Physiotherapist- and peer-led physical activity counseling for people with spinal cord injury: a cross-sectional study of barriers and facilitators to implementation in the rehabilitation to community transition.

Introduction: A large decrease in physical activity (PA) is typically observed among people with spinal cord injury (SCI) upon discharge from in-hospital rehabilitation. Physiotherapists and SCI peers are well-positioned to intervene at this critical timepoint; however,the implementation of coordinated PA interventions between these two groups have yet to be studied.

Purpose: To identify barriers and facilitators that affect the implementation of coordinated PA counseling among physiotherapists and SCI peers during the transition from in-hospital rehabilitation to the community.

Methods: Semi-structured interviews were conducted with nine physiotherapists and two SCI peer coaches, using an interview guide informed by the Theoretical Domains Framework (TDF). Interviews were transcribed and coded deductively onto the TDF with themes and subthemes generated by inductive content analysis.

Results: The most salient TDF domains were social influences, environmental context and resources, and skills. Specifically, participants identified challenges such as addressing patient barriers and continual staff onboarding. Facilitators included the availability of peer coaches with lived experience, support from champions of the PA counseling intervention, group training sessions for physiotherapists and SCI peer coaches, and an adaptable PA counseling form as a conversation guide.

Conclusion: Successful coordination of services provided during the transition from in-hospital rehabilitation to the community may be strengthened by 1) providing resources and training that guide both content and delivery of PA counseling and 2) a referral system that leverages the strengths of both physiotherapists and peer support.