Element (s) of EG concept | Activity | Domain | ||||||
---|---|---|---|---|---|---|---|---|
Actors | Actions | Targets of change | Temporality (frequency) | Dose | Implementation outcomes affects; assessment | Justification | ||
Physiotherapists | Â | Â | Â | Â | Â | Â | Â | Â |
(a) | Information | Study staff, self-study | Learn/recall characteristics of effectively dosed PA and exercise, purpose and methods of PA and exercise in line with actual guidelines/EULAR recommendations | Knowledge and awareness | Workshop before implementation in EGs | 2Â h | Knowledge, feeling of confidence in dealing with topic and promoting exercises; interview | Consciousness raising, self-reevaluation (both transtheoretical model) |
(a) | Education | PRISM expert | Aim, methodology and practical application of PRISM [27] in 1:1 counselling situation; communication skills to motivate and support groups, manage difficult situations, and encourage participants to perform (more) exercise | Skills | Workshop before implementation in EGs | 8Â h | Use of and adherence to the counselling elements (PRISM, MI); diary | Guided practice (social cognitive theory) |
(a) | Education | Study staff, self-study | Learned/recalled how to elaborate a progressive exercise plan | Skills | Workshop before implementation in EGs | 1Â h | Knowledge and development of exercise plans; diary | Guided practice (social cognitive theory) |
(a) | Support | PT peer | PTs know each other and ask each other for support, exchange experiences | Peer-factor | n.d | n.d | Feeling supported; interview | Enhance network linkages (theory of social networks) |
(c) | Supervision | Study staff | A "help desk" is provided by a study staff member to support in current issues. Regular refresher/supervision events with a PRISM expert are provided | Motivation to ensure quality of intervention | As needed | As needed | Beeing motivated; interview | Feedback (goal-setting theory, social cognitive theory) |
Element(s) of EG concept | Strategy | Domain | ||||||
---|---|---|---|---|---|---|---|---|
Actors | Actions | Targets of change | Temporality (frequency) | Dose | Implementation outcomes affects; assessment | Justification | ||
Patients with axSpA | Â | Â | Â | Â | Â | Â | Â | Â |
(b); (e) | Information | PTs, SVMB | PTs distribute handouts to patients and explain the four exercise dimensions and how to exercise appropriately. Questions are discussed in the EGs SVMB supports the knowledge transfer by proving information on website and SVMB journals | Knowledge and awareness of PAR | Weekly (PT) As needed (website) 4×/year (SVMB journal) | Ca. 5 min. As needed Ca.30 min. reading time | Awareness of how to perform effective exercises for each exercise dimension; exercise diarya | Consciousness -raising, self-reevaluation (both Transtheoretical model) |
(b); (e) | Support | Peer patients | Suitable peers, who successfully perform regular exercise, act as role models to support peers from their EG | Empower peer-factor | n.d | n.d | Feeling supported; survey | Modelling (social cognitive theory) |
(c); (d) | Individualisation | PTs | Assessments help to identify active and non-active participants and which of the exercise dimensions have the potential for improvement. An individual goal and action plan is developed during the 1:1 sessions in a shared decision manner | Setting goals, action planning, evaluation goal attainment | Bi-annual assessments Quarterly counselling sessions | 45Â min. 30Â min | Performance in assessments and (frequency and dose) training in each exercise dimension; exercise diarya | Individualisation (Transtheoretical model) Tailoring (Transtheoretical model) Planning coping responses (Relapse Prevention Theory) Goal Setting (Goal Setting Theory) Set graded tasks (Social Cognitive Theory) |
(c) | Individual exercise counselling | PTs | PTs and each patient have five 1:1 exercise counselling sessions, to define exercise goals, identify and deal with barriers and utilisation of facilitators, supporting self-efficacy, relapse prevention Furthermore, regular counselling sessions within the whole group are performed | Motivation and coping, self-efficacy | 5 sessions within 18 months (3 sessions within first 6 months/pilot phase, 2 booster sessions) | 30 min | Goal and action plan; exercise diary, activity tracker Changes according to PRISM in the patients perceived burden of disease and importance of PA; PRISM | Feedback (goal-setting theory, social cognitive theory) Reinforcement (social cognitive theory) Goal setting (goal setting theory) Set graded tasks (social cognitive theory) |
(e) | Self-monitoring | Patients | Patients keep a diary about their exercise-activities, polar watches are provided for self-monitoring of the heart rate (not for data analysis) | Organisation in daily life/routine | Daily reporting | Ca. 2–5 min | Exercise is part of the daily routine; exercise diary, activity tracker | Implementation intensions (theories of goal directed behaviour) Feedback (goal-setting theory, social cognitive theory) Reinforcement (social cognitive theory) |
Strategy | Domain | ||||||
---|---|---|---|---|---|---|---|
Actors | Actions | Targets of change | Temporality (frequency) | Dose | Implementation outcomes affects; assessment | Justification | |
Organisation | Â | Â | Â | Â | Â | Â | Â |
Regular information exchange and discussion | Study staff | Study staff explains elements of the EG concept, which are discussed with SVMB management | Awareness, decision to change routine care | Every 3Â months | 30Â min | Accept and implement new EG concept as usual care; vote of SVMB management | Sense-making (organizational development theory) |
Acquisition of third-party funds Support negotiations with insurers | CEO, SVMB project leader | Responsible members of SVMB management establish personal and financial resources to continue all elements of the EG concept after the pilot phase | Embedding of new care in organi-sation | n.d | n.d | Establish finances and structures to maintain concept; staff positions, working hours/week | Technical assistance (organizational development theory) |
Integration of SVMB-stakeholder in adaptation process | CEO, SVMB project leader | Study staff and SVMB management were in continuous exchange to ensure the feasibility of the new EG concept and satisfaction with its integration into routine care | Acceptance EG concept | Every 3Â months | 30Â min | Feasibility and satisfaction; continous contact | Increasing stakeholder influences (stakeholder theory) |