None listed
Conditions
Brief summary
Physical activity counselling increases physical activity when delivered in healthcare settings; however, implementation efforts have been sub-optimal. The BEHAVIOUR trial aims to address this important evidence-practice gap by delivering implementation strategies (education, training, tailored strategies to address community referral barriers, creation of a learning collaborative, and facilitation and audit and feedback) to enable physiotherapists working in South Western Sydney Local Health District to provide physical activity counselling within routine care. It is hypothesised that physical activity counselling will be implemented into practice and that patients receiving treatment from physiotherapists who receive the implementation strategies will be more likely to participate in greater amounts of self-reported planned physical activity at 6-months after baseline assessment compared to patients whose physiotherapist have not received the implementation strategies.
Interventions
As this is a hybrid type II implementation effectiveness trial there are two interventions; 1. Implementation strategies delivered by the research team to the physiotherapists to support them to incorporate physical activity counselling into their routine care; and 2. Evidence-based intervention (physical activity counselling) delivered by physiotherapists to their patients within their routine care.
1. Implementation strategies:
Clinical physiotherapists randomised to the intervention group wi
As this is a hybrid type II implementation effectiveness trial there are two interventions; 1. Implementation strategies delivered by the research team to the physiotherapists to support them to incorporate physical activity counselling into their routine care; and 2. Evidence-based intervention (physical activity counselling) delivered by physiotherapists to their patients within their routine care. 1. Implementation strategies: Clinical physiotherapists randomised to the intervention group will have access to all implementation strategies to support and train them to incorporate physical activity counselling into their routine practice. The implementation strategies will include education and training (online and two face-to-face workshops three months apart) with tailored strategies to address community referral barriers, creation of a learning collaborative across the district, and facilitation and audit and feedback provided within teams to build clinicians’ Capabilities, Opportunities and Motivations to delivering physical activity counselling within routine care (see below for further information). The implementation strategies were derived from the Expert Recommendations for Implementing Change (ERIC) project(Powell B, 2015, Implement Sci) and the COM-B behaviour change theoretical model (Michie S, 2011, Implement Sci) and are based around literature describing barriers physiotherapists report stop them from incorporating physical activity counselling into routine practice, as well as literature on existing programs and resources promoting physical activity in clinical or similar populations. In addition, as behaviour is context specific, the findings from pre-implementation work (BEHAVIOUR part 1 survey conducted in 2020) and interview style consultation with local clinicians and physiotherapy managers have informed the implementation strategies to ensure the correct local influences are addressed as part of the implementation strategies. Implementation strategy 1: Education Mode of delivery/ where/ length: Series of short education videos /online/~ 1hr total Time- frame: Prior to attending workshop 1 Intervention content: 3-10 min videos on different topics identified as knowledge gaps in BEHAVIOUR part 1 survey (conducted as part of pre-implementation work in 2020). Implementation strategy 2: Education and training (Conduct educational meetings and ongoing training, change record systems, make training dynamic, promote adaptability) Mode of delivery/ where/ length: Workshops 1 & 2: face-to-face workshop /at team’s hospital/ maximum 4 hours Time- frame: workshop 1: 2-3 weeks after hospital rotation, workshop 2: 3-mths later. Intervention content: Made up of presentations (e.g. how to do PA counselling- 1st encounter, follow up encounters, PA counselling with patients from Culturally And Linguistically Diverse (CALD) communities), tasks (e.g. role playing, using scripts, reviewing resources), discussions (e.g. group sharing reflections & experiences of content presented and practised) and audio clips (e.g. experienced PT delivering PA counselling). Paper-based and PDF manuals designed specifically for this study with slides and resources will be given to each participant. Resources will include links to available resources e.g. Moving Medicine https://movingmedicine.ac.uk/; WHO: https://www.who.int/health-topics/physical-activity; and copies of study developed resources. Implementation strategy 3: Create a learning collaborative Mode of delivery/ where/ length: Communication platform/online-Microsoft Teams/ length project Time- frame: Added at workshop 1 Intervention content: Access to online videos, sharing resources developed across teams, place to communicate, ask questions, share feedback on audit Implementation strategy 4: Tailored strategies to address community referral barriers Mode of delivery/ where/ length: This will be tailored and determined with each team to address their specific context and the barriers they have with community referrals for their patients. Time- frame: Start at workshop 1 Intervention content: Provide training in finding PA opportunities, help to develop links with physical activity services, referral resources, evaluation tools of community PA opportunities Implementation strategy 5: Facilitation and Audit & Feedback within teams Mode of delivery/ where/ length: Mix of face-to-face & remote delivery to included physiotherapists in immediate cluster teams/ in their clinical settings/ ~ monthly (1-2hrs) Time- frame: Between workshop 1 & workshop 2 Intervention content: Working with team to identify/ modify/ develop resources for their team (including local Activity Directory or similar resource), identify & connect with appropriate PA opportunities, modify physiotherapy assessment forms to include PA information to collect, Audit and feedback with colleague between workshops. 