Abstract
Background People living with acquired brain injury (ABI) are more likely to be physically inactive and highly sedentary and, therefore, to have increased risks of morbidity and mortality. However, many adults with ABI experience barriers to participation in effective physical activity interventions. Remotely delivered self-management programs focused on teaching patients how to improve and maintain their physical activity levels have the potential to improve the overall health of adults with ABI.
Objective The study objective was to evaluate the acceptability and feasibility of a remotely delivered self-management program aimed at increasing physical activity among adults who dwell in the community and have ABI.
Design A single-group design involving comparison of baseline measures with those taken immediately after intervention and at a 3-month follow-up was used in this study.
Methods The myMoves Program comprises 6 modules delivered over 8 weeks via email. Participants were provided with regular weekly contact with an experienced physical therapist via email and telephone. The primary outcomes were the feasibility (participation, attrition, clinician time, accessibility, and adverse events) and acceptability (satisfaction, worthiness of time, and recommendation) of the myMoves Program. The secondary outcomes were objective physical activity data collected from accelerometers, physical activity self-efficacy, psychological distress, and participation.
Results Twenty-four participants commenced the program (20 with stroke, 4 with traumatic injury), and outcomes were collected for 23 and 22 participants immediately after the program and at a 3-month follow-up, respectively. The program required very little clinician contact time, with an average of 32.8 minutes (SD=22.8) per participant during the 8-week program. Acceptability was very high, with more than 95% of participants being either very satisfied or satisfied with the myMoves Program and stating that it was worth their time. All participants stated that they would recommend the program to others with ABI.
Limitations The results were obtained from a small sample; hence, the results may not be generalizable to a larger ABI population.
Conclusions A remotely delivered self-management program aimed at increasing physical activity is feasible and acceptable for adults with ABI. Further large-scale efficacy trials are warranted.
After acquired brain injury (ABI), physical activity levels are typically low, increasing the risk of chronic disease and death.1–7 Acquired brain injury is any damage to the brain that has occurred after birth and is most commonly caused by stroke or trauma.8 More than half of people with stroke do not reach recommended physical activity levels9,10; people 3 years after stroke spend an average of 73% of their day sitting or lying down.11 After traumatic brain injury, people spend less than 50 min/wk being physically active.12,13 Despite the potential to experience the same benefits of physical activity as their counterparts who are healthy,14 people with ABI face many barriers to increasing physical activity levels, such as ongoing pain, fatigue, and fear.15 In addition, access to physical activity programs is made difficult by transportation limitations, mobility limitations, and time restrictions.13,16
Remote intervention delivery may provide another way for people living with ABI to access a physical activity program. Instead of an intervention being delivered face-to-face in the same geographical location, a remotely delivered intervention is provided at a distance through modes such as telephone, email, internet, text message, and teleconference. Remotely delivered interventions aimed at improving physical activity were evaluated in a systematic review that included 11 studies examining 5,862 adults who were healthy and dwelled in the community; the findings demonstrated significant positive effects on both self-reported physical activity levels and cardiovascular fitness at the 1-year follow-up.17 The greatest effects were found when the intervention was tailored to the individual and incorporated feedback and support via telephone.17
Self-management programs are designed to provide people with the information, skills, and support they need to effectively manage their condition and are most effective when they are founded on theories and principles of behavior change.18 Self-management programs have been shown to result in better long-term outcomes for people with chronic disease, including those with ABI—specifically, stroke.18–20 Remotely delivered self-management programs specifically are seen as a way of increasing accessibility to programs for people who face multiple barriers to accessing optimal health care.21 Such programs have been shown to be successful in a variety of populations, such as people with chronic pain,22,23 anxiety and depression,24 and arthritis and fibromyalgia.25 However, a recent systematic review showed that only a limited number of studies have examined the efficacy of self-management programs in improving physical activity in people living in the community after ABI.26 Three studies included in that review revealed favorable physical activity outcomes after self-management interventions for stroke27–29; in 2 of those studies, remote delivery was used in conjunction with face-to-face intervention.27,29 However, the risk of bias was high, and efficacy remains unclear.
