Evaluating implementation of the train-the-trainers model to improve access to community-based physical activity for people with spinal cord injury.

INTERVENTION: The Train‐The‐Trainer Spinal Cord Injuries (T3‐SCI) intervention is a multi‐component program consisting of (1) training of exercise professionals and (2) delivery of an individualised, supervised physical activity program for people with spinal cord injury (SCI). Exercise professionals complete the T3‐SCI training program via the Spinal Cord Injuries Australia online platform, incorporating self‐directed modules, mentored case‐based assessments, and facility safety checks (estimated completion10hrs). The modules cover content designed to improve knowledge of SCI pathophysiology and clinical characteristics, risks associated with physical activity, and how to develop safe and inclusive exercise programming with modifications for people with SCI. Content of the T3‐SCI program is delivered through presentations, short videos, case studies, multiple choice assessments, self‐directed reading and mentorship with an exercise physiologist or physiotherapist experienced in exercise prescription to people with SCI. Following training, participants with SCI receive a 12‐week, face‐to‐face exercise program delivered in participant‐nominated community fitness centres by T3‐SCI–trained exercise professionals. Sessions are delivered individually or in small groups (1–3 participants), twice weekly for 30–60 minutes, and include moderate‐vigorous intensity aerobic exercise, progressive resistance training, and flexibility and balance activities consistent with current SCI physical activity guidelines. Exercises might involve use of gym equipment (i.e.: free weights, ergometers, weight machines) and body‐weight exercises. Exercise intensity will be determined based on the BORG scale of perceived exertion (RPE). Exercise programs are tailored to individual goals, injury characteristi CONDITION: Injuries and Accidents ‐ Other injuries and accidents Neurological ‐ Other neurological disorders Public Health ‐ Health promotion/education Spinal Cord Injury;Physical inactivity; ; Spinal Cord Injury ; Physical inactivity INCLUSION CRITERIA: People with Spinal Cord Injury (SCI): 1. Adults aged greater than, or equal to, 18 years. 2. Diagnosis of spinal cord injury of any aetiology and time since injury. 3. Self‐reported neurological level C5 to S4–5, with ISNCSCI classification A–D, or C1–C4 incomplete where able to actively exercise in the community. 4.Discharged from inpatient rehabilitation. 5. Medically cleared by a GP or physician to participate in physical activity. Exercise Professionals: 1. Adults aged greater than, or equal to, 18 years. 2. Able to communicate in English. 3. Accredited Exercise Physiologist, Exercise .Scientist, or Registered Personal Trainer. 4. Currently working in a fitness centre for more than 3 months. 5. Completion of the T3‐SCI training program. PRIMARY OUTCOME: Effectiveness of the T3‐SCI program at improving physical activity (minutes/week).[Physical activity recall assessment for people with SCI (PARA‐SCI) For people with SCI, at baseline, 12 weeks, and 24 weeks post‐intervention commencement.] We will measure a composite primary implementation outcome, based on consumer's perceptions of acceptability, appropriateness, adoption, fidelity, feasibility, and sustainability.[Our primary composite outcome will be assessed using previously validated short surveys (AIM/IAM/FIM) and Theory‐informed focus groups and mapped to Proctor's Conceptual Framework for Implementation outcomes. Focus groups and short‐surveys will be collected from the first 24 people with SCI and 24 exercise professionals who opt‐in to additional focus‐group measures, after completion of the T3‐SCI program. ; Acceptability will be assessed the Acceptability of Intervention Measure (AIM) and focus group data. ; Appropriateness will be assessed using the Intervention Appropriateness Measure (IAM) and focus group data. ; Feasibility will be assessed using the Feasibility of Intervention Measure (FIM) and focus group data. ; Sustainability will be assessed using focus group data. ; Focus groups question development, and analysis, will be informed by the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). ; Adoption will be assessed quantitatively, as the proportion of eligible participants who enrol into the study. Fidelity, or adherence, will be assessed quantitatively through attendance records, and analysis of behavioural change among exercise professionals’ video‐recorded sessions (with optional consent). We will run approximately 4 focus groups each containing 6 individuals for both people with SCI (total sample=24) and exercise professionals (total sample=24). Our sample is guided by ‘Information Power’, which is typically achieved after 3‐4 focus groups with 4‐6 people (please see, reference: Materud et al., 2016. Sample size in qualitative interview studies: guided by information power. Qualitative Health research, 26(13): 1753‐1760). ; Focus groups will be scheduled during 12‐24 weeks post intervention commencement, based on participant availability.] SECONDARY OUTCOME: Cost‐effectiveness of the T3‐SCI program compared to no intervention.[Self‐rated direct and indirect costs related to the intervention (e.g. transport, healthcare, out‐of‐pocket expenses) will be collected using patient diaries. Intervention costs will be calculated based on staffing hours (exercise professionals, and T3‐SCI mentors), wage costs (industry norms), equipment provided, and any other unforeseen T3‐SCI‐related expenses. Health‐care utilisation and study‐related costs will be collected monthly, from baseline up to 24‐months post‐commencement of the program.] Frequency of secondary conditions[Spinal Cord Injury Secondary Conditions Scale For people with SCI at baseline, 12 weeks and 24 weeks post‐commencement of the intervention] Goal achievement[Patient Specific Functional Scale For people with SCI at baseline, 12 weeks and 24 weeks post‐commencement of the intervention] Personal well‐being [Personal Well‐being Index‐Adults For people with SCI at baseline, 12 weeks and 24 weeks post‐commencement of the intervention] Quality of life[Health‐related quality of life questionnaires (aQoL‐4D & EQ‐5D‐5L) For people with SCI at baseline, 12 weeks and 24 weeks post intervention commencement] Safety[Record of adverse events using a study‐specific telehealth questionnaire Audited for people with SCI monthly, from baseline up to 24‐months post‐commencement of the program.] Self‐efficacy[ SCI Ecxercuse Self‐efficacy Scale & Moorong Self‐efficacy Scale For people with SCI at baseline, 12 weeks and 24 weeks post‐commencement of the intervention]