2. Physical activity counselling within routine care Patients who are recruited into the trial will receive their routine physiotherapy assessment and intervention to address the therapeutic reason that they have been referred to physiotherapy. This may include some aspects of physical activity counselling as we know from preliminary work done in the local health district that some physiotherapists incorporate some aspects of physical activity counselling in routine care. It is anticipated that patients who are treated by physiotherapists who have received the implementation strategies will be more likely to receive more elements of physical activity counselling as part of their usual practice (with no additional time added onto the consultation). The frequency and length of physiotherapy consultations will vary and will be based on the therapeutic reason the person has been referred for physiotherapy and the appointment schedules for the different teams. Therefore, the overall duration of the intervention will vary between teams and patients (depending on their therapeutic needs), however it will range between being seen for one day up to being seen over a period of 6 months in total. Physical activity counselling refers to a component of patient consultation aimed at changing health behaviour as a means of primary or secondary prevention of life-style related chronic health conditions. The physical activity counselling intervention is underpinned by theoretical models of behaviour change (COM-B, Self Determination Theory, Social Cognitive Theory), Motivational Interviewing and incorporates behaviour change techniques shown to increase physical activity in the general population as well as people with physical disabilities. The physical activity counselling elements include: 1. Asking, raising the topic of physical activity; 2. Assessing physical activity levels (questionnaire or device-based) and influences on physical activity behaviour; 3. Provide tailored advice about physical activity (e.g. benefits, options- delivered verbally, or using handouts or website links); 4. Collaborative goal setting and action planning; 5. Arrange referral or signpost to community physical activity services/opportunities; 6. Provide self-monitoring strategies (e.g. activity diary, pedometer, phone App); 7. Review physical activity status, discuss barriers and facilitators in follow up treatment sessions; 8. Use motivational interviewing techniques (person-centred approach) throughout. The fidelity of the delivery of physical activity counselling will be measured by audit of medical records and physiotherapist self-report checklist (see outcome measure section).
Sponsors
The University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Physiotherapy team inclusion: This trial will include 30 clusters. A cluster is defined as a hospital clinical team that provides a service for inpatients or outpatients within South Western Sydney Local Health District (SWSLHD), NSW, Australia, that has one or more physiotherapists within the team. For the cluster to be included in the trial there needs to be at least one physiotherapist within the team interested in participating and who meets the following eligibility criteria: • anticipate they will remain employed within SWSLHD for the next 12 months; • either permanent or at least 6-month rotation in the identified clinical team; • would treat at least 10 new eligible adult patients within their clinical team over a 3-month period; • not working in a split role across two clinical teams that have both been identified as potential clusters for the trial. Patient inclusion: Patient-participants are likely to be affected by common and/or burdensome conditions such as, but not limited to, osteoarthritis, lower limb amputations, chronic pain, stroke, brain injury, cardiac and pulmonary disease. The trial will include any consenting adults (18 + years) who: • are a new patient of one of the participating physiotherapists during the recruitment period; • live in the community (as opposed to residential care); • are able to leave their home without physical assistance from another person but may use a walking aid or wheelchair (anticipated within 6-months of recruitment); • are without major cognitive impairment (e.g. diagnosis of dementia); • have sufficient language capabilities to respond to written questionnaires in English, Arabic or Vietnamese.
Exclusion criteria
Physiotherapy team exclusion: Nil Patient exclusion criteria: The trial will exclude adults who: • are residents of residential aged care facilities; • have the following medical conditions: delirium, acute medical illnesses, severe psychiatric disorders, rapidly progressive neurological diseases; • have any medical reason for which strategies to increase physical activity would be contra-indicated, determined by the treating physiotherapist.
Outcome results
None listed