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Study design Type II hybrid effectiveness-implementation trial protocol. Objectives To (1) evaluate the implementation of coordinated physical activity (PA) coaching delivered by physiotherapists and spinal cord injury (SCI) peers during the transition from in-hospital care to living in a 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 received 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 summarised using the reach effectiveness adoption implementation maintenance (RE-AIM) framework. Ethics and dissemination The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-02694), clinicaltrials.gov registration NCT04493606. Documentation of the adoption process will inform implementation in future sites.

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Background: The most profound drop in physical activity among people with spinal cord injury (SCI) is observed in the months following discharge from rehabilitation. The ProACTIVE SCI intervention has previously demonstrated large-sized effects on physical activity among people with SCI in the community setting. If implemented successfully during the transition from hospital to community setting, this intervention may help improve physical activity at a critical, yet understudied, timepoint for people with SCI. The purpose of this study is to evaluate the effects of an implementation intervention on physical activity coaching behaviour and its determinants to inform future adaptation of the intervention for sustained implementation.Methods: This study employed a single group, pre-post design. The Knowledge to Action Framework supplemented by the Quality Implementation Framework were used to engage end-users in adapting the intervention and implementation process. The implementation intervention consisted of training (instructions, demonstration, behavioural practice, feedback), provision of educational resources, the addition of a physical activity prompt in patient discharge forms, and engagement of champions. The determinants of physical activity coaching were evaluated using a survey based on the Theoretical Domains Framework (TDF), administered before and immediately following training. Paired two-tailed t-tests were conducted to detect a significant within-subject effect over time on physical activity coaching determinants.Results: A total of ten participants attended training and completed the TDF survey. No significant differences were observed in any of the current physical activity coaching behaviours evaluated during the training period. However, participants reported significant improvements in physical activity coaching behavioural determinants including knowledge, skills, beliefs about capabilities, environmental context and resources, social influences, behavioural regulation, and memory, attention and decision processes (ps<0.05).Conclusions: Improvements in determinants signal the potential for changes in physical activity coaching behaviour. Determinant scores that remained low will be targeted to inform the ongoing adaptation of the implementation intervention. This study serves as an example of using the TDF, the Knowledge to Action Framework, and the Quality Implementation Framework to guide adaptation and implementation of an intervention.Trial Registration: U.S. National Library of Medicine, NCT04493606. Registered 29 July 2020, https://clinicaltrials.gov/ct2/show/NCT04493606