Assessing the reach, effectiveness, adoption, implementation, and maintenance of the ProACTIVE SCI physical activity counseling intervention among physiotherapists and SCI peer coaches during the transition from rehabilitation to community

IntroductionPhysical Activity (PA) levels for individuals with spinal cord injury (SCI) peak during rehabilitation and sharply decline post-discharge. The ProACTIVE SCI intervention has previously demonstrated very large-sized effects on PA; however, it has not been adapted for use at this critically understudied timepoint. The objective is to evaluate the reach, effectiveness, adoption, implementation, and maintenance of the ProACTIVE SCI intervention delivered by physiotherapists and SCI peer coaches during the transition from rehabilitation to community.MethodsA single-group, within-subjects, repeated measures design was employed. The implementation intervention consisted of PA counseling training, champion support, prompts and cues, and follow-up training/community of practice sessions. Physiotherapists conducted counseling sessions in hospital, then referred patients to SCI peer coaches to continue counseling for 1-year post-discharge in the community. The RE-AIM Framework was used to guide intervention evaluation.ResultsReach: 82.3% of patients at the rehabilitation hospital were reached by the intervention. Effectiveness: Interventionists (physiotherapists and SCI peer coaches) perceived that PA counseling was beneficial for patients. Adoption: 100% of eligible interventionists attended at least one training session. Implementation: Interventionists demonstrated high fidelity to the intervention. Intervention strategy highlights included a feasible physiotherapist to SCI peer coach referral process, flexibility in timepoint for intervening, and time efficiency. Maintenance: Ongoing training, PA counseling tracking forms, and the ability to refer to SCI peer coaches at discharge are core components needed to sustain this intervention.DiscussionThe ProACTIVE SCI intervention was successfully adapted for use by physiotherapists and SCI peer coaches during the transition from rehabilitation to community. Findings are important for informing intervention sustainability and scale-up

Enhancing the quantity and quality of leisure-time physical activity participation among individuals with spinal cord injury who walk

Individuals with spinal cord injury (SCI) who walk participate in low levels of leisure-time physical activity (LTPA) due to barriers to quality LTPA experiences. Quality LTPA experiences are important as they confer several benefits such as improved well-being. Behavioural interventions that support quantity and quality of LTPA participation are lacking for ambulators with SCI. To support LTPA behaviour, theory-informed, partnered interventions are needed. The purpose of this dissertation was to conduct a series of studies that will aid in understanding and improving the quantity and quality of LTPA participation among individuals with SCI who walk. First, a scoping review was conducted to understand the amounts, types, correlates, and outcomes of physical activity participation for ambulators with SCI. Second, a cross-sectional study, informed by behaviour change theory, was conducted to identify factors related to LTPA participation in individuals with SCI who ambulate. Third, a qualitative study consisting of interviews with ambulators with SCI was conducted to explore the conditions and elements involved in positive and negative quality LTPA experiences. Fourth, using the findings from the first three studies, an LTPA-enhancing mHealth intervention was designed (SCI Step Together). Fifth, an 8-week randomized controlled trial was conducted to assess the feasibility, acceptability, engagement, and preliminary efficacy of the SCI Step Together program. The results of this programmatic, theory-informed series of studies contribute substantively to knowledge regarding LTPA in a sub-population that has been largely ignored. This dissertation revealed that among ambulators with SCI, LTPA levels are generally low and there are few interventions that support their quality LTPA participation. The studies found that factors that contribute to the quantity and quality of LTPA can be mapped onto existing behaviour change and quality participation frameworks. Conditions that influence elements of quality participation are valuable for designing behavioural interventions, like the SCI Step Together program. The SCI Step Together program demonstrated good feasibility, acceptability, engagement, and preliminary efficacy for some psychosocial variables (e.g., basic psychological needs). Overall, researchers and programmers are strongly encouraged to continue to study and develop resources in partnership with ambulators with SCI to encourage quality participation in LTPA.Health and Social Development, Faculty of (Okanagan)Health and Exercise Sciences, School of (Okanagan)Graduat