"No Matter the Age or Medical Complexity, People Benefit From That Intensity of Exercise": A Mixed-Methods Study Describing Rehabilitation Provider Perceptions of High-Intensity Resistance Training Among Veterans Receiving Post-Acute Care.

Background: In skilled nursing facilities (SNFs), i-STRONGER is a novel, high-intensity resistance training approach that incorporates progressive resistance training to promote greater improvements in patient function compared to usual care. To inform large-scale expansion of i-STRONGER as standard-of-care in SNFs, this mixed-methods study assessed rehabilitation providers' perceptions of i-STRONGER and purported needs for its adoption.

Methods: Forty-three rehabilitation providers participated in an 18-week, interactive i-STRONGER training program. Post-training, the validated Perceived Characteristics of Intervention Scale was used to evaluate i-STRONGER relative advantage, compatibility with practice, complexity, potential for reinvention (ie, adaptability), trialability, and risk. Providers reported the top 3 needs for successful i-STRONGER adoption and described i-STRONGER perceptions in training modules and focus groups. A convergent mixed-methods design was used to evaluate and describe clinician perceptions of i-STRONGER.

Results: i-STRONGER program conceptually aligned with providers' practice. The patterns and was endorsed as feasible and adaptable as part of patient care; however, initial hesitancies surrounding patients' physical abilities and motivation were noted as barriers and appeared to reflect negative age-related beliefs and attitudes within SNF cultures. Providers feared patients would be unwilling or unable to engage with i-STRONGER activities due to their age, deconditioning, medical complexity, or expectation that rehabilitation should feel "easier." As providers began implementing i-STRONGER in real-time, concerns surrounding i-STRONGER's potential risks lessened as providers observed improvements in patient function and motivation, and patients were described as "embracing" i-STRONGER principles. Patient acceptance and satisfaction, equipment, time, and clear communication among providers were cited as critical needs for i-STRONGER adoption.

Conclusions: With i-STRONGER, a safe and effective approach for delivering resistance training to older adults in SNF settings, "seeing is believing." Real-time implementation of i-STRONGER facilitated an evolution of perspective among providers, fueled by observable, positive changes in patient function and affect as well as unexpected patient participation. Findings support i-STRONGER use in SNF settings, provided that specific training strategies showcase older adults with medical complexity participating in progressive resistance training.