Implementation and scale-up of a co-designed physical activity promotion program for people with moderate-to-profound disabilities

Brief name: The APAP-OMNI Program APAP-OMNI is a client-centred, community-based program designed to empower people with moderate-to-profound disability and high support needs to adopt and maintain a physically active lifestyle. APAP-OMNI is delivered in the community by trained Allied Health Professionals (i.e., exercise physiology, physiotherapy, occupational therapy) in collaboration with the client and their relevant social support (e.g., family, support worker, community service providers). Briefly, APAP-OMNI comprises four steps: Step 1: Information Gathering and Sharing (1-2 sessions). This includes participants demographic information, medical history, communication preferences, and access to physical activity resources will be collected to design a tailored physical activity program that is safe, sustainable, enjoyable and effective. The activities included in this step aim to reduce the time commitment required to collect this information while prioritising activities that build rapport and support the client’s voice and autonomy. This information will be collected via medical records, referral documentation, one on one interviews with the client / family / support worker and the Support Needs Assessment Tool – Sport and Exercise (SNAT-SE) to assess required supports for participating in sport and exercise related activities. Step 2: Identifying motivators, barriers, facilitators and opportunities for participating in physical activity (2-3 sessions). During Step 2, Allied Health Professionals (AHPs) will conduct one-to-one client-centred consultations with participants (and parents/caregivers where appropriate) to identify motivators, barriers, facilitators and opportunities for increased physical activity participation. Information will be gathered through guided interviews, discussion-based activities, review of daily routines and available resources, and consideration of relevant functional abilities, environmental factors, and assistive equipment where applicable. Allied health professionals will then apply tailored behaviour change strategies to identify: 1) motivators, barriers and facilitators for increased physical activity participation (Step 2A); and 2) opportunities for physical activity that align with the client's interests, available time and resources (Step 2B). Step 3: Facilitating safe, sustainable, enjoyable and effective physical activity (2-3 sessions). The object of Step 3 of the APAP-OMNI is to facilitate participation in the client’s chosen physical activity. Firstly in this step, AHPs work collaboratively with clients through individual consultations to develop and implement an Action Plan (Step 3A). Information collected during Steps 1 and 2 is used to identify participation goals, required supports, potential barriers, and strategies to facilitate successful participation. Where relevant, clinicians may also consult with family members, support workers, community activity providers, schools, employers, or other stakeholders involved in supporting participation. The action plan is a personalised document that outlines the client's chosen physcial activity, participation goals, specific actions required to support participation, the person responsible for each action, and timelines for completion. Examples of actions that may be included in the Action Plan include identifying suitable community exercise or sport program, arrangin transport, adapting equiptment, modifyin home or community environments, educating activity providers regarding disability-specific needs, organising support worker assistance, establishing social supports, setting reminders, monitoring activity participation, and identifying rewards for achieveing participation goals. For some clients, the Action Plan may also include a graduated participation schedule or simple exercise program designed to biuld the skills, confidence, fitness or endurance required to participate successfully in their chosen activity. Then, the AHP focuses on implementing the Action Plan and supporting participation in the community (Step 3B). Support may be provided through face-to-face consultations, telephone calls, telehealth appointments, email communication, text messages, environmental modifications, equipment recommendations, liaison with community providers, and ongoing review of progress towards participation goals. The intensity and type of support provided are tailored to the client's goals, abilities, and participation context. Step 4: Promoting ongoing participation in physical activity (1-2 sessions). The object of Step 4 is to promote the long-term maintenance of physical activity participation after completion of the APAP-OMNI program. During this step, AHPs work collaboratively with clients, and where appropriate their families, caregivers, support workers and community providers, to develop a personalised Participation Promotion Plan that supports sustainable engagement in physical activity. The Participation Promotion Plan is a written document that summarises the physical activity goals, successful participation strategies identified during the program, key sources of social and community support, and plans for maintating partcipation over time. The plan may include short-, medium-, and long-term participation goals (e.g., 3-6 month , and 12-month goals), strategies for managing anticipated barriers such as illness, injury, weather changes, transport difficulties, changes in support arrangements or funding, and contingency plans for restarting participation following interruptions. The plan may also identify opportunities for progression of physical activity participation, including increasing attendance frequency, participation duration, skill development, transition to new activities, or progression from supported to independent participation where appropriate. Examples of components that may be included in the Participation Promotion Plan include shedules for ongoing participation, identification of community programs and support networks, strategies for self-monitoring and self-evaluation, future goal setting activities and guidance regarding safe progression of physical activity. A physical or electronic copy of the plan is provided to the client to support ongoing participation after completion of the intervention. The intervention is delivered over 16 weeks and comprises up to 10 sessions, each lasting between 30 and 60 minutes depending on the participants needs and session objectives. Sessions are typically delivered more frequently during the inital phase of the program, with reduced frequency in the later strages as participants transition towards greater independence and sustained participation. The study will be conducted across eight community-based allied health clinics in Queensland, Australia, serving communities in both metropolitan and regional areas (Brisbane, Gold Coast, Sunshine Coast, Townsville and Cairns). The clinics are multidisciplinary, providing services such as physiotherapy, exercise physiology and occupational therapy. AHPs will receive training in the delivery of APAP-OMNI during the month prior to crossing over to the intervention period. The workforce training package comprises of a hybrid of online and face-to-face training modules. The online component involves six self-paced modules that provide AHPs with a comprehensive foundation for delivering the APAP-OMNI program, covering its aims, implementations strategies and trial-specific responsibilities. The online modules are estimated to take approximately 3.5 hours to complete. Following completion of the self-paced online modules, AHPs will participate in a face-to face workshop focused on the practical application of APAP-OMNI program. The workshop will use an interactive, case-based format organised around the four-step APAP-OMNI delivery process. Training activities will include guided practice in infomatin gathering and sharing, behavioural change techniques, motivational interviewing, goal setting, action planning, communtiy participation planning and problem-solving strategies to support physical activity participation among individuals with moderate to profound disability. The workshop will incorporate reflective learning activities, case-based discussions, role-play senarios and collaborative community service planning exercises designed to build AHP confidence and capability in delivering sustainable, community-based physical activity support. For quality assurance and to support intervention fidelity, AHPs will complete an Essential Elements Checklist (EEC) following each of the 10 APAP-OMNI intervention sessions. The EEC records session details (date, duration, and AHP name), the APAP-OMNI step(s) completed during the session and a structured summary of session content and participant engagement. AHPs will document the key focus of the session, behaviour change strategies or tools used, participant or caregiver responses, agreed actions and plans, responses to participation, and any barriers, safety considerations or contextual factors affecting implementation or progress.