A remotely delivered self-management program may offer people living in the community with ABI the support they need to improve their knowledge and skills, empowering them to lead a more physically active life. Therefore, the research team undertook a comprehensive and thorough intervention development process using an intervention mapping framework30 and designed the myMoves Program.31 The myMoves Program involves the delivery over 8 weeks of 6 modules that focus specifically on building people's knowledge and skills, empowering them to manage their physical activity levels. An experienced physical therapist delivers the program entirely remotely using telephone and email.
The primary aim of this study was to examine the feasibility and acceptability of a remotely delivered self-management program, the myMoves Program. The secondary aims were to examine changes in levels of physical activity, physical activity self-efficacy, levels of psychological distress, and participation levels after completion of the myMoves Program.
Method
Design
A single-group design involving comparison of baseline measures with those obtained immediately after the intervention and at a 3-month follow-up was used.
Participants and Recruitment
Applications to participate in this study were taken over a 3-month period between December 2014 and February 2015. Participant recruitment was commenced online and completed via telephone interview. Potential applicants were directed to an online application form, including a participant information and consent form, via advertisements on websites, on social media sites, and in print from major consumer groups associated with ABI in Australia, including the National Stroke Foundation and Brain Injury Australia. Email invitations also were extended to participants from an earlier survey study conducted to examine potential interest in the myMoves Program15 and via stroke support groups and other professional networks.
To be eligible for the myMoves Program, participants had to meet the following 7 inclusion criteria: age of 18 years or older, having sustained an ABI, currently living in an Australian community, ability to walk at least 50 m outside without assistance from another person, having regular access to the internet, ability to read and understand written English, and having been seen by their treating medical practitioner within the preceding 3 months to ensure that they were medically stable and able to participate in the intervention. The 6 exclusion criteria were: scoring 30 of 40 or higher on the Kessler Psychological Distress Scale (K-10)32–34; scoring less than 14 of 17 on the Telephone-Assessed Mental State35 instrument; pregnancy; a neurodegenerative condition, such as Parkinson disease or multiple sclerosis; having undergone surgical intervention within the preceding 6 months; and having undergone treatment for cancer within the preceding 5 years.
The K-10 is a brief self-report measure of nonspecific psychological distress32–34 and was administered to potential participants as part of the online application form. A score of 30 or higher indicates a very high level of psychological distress,33,34 and people with such scores were advised to seek assistance for their emotional well-being before commencing the myMoves Program. The Telephone-Assessed Mental State instrument provides a brief assessment of attention, orientation, and memory; a higher score indicates a higher level of cognitive functioning.35 The Telephone-Assessed Mental State instrument has been shown to correlate strongly with the Mini-Mental State Examination (ρ=.81).35 Because participants were required to read, understand, and apply a significant amount of material over the duration of the myMoves Program, a high cutoff point was deemed necessary for the intervention.
Interested applicants completed the application form online, providing initial consent to the study. During a subsequent telephone interview, the Telephone-Assessed Mental State instrument was administered, and applicants confirmed that they met the remaining eligibility criteria. At this time, further detailed information about the program was provided, and applicants were given the opportunity to ask questions before confirming their consent to participate.
Once consent to participate in the study was confirmed, participants were placed on a waiting list until the next available group commenced the intervention program. During this time, a letter was sent to the participants' treating medical practitioners, informing them about the study and providing an opportunity to raise any concerns regarding participation in the study. No concerns about any of the participants entering the intervention program were raised by the medical practitioners. Participants entered the intervention program in 2 groups—the first group in February 2015 and the second group in March 2015.
