Brief physical activity counselling by physiotherapists (BEHAVIOUR): protocol for an effectiveness-implementation hybrid type II cluster randomised controlled trial

Abstract

Background Physical inactivity is a leading risk factor for chronic disease. Brief physical activity counselling delivered within healthcare systems has been shown to increase physical activity levels; however, implementation efforts have mostly targeted primary healthcare and uptake has been sub-optimal. The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) trial aims to address this evidence-practice gap by evaluating (i) the effectiveness of a multi-faceted implementation strategy, relative to usual practice for improving the proportion of patients receiving brief physical activity counselling as part of their routine hospital-based physiotherapy care and (ii) effectiveness of brief physical activity counselling embedded in routine physiotherapy care, relative to routine physiotherapy care, at improving physical activity levels among patients receiving physiotherapy care. Methods Effectiveness-implementation hybrid type II cluster randomised controlled trial with embedded economic evaluation, qualitative study and culturally adapted patient-level outcome measures. The trial will be conducted across five hospitals in a local health district in Sydney, Australia, with a lower socioeconomic and culturally diverse population. The evidence-based intervention is brief physical activity counselling informed by the 5As counselling model and behavioural theory, embedded into routine physiotherapy care. The multi-faceted strategy to support the implementation of the counselling intervention was developed with key stakeholders guided by the Consolidated Framework for Implementation Research and the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model, and consists of clinician education and training, creating a learning collaborative, tailored strategies to address community referral barriers, team facilitation, and audit and feedback. Thirty teams of physiotherapists will be randomised to receive the multi-faceted implementation strategy immediately or after a 9-month delay. Each physiotherapy team will recruit an average of 10 patients (n=300) to collect effectiveness outcomes at baseline and 6 months. The primary effectiveness outcome is self-reported planned physical activity using the Incidental and Planned Exercise Questionnaire, and the primary implementation outcome is reach (proportion of eligible new physiotherapy patients who receive brief physical activity counselling). Secondary effectiveness and implementation outcomes will also be collected. Discussion This project focuses on physiotherapists as health professionals with the requisite skills and patterns of practice to tackle the increasing burden of chronic disease in a high-risk population. Trial registration ANZCTR, ACTRN12621000194864. Registered on 23 February 2021.

Physical activity service provision in hospice care: A national mixed-methods study

“…This result is consistent with other studies which have found that physiotherapists, across diverse healthcare settings (e.g., general practice, cancer care), have expertise and knowledge in PA promotion and typically integrated some form of discussion about activity with their patients (Albert et al 2020;Hassett et al 2022). Physiotherapists agree that PA promotion should be part of their clinical role (Aweto et al 2013;Freene et al 2017;Hassett et al 2022;Mouton et al 2014;Shirley et al 2010). Our qualitative findings confirm those of previous research; yet, participants in our study felt that all members of the MDT should prioritize and take an active role in encouraging patients to move more.…”

“…Survey results showed that 85% of physiotherapists delivered sessions to patients. This result is consistent with other studies which have found that physiotherapists, across diverse healthcare settings (e.g., general practice, cancer care), have expertise and knowledge in PA promotion and typically integrated some form of discussion about activity with their patients (Albert et al 2020;Hassett et al 2022). Physiotherapists agree that PA promotion should be part of their clinical role (Aweto et al 2013;Freene et al 2017;Hassett et al 2022;Mouton et al 2014;Shirley et al 2010).…”

“…Hospices, which are a leading setting in which specialist palliative care is provided, can play a vital role in promoting PA. Evidence suggests that care settings (e.g., primary and secondary care) and health professionals (e.g., general practitioners, nurses, physiotherapists) who work within them have considerable influence on patients' health behavior and are wellpositioned to promote PA (Cunningham and O'Sullivan 2021;Hassett et al 2022). However, promoting PA in the health sector is often varied and dependent on multiple key enablers such as funding and available expertise (Albert et al 2020).…”

Hybrid effectiveness-implementation study designs in sports injury prevention research

“…In this instance, effectiveness data may be yielding lower outcome change than in efficacy trials, so a closer examination of implementation strategy or strategies is necessary. A Type II hybrid design would be appropriate if there is strong evidence for both the intervention itself as well as strong evidence for the implementation strategy being studied, but the two components are being applied in a novel way—such as in a new population and/or are being studied together for the first time (Hassett et al, 2022 ).…”

Application of an Algorithm as an Educational Strategy to Improve the Learning of the Intervention Model in Physiotherapy in University Students

“…Physiotherapy is a service provided solely by or under the direction and supervision of an accredited physiotherapist, through a degree and professional certificate, which enable him to manage the Intervention Model in Physiotherapy which includes: examination, assessment, diagnosis, prognosis, intervention or treatment plan and reassessment. Physiotherapy deals with potentiating and maximizing quality of life, identifying, and treating movement disorders within the areas of promotion, prevention, treatment and/or intervention, habilitation and rehabilitation (Hassett et al, 2022).…”