Co-development of a physiotherapist-delivered physical activity intervention for adults with spinal cord injury

Spinal Cord. 2020 Jul;58(7):778-786. doi: 10.1038/s41393-020-0422-x. Epub 2020 Jan 22.


Study designs: Cross-sectional survey, semi-structured interview, and randomized-controlled trial.

Objectives: Optimal spinal cord injury (SCI)-specific PA intervention strategies appropriate for the physiotherapist setting are unknown. The purpose of this paper is to describe the rigorous co-development process of a theory-based, physiotherapist-led PA intervention for people with SCI and assess its feasibility for implementation in the rehabilitation setting.

Setting: Community.

Methods: Co-development of the intervention included (1) a review of the literature; (2) key informant interviews with people with SCI (n = 26); (3) a national online survey of physiotherapists' barriers, needs, and preferences (n = 239); (4) a review of the evidence and recommendations for the intervention from a stakeholder expert panel (n = 13); and (5) a randomized controlled trial of intervention training and its effects on implementation determinants amongst physiotherapists (n = 20).

Results: Almost 300 people with SCI and physiotherapists were engaged in the intervention development process. Optimal intervention delivery should be tailored and include (1) education on safety, PA guidelines, and behaviour change techniques, (2) referral to other peers, local programmes, and health professionals, and (3) adapted exercise prescriptions. Following intervention implementation training, physiotherapists demonstrated stronger tested and perceived knowledge, skills, resources, and confidence for promoting PA to people with SCI, ps < 0.05.

Conclusions: This development process serves as an example methodology for using theory to co-create a leisure-time physical activity behaviour change intervention tailored for people with SCI.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Behavior Therapy
  • Cross-Sectional Studies
  • Exercise Therapy* / methods
  • Exercise Therapy* / standards
  • Exercise*
  • Feasibility Studies
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Leisure Activities*
  • Neurological Rehabilitation* / methods
  • Neurological Rehabilitation* / standards
  • Patient Education as Topic
  • Physical Therapists*
  • Professional Competence
  • Spinal Cord Injuries / rehabilitation*
  • Stakeholder Participation*