Skip to main content

Table 1 Elements of implementation strategy and implementation intervention activities according to proctor [23]

From: Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy

Element (s) of EG concept

Activity

Domain

Actors

Actions

Targets of change

Temporality (frequency)

Dose

Implementation outcomes affects; assessment

Justification

Physiotherapists

        

(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

2 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

8 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

1 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

        

(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

45 min.

30 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

       

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 3 months

30 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 3 months

30 min

Feasibility and satisfaction; continous contact

Increasing stakeholder influences (stakeholder theory)

  1. n.d. not defined, SVMB ankylosing spondylitis association of Switzerland, PT physiotherapist, EG exercise group, PRISM pictorial respresentation of illness and self measure
  2. a Paper or free app «Trainungstagebuch» by Johannes Tscholl