Tele-rehabilitation intervention to increase leisure time physical activity among adults with spinal cord injury: An implementation evaluation


Purpose: To conduct an implementation evaluation on a pilot RCT examining a Self-Determination Theory-based (SDT) online intervention aimed at increasing physical activity for adults with spinal cord injury (SCI). For the intervention, 12 adults with SCI completed eight online sessions with a physical activity counsellor trained in 33 SDT-based counselling behaviours (i.e., autonomy support). Methods: To determine whether the intervention was delivered as intended, three metrics were examined: (1) participants' perceptions of the counsellor's SDT behaviours, (2) the counsellor's self-reported use of SDT behaviours after each session, and (3) second-by-second video coding of the counsellor's SDT behaviours by 2 independent evaluators (n = 12 coded sessions; 3 sessions of 4 selected participants). Results: Participants' agreed that overall, the counsellor engaged in SDT behaviours during the sessions (M = 6.23 out of 7, SD = 0.54). The counsellor self-reported that they engaged in an average of 20.18 (SD = 2.79) counselling behaviours during each session (adherence rate = 65%), whereas the independent coders found the counsellor only engaged in an average of 13.23 (SD = 3.19) SDT behaviours. The coders did find, however, that when speaking, the counsellor was engaging in these behaviours 73% of the time. Conclusion: Overall, using these three indicators, it can be concluded that the intervention was delivered as intended. Despite the resources required to conduct an implementation evaluation using these metrics, intervention fidelity helps increase the trustworthiness of results and plays a very important role in the design and replication of effective health behaviour change interventions.

Acknowledgments: Craig H Neilsen Foundation