Intervention
A summary of the myMoves Program is shown in the Appendix. In brief, the myMoves Program consists of 6 modules delivered over 8 weeks. Each module comprises the following 3 components: a lesson detailing the core content for that module, case stories about 6 people who have ABI and are monitored throughout the program, and a worksheet with tasks aimed at building the skills covered in the lesson for that module. Additional resources of interest, including information on strengthening activities and remaining active during winter, also were delivered over the study period. Rather than prescribing a set physical activity program for a participant, the myMoves Program aims to empower people with the knowledge and skills required to build and manage their own physically active lifestyle. Participants are introduced to the concept of physical activity as incorporating both planned exercise and incidental physical activity, such as that accrued during tasks of daily living, transport, and recreation. The myMoves Program aims to enhance an individual's self-efficacy by focusing on small and sustainable changes in physical activity to establish good habits. The program also focuses on improved emotional and physical well-being and the building of skills such as problem solving, planning, and pacing.
All materials were delivered in portable document format (PDF) via email. Before commencing the program, participants received a detailed myMoves Program guide outlining the program schedule. During the program, all participants received, at the start of each week, an email containing the program materials for that week. Participants were advised to allow approximately 30 to 60 minutes to complete each lesson but to work through the materials at their own pace and to review them as often as they liked. Participants also were encouraged to spend 3 to 4 hours each week reflecting on the information covered and practicing the skills taught in that module. No new information was provided in week 6 or week 8, allowing time for participants to review the content previously covered and consolidate their skills.
Each participant was contacted at least one additional time each week via telephone or email, based on participant preference. This contact was aimed at ensuring the materials were understood, assisting participants to customize the information and skills taught to their specific situations, and clarifying any concerns. The first author (T.M.J.), a senior physical therapist with more than 10 years of experience working with people with ABI, delivered the intervention program, provided all clinical support during the intervention period, and provided administrative contact with participants during the application process and the preprogram and follow-up periods.
Demographics and Participant Characteristics
We collected data about demographic details, participant characteristics, mobility status, and general health. The Australian Statistical Geographical Classification was used to establish the remoteness area for each participant's residential address. This classification system divides Australia into classes of remoteness on the basis of access to services: RA1=major city, RA2=inner regional area, RA3=outer regional area, RA4=remote area, and RA5=very remote area.36,37 Participants were asked about the level of assistance they required to walk and the distance and time they could walk on an average day before requiring a rest.
Primary Outcomes
Feasibility.
Feasibility was examined by collecting data regarding 5 key factors: (1) participation in the intervention, examined via participant-reported feedback as to which lessons were completed during the 8-week program; (2) attrition from the study; (3) clinician time spent per participant, examined via data collected on the frequency and duration of contact with participants, including emails and telephone calls; (4) accessibility, examined via successful acquisition of program materials by participants and successful access to and use of outcome data collection tools, including physical activity monitors; (5) and any adverse events.
Acceptability.
Acceptability was assessed immediately after the myMoves Program with the Program Satisfaction Questionnaire, a purpose-built questionnaire for examining satisfaction with the myMoves Program; the questionnaire was modeled on those used extensively by the Macquarie University eCentreClinic.22–24,38–41 Participants were asked to rate their overall satisfaction with the myMoves Program on a 5-point scale with the following options: very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, and very dissatisfied. They also were asked whether they felt the myMoves Program was worth their time (“yes” or “no”) and whether they felt confident in recommending the myMoves Program to others with an ABI (“yes” or “no”). Participants also were invited to leave qualitative comments about the program.
Secondary Outcomes
Physical activity.
