU - Duong, Kitty

AU - Wong, David

AU - Lambert, Tara E.

AU - Lucas, Barbara R.

AU - Taylor, Deborah

AU - Maher, Christopher G.

AU - Sherrington, Catherine

AU - Zadro, Joshua R.

AU - Harvey, Lisa A.

PY - 2025/8/28

Y1 - 2025/8/28

N2 - Objectives: The objectives of this process evaluation were to explain the results of the REFORM (REhabilitation FOR Musculoskeletal conditions) trial and identify potential facilitators and barriers to the future rollout of a remotely delivered physiotherapy model of care.Setting: Outpatient physiotherapy units in five government-funded public hospitals in Sydney, Australia.Design: This process evaluation was run alongside the REFORM trial. The REFORM trial (n=210) set out to determine whether remotely delivered physiotherapy (with one initial face-to-face session with a physiotherapist) was as good or better than a course of face-to-face physiotherapy. The process evaluation was informed by The UK Medical Research Council Process Evaluation Guidance. It was also based on the Realist Evaluation and the dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework. Qualitative and quantitative data were collected. The qualitative data included semistructured interviews. The quantitative data included audits of screening logs and participants’ self-reported satisfaction with service delivery. A thematic analysis using both inductive and deductive approaches was used for qualitative analysis. Multiple data were used to triangulate the process evaluation findings.Participants: Quantitative data were collected on 210 participants. Qualitative interviews were conducted with 20 participants, 15 physiotherapists and 5 stakeholders.Results: Some participants valued the convenience and accessibility of remotely delivered physiotherapy. It was also deemed to have the potential of improving the efficiency in the way physiotherapy is delivered. The findings from the RE-AIM framework were mixed. For example, the Reach was limited, and the Adoption and Maintenance were inconsistent across sites.

AB - Objectives: The objectives of this process evaluation were to explain the results of the REFORM (REhabilitation FOR Musculoskeletal conditions) trial and identify potential facilitators and barriers to the future rollout of a remotely delivered physiotherapy model of care.Setting: Outpatient physiotherapy units in five government-funded public hospitals in Sydney, Australia.Design: This process evaluation was run alongside the REFORM trial. The REFORM trial (n=210) set out to determine whether remotely delivered physiotherapy (with one initial face-to-face session with a physiotherapist) was as good or better than a course of face-to-face physiotherapy. The process evaluation was informed by The UK Medical Research Council Process Evaluation Guidance. It was also based on the Realist Evaluation and the dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework. Qualitative and quantitative data were collected. The qualitative data included semistructured interviews. The quantitative data included audits of screening logs and participants’ self-reported satisfaction with service delivery. A thematic analysis using both inductive and deductive approaches was used for qualitative analysis. Multiple data were used to triangulate the process evaluation findings.Participants: Quantitative data were collected on 210 participants. Qualitative interviews were conducted with 20 participants, 15 physiotherapists and 5 stakeholders.Results: Some participants valued the convenience and accessibility of remotely delivered physiotherapy. It was also deemed to have the potential of improving the efficiency in the way physiotherapy is delivered. The findings from the RE-AIM framework were mixed. For example, the Reach was limited, and the Adoption and Maintenance were inconsistent across sites.

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Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework

Abstract

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