Physical Activity Coaching Implementation Among Physiotherapists and SCI Peer Mentors: Behavioural Determinants and Effects

Abstract

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