For this study, 3 objective physical activity outcomes were collected: average daily step count, average daily time spent sitting or lying down, and average daily time spent in moderate to vigorous physical activity. Physical activity data were collected over 7 consecutive days, as recommended for reliable physical activity monitoring in adults, to reflect daily fluctuations in physical activity that typically occur over a week.42
Physical activity data were extracted from 2 physical activity–monitoring devices worn concurrently by participants. Average daily step count and average daily time spent sitting or lying down were extracted from data collected with the activPAL3 (PAL Technologies Ltd, Glasgow, United Kingdom), a small, lightweight (15-g) triaxial accelerometer and inclinometer worn attached to the anterior thigh with a waterproof dressing, allowing for continuous 24-hour recording. The activPAL3 was previously used in people with ABI.43,44 It directly measures posture, allowing for the accurate representation of sedentary time—that is, time spent sitting or lying down—and time spent standing and stepping.44–46 The activPAL3 has been shown to be accurate for quantifying step count at a variety of walking speeds,47 although there is a tendency to underestimate step count at slow walking speeds (0.47 m/s or less).44 However, given that people with a walking speed of 0.4 m/s or less are unlikely to ambulate in the community,48 the activPAL3 was considered to be a useful device for collecting data in this study because people were ineligible if they were unable to walk outside without assistance.
Average daily time spent in moderate to vigorous physical activity was extracted from data collected with the ActiGraph GTX3 (ActiGraph, Pensacola, Florida). The ActiGraph GTX3 is a lightweight (27-g) triaxial accelerometer worn on an elasticized belt above the hip of the least-affected or dominant side. The ActiGraph GT3X measures and records time-varying accelerations, which are related to the intensity of a participant's physical activity during a particular period, classifying activity intensity as light, moderate, or vigorous.49 Participants were instructed to remove the device for showering or water-based activities. Participants were encouraged to wear the device to bed but were invited to remove the device if sleeping with it in situ was uncomfortable. The ActiGraph GTX3 has been shown to be valid for classifying physical activity intensity in people with a brain injury.50
In addition, participants were asked to rate their level of satisfaction with their physical activity status on a 5-point scale with the following options: very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, and very dissatisfied.
Physical activity self-efficacy.
Physical activity self-efficacy was calculated with a 10-item scale adapted from the Spinal Cord Injury Exercise Self-Efficacy Scale.51 This scale instructs participants to indicate, on a 4-point scale (1=not at all true, 2=rarely true, 3=moderately true, 4=always true), how confident they are in carrying out regular physical activities. The scores on these items are summed to provide a total of 10 to 40; a higher score indicates greater self-efficacy. This scale has been found to have a high level of internal consistency for people with spinal cord injury (Cronbach α=.9269).51 The Spinal Cord Injury Exercise Self-Efficacy Scale was selected because the specific exercise questions closely represented the focus of the myMoves Program. Adaptations to the scale were made by replacing “spinal cord injury” with “injury” and by replacing “exercise” with “physical activity” when a noun was required or with “be physically active” when a verb was required.
Participants were asked to select, from a list of 17 common barriers to physical activity experienced by people with ABI in a previous study,15 any barriers to physical activity they were experiencing. Participants were not restricted in the number of barriers they could select. Included in the list were an option to select “I do not experience any barriers to physical activity” and an “other” option, which allowed participants to outline any barriers not listed.
Psychological distress.
Participants' psychological distress was assessed with the K-10, a brief self-report measure of nonspecific psychological distress.32–34 This scale includes 10 items rated on a 5-point scale (1=none of the time, 2=a little of the time, 3=some of the time, 4=most of the time, 5=all of the time). The scores on the items are summed to provide a total of 10 to 50, which is used to categorize people according to their level of psychological distress (10–15: low; 16–21: moderate; 22–29: high; 30–50: very high). The K-10 has been shown to have excellent internal consistency (Cronbach α=.92) and has been used extensively by the primary health care sector, by various governmental and nongovernmental bodies within Australia and North America, and by the World Health Organization both for screening purposes and as an outcome measure.32–34
Participation.
