My Personal Rehab: A digital home-based program to improve physical function in older people undergoing rehabilitation

Brief name: My Personal Rehab This is a pragmatic, assessor-blinded, parallel-group, multi-site randomised controlled trial using a Hybrid Type 1 effectiveness-implementation design. Physical or informational materials & procedures: Participants in both groups will: •Download the MyPersonalRehab app to access all participant-facing study resources including validated questionnaires and educational materials (developed for the purpose of this study). • Receive a Garmin watch (free of charge) to track physical activity during the 6-month study. • Complete questionnaires at the start, midway (3-months) and end of the study (6-months) taking up to 30-minutes each time. Complete short monthly surveys about physical activity, health services accessed, falls, and other adverse events, taking up to 5-minutes each time. Participants in the digital rehabilitation program will: • Continue with usual activities, and in addition: • Use the StandingTall program: a home-based balance, mobility, strength and heart health exercise program. It features animations and instructions, assessments, progress tracking and motivational prompts. The intensity and difficulty of the program is individually tailored through baseline and ongoing balance and mobility assessments and continuous progress tracking. The program adjusts exercise prescription and difficulty based on user performance, confidence, and adherence. This ensures each participant receives a personalised and adaptive training plan that evolves with their ability. The program is accessed via a tablet, if participants do not have a tablet they will be loaned one for the duration of the study. • Follow a tailored Walking Program: participants are able to start the walking program in Week 7 (depending on readiness, determined by questionnaire response to ‘Do you feel ready to add a daily walk to your routine?') and will continue until the end of the study, designed to engage participants in a structured walking plan to increase and/or maintain their daily walking levels. Participants will use a Garmin watch to help monitor the number of steps they have taken each day. Participants will receive a tailored daily walking target based on their baseline and ongoing activity levels. •Receive Physical Activity Coaching digitally via the MyPersonalRehab app . This includes digital activities which aim to guide the participants to use motivational techniques to support adherence to the StandingTall and walking program. Coaching (via phone call) aims to support low adherers to start and/or continue StandingTall and/or the walking program using motivational techniques • The goal is to gradually reach 2.5 hours of exercise each week, made up of StandingTall, the walking program, and any other activities (e.g. usual care exercises). This can be split into smaller sessions across the week. The programs are designed by Exercise Physiologists for digital, independent use at home. If participants do not meet program targets for two weeks in a row, they will be contacted by the research team. • Health Education: Delivered every two weeks via the MyPersonalRehab app, this includes 13 short, evidence-based fact sheets over 6 months with more specific and prescriptive information designed to support the intervention, on topics relevant to rehabilitation, such as exercising safely, physical activity, falls, habit forming, common barriers to exercise, self-compassion • Participants willing to participate in an optional interview or focus group (duration: 60-90 mins, either face-to-face or online, to share experiences and feedback, towards the end of the study) will be randomly allocated using stratified randomisation to ensure equal representation across age, gender, adherence, and rehabilitation indication Adherence: Will be assessed via the Garmin watch to track walking, StandingTall application to track weekly exercise minutes, and education completion tracked via the MyPersonalRehab application. Implementation strategies: • To support delivery and uptake of the intervention, several pragmatic implementation strategies will be used. These include a site coordinator, central support via telehealth and use of embedded behaviour change techniques such as goal setting, feedback and monitoring, habit formation, and coaching. Onsite healthcare professionals will receive initial guidance and access to training materials to facilitate appropriate use of the My Personal Rehab platform.