Table 1 Evidence-based intervention description using the Template for Intervention Description and Replication (TIDieR) checklist

Why

Physical inactivity is a global health problem, with estimated 5.3 million deaths per year. Brief physical activity counselling (e.g. 5As model) [1] delivered by healthcare professionals as part of routine care is seen as opportunistic healthcare to address a public health problem. Evidence indicates that for every 12 sedentary people who receive physical activity counselling within healthcare at least one will increase activity to meet physical activity guidelines for health benefits [6]. As a public health intervention, this has the potential for community-based health benefits and healthcare cost savings. A theoretical basis combining Capability Opportunity Motivation-Behaviour change theory and Self Determination Theory informs intervention components and underpins patient materials.

What procedures

Patients receive their usual physiotherapy care to address the therapeutic reason that they have been referred for physiotherapy. Within this routine care, the physiotherapist will incorporate brief physical activity counselling comprising the following:

 ➢ Ask: Raise the topic of physical activity with permission (use motivational interviewing techniques and consider cultural influences throughout).

 ➢ Assess: Current physical activity level (objective and/or subjective); influences on physical activity using COM-B model.

 ➢ Advise: Discuss the benefits of physical activity; benefits of change; amount, type and intensity of physical activity (use elicit-provide-elicit framework).

 ➢ Agree: Collaboratively set 6–12-month behavioural sustainable goal(s); set short-term physical activity goals (use confidence scales for goal setting); develop action plan: what, where, when, how much, who with (include what if…. to anticipate barriers).

 ➢ Assist: Self-monitoring strategy (checklist, practice sheet, step count), assess/re-assess physical activity and goals, discuss barriers/facilitators, collaboratively identify community/home physical activity options, share plan for social support, build competence, control, connection (Self-Determination Theory).

 ➢ Arrange: Referral/contact/recommendation for healthcare/community/home-based physical activity, social support for practical (e.g. transport), emotional and motivational (e.g. family, friend, neighbour, carer, exercise/health professional)

What materials

Physiotherapists have access to a Microsoft Teams site that includes patient-facing resources:

 ➢ Handouts on physical activity guidelines and benefits of physical activity for a range of health conditions and produced by a number of organisations (e.g. Moving Medicine UK, Arthritis Association Australia, Australia National Disability Service Scheme, Cancer Council of Australia). Where available, handouts are available in English, Arabic and Vietnamese.

 ➢ Worksheets developed from a range of organisations (e.g. Agency for Clinical Innovation, National Institute on Aging)

 ➢ Study-developed worksheets including action plans, goal setting sheets, practice sheets, checklists, pedometer recording sheets, activity diary, Smartphone step counting instructions.

 ➢ Study-developed searchable activity directory with details of local physical activity opportunities that can be searched based on type of activity, cost, location.

In addition, each team was provided with 10 pedometers (Yamax CW300) to use as they wished with patients.

Who provided

The intervention will be delivered by tertiary trained physiotherapists employed in the local health district who consent to participate in the study. Physiotherapists in the teams randomised to the immediate group, will receive the multi-faceted implementation strategy to support them to deliver physical activity counselling within routine care.

How

The physical activity counselling is delivered within routine care. How routine care is delivered may differ between teams and hospital sites but is most likely to be face-to-face (some virtual if COVID-19 restrictions apply). Any handouts, booklets or pedometers will be provided during the face-to-face session.

Where

Where the intervention is delivered may differ between teams and hospital sites but is likely to be delivered in an inpatient, outpatient or community setting within the boundaries of South Western Sydney Local Health District in the state of New South Wales, Australia.

When and how much

The frequency and duration of routine care will differ between services and sites and patient types. Data collected as part of pre-implementation work found that regardless of setting (inpatient, outpatient, mixed), physiotherapists reported an average of at least six occasions of service per patient lasting over 30 min per session [24]. Brief physical activity counselling is likely to be < 5min within these usual care sessions.

Tailoring

This is a tailored intervention. Depending on patient type, setting and frequency of interaction, the components of physical activity counselling will be incorporated. The core elements that all should receive include assess, advise and arrange using motivational interviewing techniques.