Participation was measured with the modified Reintegration to Normal Living Index (mRNLI).52 This index is a global functional status measure that assesses how well people return to normal living patterns after disease or injury and includes items related to participation in daily activities, recreational activities, social activities, family roles, and relationships.52 Participants rank 11 items on a 4-point scale (0=does not describe me or my situation, 1=sometimes describes me or my situation, 2=mostly describes me or my situation, 3=fully describes me or my situation) to provide a total score ranging from 0 to 33. The mRNLI has been found to have good construct validity and internal consistency (Cronbach α=.80) and test-retest reliability (intraclass correlation coefficient [3,1]=.83, P=.0001) in adults dwelling in the community.52
Data Collection
All questionnaires were administered online with Qualtrics software (version 62626; Qualtrics, Provo, Utah). Physical activity monitors were sent to participants via Express Post, with detailed instructions on how to apply and care for the devices. The monitors were returned via Express Post upon completion of data collection. Data on frequency and duration of contact with participants as well as any adverse events were logged directly onto a password-protected spreadsheet by researchers as they occurred throughout the course of the study.
Data regarding the acceptability of the myMoves Program and the participation in the program were collected in the week immediately after completion of the program (ie, postprogram). All other feasibility data, that is, attrition, clinician time, accessibility, and adverse events, were collected on an ongoing basis throughout the study period. Data for all secondary outcomes were collected from participants at 3 time points: the week before starting the program (ie, preprogram), the week immediately after completion of the program (ie, postprogram), and 3 months from the date of completion of the program (ie, follow-up).
Data Analysis
Descriptive statistics were used to characterize participants' demographic data and to evaluate feasibility and acceptability. Secondary outcome data were presented as means (standard deviations) for continuous measures and as number of participants for categorical measures. In addition, questionnaires used to assess physical activity self-efficacy, psychological distress, and participation were all assessed for reliability with the Cronbach α.
Objective physical activity data from the activPAL3 were downloaded with the manufacturer's software (activPAL3 version 7.2.32). A weekly summary was saved, and time spent sitting or lying down and step counts were extracted from this summary for each full day of recording. ActiGraph GTX3 data were processed with ActiLife software (version 6.8.2, ActiGraph). Nonwear validation was performed with the algorithm of Choi et al.53 To ensure reliability, we excluded data from participants who did not wear the device for at least 4 days out of 7 and for at least an average of 10 hours per day on the days when the device was worn.42,54 Cutoff points for physical activity intensity were based on the Freedson VM3 equation of Sasaki et al,55 in which moderate to vigorous physical activity equates to 3.00 metabolic equivalents of a task or higher.
Statistical analyses of secondary outcome data were performed. For continuous measures, a repeated-measures analysis of variance was conducted to assess whether mean differences were associated with time (preprogram versus postprogram and preprogram versus follow-up). The F test of significance was used to assess the effects of time. In the case of significance, pairwise comparisons were performed to assess the differences. For each outcome, normality assumptions were checked using skewness and kurtosis values. In addition, assumption of sphericity were assessed using the Mauchly test. Categorical data were assessed with the McNemar test, including P values. All data analyses were conducted with IBM SPSS Statistics for Macintosh (version 22.0, IBM Corp, Armonk, New York).56
Role of the Funding Source
Dr Jones was supported by a Macquarie University Research Excellence Scholarship. Dr Dear was supported by a National Health and Medical Research Council Australian Public Health Fellowship.
Results
Participants
Participant flow through the study is outlined in the Figure. Demographic data are shown in Table 1, and mobility and health characteristics are shown in Table 2. Participants from 4 Australian states were involved in this study; one-third of the participants resided in a regional area. No participants resided in remote areas, but 2 participants did travel to remote areas of Australia during the course of the study and a third participant traveled overseas for work.
Participant flow through the study. GP=general practitioner, K-10=Kessler Psychological Distress Scale.
ABI and Demographic Characteristics of Participantsa
Participant Mobility and Health Characteristics
Feasibility and Acceptability
Participation and attrition.
