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

Implementation of the spinal cord injury exercise guidelines in the hospital and community settings : Protocol for a type II hybrid trial

Study design: Type II hybrid effectiveness-implementation trial protocol. Primary objectives: To 1) evaluate the implementation of coordinated physical activity (PA) coaching delivered by physiotherapists and spinal cord injury (SCI) peers during transition from in-hospital care to living in community (implementation objective) and 2) assess the effect of coaching on PA behaviour and psychosocial predictors among people with SCI (effectiveness objective). Setting: Rehabilitation hospital and home/community settings in British Columbia, Canada. Methods: Implementation objective: PA coaches (physiotherapists and SCI peers) receive an implementation intervention including training, monitoring, feedback, and champion support. A Theoretical Domains Framework-based questionnaire is collected at baseline, post-training, 2, and 6 months follow-up and semi-structured interviews conducted at 6 months. Effectiveness objective: Using a quasi-experimental design, 55 adults with SCI are allocated to intervention (PA coaching, n=30) or control (usual care, n=25) groups. Participants in the intervention group are referred by physiotherapists to receive 11 SCI peer-delivered PA coaching sessions in the community. Control participants receive usual care. Questionnaires assessing PA behaviour and psychosocial predictors are administered at baseline, 2-months, 6-months, and 1-year. Semi-structured interviews are conducted to assess intervention satisfaction at 6 months. Analyses include one-way (implementation objective) and two-way (effectiveness objective) repeated measures ANCOVAs for questionnaire-reported outcomes and thematic content analysis for interview data. Data are summarized using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework.Health and Social Development, Faculty of (Okanagan)Medicine, Faculty ofNon UBCHealth and Exercise Sciences, School of (Okanagan)Medicine, Department ofReviewedFacultyResearcherPostdoctoralOthe

“The healing power of that should never be underestimated” : Implementing coordinated physical activity counselling among physiotherapists and spinal cord injury peer coaches

Purpose: A large decrease in physical activity (PA) is typically observed among people with spinal cord injury (SCI) when discharged from inpatient rehabilitation. We aimed to identify implementation factors of coordinated PA counselling among physiotherapists and SCI peer coaches during the transition from inpatient rehabilitation to community. Methods: Semi-structured interviews guided by the Theoretical Domains Framework (TDF) were conducted. Using the TDF, factors affecting PA counselling delivery were coded abductively. A critical friend and member checking were used throughout analysis. Results: Participants included nine physiotherapists and two SCI peer coaches. The most salient TDF domains were social influences (34%), environmental context and resources (31%), and skills (15%). Specifically, participants identified challenges in addressing patient barriers and continual staff onboarding. Intervention delivery was supported by the ability to refer out to peer coaches with lived experience, having champion support, a time-efficient PA counselling form, and training sessions that included motivational interviewing skill development. Conclusion: Successfully implementing coordinated PA counselling during the transition from rehabilitation to community may be strengthened by 1) providing resources/training that guide both content and delivery of PA counselling and 2) a referral system that leverages the strengths of both clinicians and people with lived experience of SCI.Education, Faculty ofHealth and Social Development, Faculty of (Okanagan)Medicine, Faculty ofNon UBCHealth and Exercise Sciences, School of (Okanagan)Kinesiology, School ofMedicine, Department ofUnreviewedFacultyResearcherGraduat