The implementation of a physical activity counseling program in rehabilitation care: findings from the ReSpAct study

Figures & data

Figure 1. The elements of the “Physical Activity Counseling Center” as part of the implementation of the Rehabilitation, Sport and Exercise program.

Table 1. Description of the process outcomes.

Process outcomes	Description	Measuring instruments
Reach	Institutional and professional level Number of locations with an active PA Counseling Center Number of professionals involved in the implementation process	LB, RS
	Patient level Total number of patients participated in the RSE program Percentage of patients participated in the RSE program (nominator) relative to the total number of patients that received rehabilitation treatment within each institution (de-nominator) yearly*	RS, aQS
Dosage	Institutional and professional level Number of and response rates to national and regional meetings organized by national coordinators Number of training courses in MI	LB
	Patient level Percentage of patients that received a referral to a community-based sport or PA during the face-to-face consultation at the “PA Counseling Center”** Number of counseling sessions received by patients (phone and email contact)**	RS
Fidelity in MI	Patient level Patient’s assessment*** of the extent to which the received face-to-face consultation and counseling sessions were based on MI	QSp (t0 + t1)
Satisfaction	Professional level Professionals’ opinion about activities related to implementation strategy Professionals’ opinion about the RSE program	QS
	Patient level Patients’ opinion about the received face-to-face consultation and counseling from the counselor of the “PA Counseling Center”	QSp (t0 + t1)
Maintenance	Institutional level The number of institutions that became a paid member of the RSE program after the program period**** Number of locations with an official “PA Counseling Center” 5 months after program period	LB

Note. Description of the process outcomes are based on definitions by [22,23].

*Eight rehabilitation institutions were not able to provide information on the total number of patients that received rehabilitation treatment within their institution (de-nominator). Therefore, the percentage data of the reach was calculated from 10 institutions instead of 18.

**Dosage outcome on patient level is assessed among patients that are enrolled in the ReSpAct-study.

***The MICAS-questionnaire was used to assess MI fidelity at patient level. ****Institutions that became paid member of RSE program officially declared that they would continue the “PA Counseling Center” after the program period. Official “PA Counseling Centers” should be a paid member of the RSE program.

PA: Physical activity; LB: Logbook by national coordinators; RS: Registration system; aQS: An additional questionnaire was sent to each institution to obtain information about the total number of patients that received a rehabilitation treatment each year. Total numbers were available from ten institutions; QS: Questionnaires from professionals at three time points (T0, T1, T2); QSp: Questionnaires from patients at two time points (t0, t1).

Figure 2. The number of patients that participated in the Rehabilitation, Sport and Exercise program each half year of the program period (period 1–5). Note. Mean and SD of the number of patients per institution (n = 18) are depicted in the top-right box.

Table 2. Characteristics of received counseling of the distinct profiles.

	Low intensive counseling (n = 841)	Frequent telephone counseling (n = 749)	Counseling as intended (n = 113)	Long telephone-based counseling (n = 16)
Number of email contacts
0	66.0	77.2	96.5	93.8
1	12.7	21.1	3.5	6.3
2	13.1	1.7	0.0	0.0
≥3	8.2	0.0	0.0	0.0
Number of telephone contacts
0	40.4	0.0	0.0	0.0
1	46.4	0.9	4.4	0.0
2	12.7	26.7	8.8	18.8
3	0.5	42.6	26.5	12.5
≥4	0.0	29.8	60.2	68.8
Referred to sports activity (% Yes)	78.1	80.1	66.4	75.0
Total duration of contacts (minutes, SD)	60.27 (15.90)	85.73 (15.00)	138.76 (15.47)	231.00 (32.83)

Table 3. Patients’ characteristics of the distinct profiles.

	Low intensive counseling (n = 841)	Frequent telephone counseling (n = 749)	Counseling as intended (n = 113)
Mean age (SD)	49.05 (14.01)	50.60 (13.46)	50.47 (13.33)
Gender (% female)	54.0	53.2	51.5
Rehabilitation treatment at baseline (%)
Inpatient	2.3	3.6	5.3
Outpatient	89.3	90.1	92.9
Medical consultation	8.4	6.3	1.8
Diagnoses (%)
Brain disorders (e.g., stroke)	25.7	27.4	24.8
Disorders of locomotor system	19.1	18.2	16.8
Chronic pain	17.5	16.0	12.4
Neurologic disorders	14.5	12.7	23.0
Disorders of organs	10.8	12.4	10.6
Other disorders (e.g., amputation, spinal cord injury, rheumatic diseases)	12.4	13.3	12.4
Psychosocial status at baseline
BREQ-score*	11.19 (5.46)	11.57 (5.22)	10.83 (5.15)
Self-efficacy	41.21 (11.51)	41.63 (11.50)	40.46 (11.99)
Stage of change (%)
(Pre)contemplation	20.1	18.9	24.3
Preparation	22.8	20.9	14.0
Action	27.4	31.9	32.7
Maintenance	29.6	28.4	29.0

*The BREQ-score is a measure for motivation for engaging in an active lifestyle [30].

Table 4. Physical activity outcomes during (T0) and after (T1) rehabilitation presented per profile and results of the multilevel analyses.

Physical activity outcomes	Descriptive		Multilevel models
	T0	T1	Crude	Adjusted
Total minutes per week physical activity	Median (IQR)	Median (IQR)	Beta (95% CI)	Beta (95% CI)
Profiles*
Low intensive counseling	1881 (1638)	2156 (1775)
Frequent telephone counselling	1817 (1650)	1954 (1830)	−91.2 (−2.5 to 47.2)	−57.0 (−197.6 to 83.7)
Counseling as intended	1727 (1553)	2089 (2009)	−139.6 (−412.6 to 133.5)	−65.8 (−341.6 to 210.0)
Sport participation	Percentage (yes)	Percentage (yes)	Odds ratio (95% CI)	Odds ratio (95% CI)
Profiles*
Low intensive counseling	54.7	61.4
Frequent telephone counseling	54.8	66.4	1.01 (0.82 to 1.25)	0.94 (0.36 to 2.46)
Counseling as intended	58.5	65.9	1.01 (0.80 to 1.26)	0.84 (0.53 to 1.33)

*The low intensive counseling profile was used as reference group in the multilevel models. The crude models included interaction terms with time and the adjusted models included also a correction for gender, age, treatment setting, self-efficacy levels at baseline and motivation levels at baseline. Descriptive information of the physical activity outcomes were based on complete case analyses.

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