Participants completed an average of 5.6 of 6 lessons (SD=1.2). Postprogram data and 3-month follow-up self-reported data were collected from 95.8% of participants (23/24) and 91.7% of participants (22/24), respectively. One participant was unable to wear the activPAL3 at any time point because of known skin sensitivity to adhesive tape, and one participant was unable to wear either of the activity monitors at the 3-month follow-up time point because of an unrelated surgical procedure. Data from both activity monitors were retrieved for all remaining participants at each time point. No activPAL3 data were excluded on the basis of insufficient wear time. ActiGraph data were excluded for 2 participants at preprogram testing, 4 participants at postprogram testing, and 5 participants at 3-month follow-up testing because of insufficient wear time.
Clinician time.
The frequency and duration of clinician contact with participants are shown in Table 3. In total, each participant averaged 218.0 minutes (SD=56.6) of clinician time over the duration of the study and 55.9 (SD=14.8) occasions of contact. During the 8-week program, the mean total clinician time per participant was 32.8 minutes (SD=22.8).
Frequency and Duration of Clinician Contact With Participants During Research Studya
Accessibility.
All participants received all program materials via email and were able to access and complete the online questionnaires. All activity monitors were received by participants and returned to the researchers successfully. Participants reported no problems in donning the activity-monitoring devices, either independently or with the assistance of a family member. There was only one technical device failure during the 3-month follow-up period. This device was replaced, and data were collected 1 week later.
Adverse events.
No adverse events occurred as a result of the myMoves Program. Five participants reported minor skin irritation from the adhesive waterproof dressing used to attach the activPAL3 device; however, this irritation was relieved when hypoallergenic tape was applied beneath the device and waterproof dressing.
Program satisfaction.
Participants reported a high level of overall satisfaction with the program, with 95.7% (22/23) reporting being very satisfied or satisfied. Most participants reported that the program was worth their time (95.7%, 22/23), and all participants (100%, 23/23) reported that they would recommend the program to others.
Secondary Outcomes
Levels of physical activity.
Physical activity outcomes are shown in Table 4. Levels of physical activity varied substantially among participants across all measures and at all time points, as indicated by the large ranges shown in Table 4. There were no significant differences in the amounts of sedentary time, average numbers of steps taken per day, or average amounts of moderate to vigorous physical activity per day among any of the time points. Compared with preprogram data, there was a significant reduction in the number of participants reporting that they were very dissatisfied or dissatisfied with their ability to be physically active after the program (P=.002) and at the 3-month follow-up (P=.012).
Secondary Outcomes and Statistical Analysisa
Physical activity self-efficacy.
The physical activity self-efficacy scale adapted from the Spinal Cord Injury Exercise Self-Efficacy Scale showed good internal consistency within our sample (Cronbach α=.83). Total physical activity self-efficacy scale scores are shown in Table 4; no significant differences were detected. However, on a single-item question in the Program Satisfaction Questionnaire, 82.6% of participants (19/23) reported that their overall confidence in managing their physical activity was much higher or higher than it was before commencing the myMoves Program.
The most common barriers to physical activity reported by participants before the program were fatigue (n=9, 37.5%) and pain or discomfort (n=8, 33.3%). At both postprogram testing and follow-up testing, fatigue was reported as a barrier by smaller proportions of participants (n=5, 20.8% and 22.7%, respectively), as was pain or discomfort (postprogram: n=4, 16.7%; follow-up: n=3, 13.6%). A lack of time and having no one with whom to perform physical activity were slightly larger concerns at the 3-month follow-up (for both: n=5, 22.7%) than before the program (for both: n=3, 12.5%).
Psychological distress.
Psychological distress, as measured with the K-10, is shown in Table 4. The K-10 showed good internal consistency within our sample (Cronbach α=.79). There was a statistically significant reduction in psychological distress of 2.76 points (95% confidence interval=−4.23, −1.23) immediately after the myMoves Program (P=.001). The number of participants scoring a low level of distress increased over time, but statistical significance was not reached.
Participation.
Participation, as measured with the mRNLI, is shown in Table 4. The mRNLI showed good internal consistency within our sample (Cronbach α=.78). There was a statistically significant improvement in participation immediately after the program, with an average increase of 2.8 points (95% confidence interval=0.84, 4.78; P=.008). Three months later, although no longer statistically significant, mean scores for all participation measures remained higher than those at the baseline.
Discussion
The primary aim of the present study was to assess the feasibility and acceptability of a remotely delivered program aimed at improving self-management of physical activity after ABI. Overall, high levels of acceptability were shown for the program, despite participants averaging just 32.8 minutes (SD=22.8) of clinician contact time during the 8-week myMoves Program. The program was delivered successfully via internet and telephone as well as postal services for objective measurements of physical activity. The research team successfully engaged with and evaluated outcomes from participants in 4 Australian states and from both metropolitan and regional areas, and there were no adverse events.
The myMoves Program was developed with the aim of providing, for people living in the community with ABI, a way to access a self-management program that specifically focuses on physical activity. Remote physical activity interventions have been found to be effective in increasing physical activity and cardiovascular fitness in adults dwelling in the community,17 and remote self-management programs have been found to be effective in improving a wide range of outcomes in people with other health conditions.22–25 However, there is currently a limited amount of research examining the efficacy of self-management programs in improving physical activity; in many situations, physical activity is included only as a small part of a larger, multifaceted program.26 Therefore, to develop a new, complex intervention to bridge this gap, a thorough developmental process should be undertaken.30,57 The present study builds on the rigorous developmental process that has already been used for the myMoves Program.31
The present study had several limitations. First, although the actual intervention program ran for 8 weeks, contact with study participants extended beyond that time. The contact time outside the 8-week myMoves Program was predominantly administrative in nature, with a particular emphasis on the delivery, application, and monitoring of the devices used to record physical activity. For transparency, it is important to include this time in the data, as any ongoing contact may provide a clinical effect, and to consider this factor in an assessment of efficacy or translation into clinical practice.
Second, most of the participants in the present study had ABI caused by a stroke, only a small number had ABI caused by trauma, and no other forms of ABI were represented. Participants also were generally younger and had a proportionally higher level of education than the general population with stroke in Australia. These limitations reduce generalizability to the larger population with ABI. In future studies, methods of recruitment should be designed to ensure the inclusion of a more representative sample of the Australian population with ABI. The form of program used in the present study may not be appropriate for all people with ABI, but it may be an option for those who prefer a remotely delivered program.
Finally, the design of the present study did not allow establishment of the efficacy of the myMoves Program with regard to physical activity and sedentary behavior. Also, the high level of heterogeneity in participant demographics, mobility, physical activity, psychological distress, and participation status further increased the difficulty of detecting statistically significant changes in outcome measures. However, this heterogeneity is representative of people with ABI, and feasibility and acceptability of the myMoves Program were demonstrated despite this variability.
In conclusion, the present study demonstrated that a remotely delivered self-management program, the myMoves Program, aimed at increasing physical activity after ABI, is feasible with regard to both program delivery and evaluation. The acceptability of the program to participants was high. Further investigation of efficacy in a larger-scale, randomized controlled trial is warranted.
Appendix.
myMoves Program Outlinea
a ABI=acquired brain injury; FITT=frequency, intensity, time, and type; DIY=do-it-yourself.
Footnotes
All authors provided concept/idea/research design. Dr Jones, Dr Dear, Dr Hush, and Professor Dean provided writing and data analysis. Dr Jones provided data collection. Dr Jones, Dr Hush, and Professor Dean provided project management. Dr Hush and Professor Dean provided facilities/equipment and institutional liaisons. Dr Hush, Professor Titov, and Professor Dean provided consultation (including review of manuscript before submission).
This study was approved by the Macquarie University Human Research Ethics Committee (Medical Sciences) (reference number 5201400830) and registered on the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12615000072516).
Dr Jones was supported by a Macquarie University Research Excellence Scholarship. Dr Dear was supported by a National Health and Medical Research Council Australian Public Health Fellowship.
- Received January 26, 2016.
- Accepted August 1, 2016.
- © 2016 American Physical Therapy Association
References
Issue highlights
