Table 1 Description of experimental and control group conditions according to the template for intervention description and replication (TIDieR) [34]

Brief name

My Therapy in addition to usual care rehabilitation

Usual care rehabilitation

Why

A higher dose of inpatient rehabilitation results in better patient and health service outcomes.

To provide a comparison with My Therapy.

What materials

In addition to usual care materials, patient information materials include a My Therapy explanation pack and an electronic or paper based My Therapy program. Additional materials include adjuncts to the recommended tasks and exercises such as written cognitive tasks, hand weights and resistance bands. Staff information materials include a My Therapy explanation pack and user guide.

Usual care materials may include exercise equipment, or equipment for practice of functional tasks, such as kitchen or bathroom facilities.

What procedures

On commencement of rehabilitation, the occupational therapist and physiotherapist will complete a full assessment of the patient and develop a rehabilitation plan that is guided by patient centred goals. Where it is deemed safe and appropriate, a sub-set of the supervised occupational therapy and physiotherapy exercises and activities will be provided to the patient to be practiced independently and outside of supervised sessions.

To be classified as a self-management program, as is the case for My Therapy, it must include each of the following, (a) a written program, (b) therapist documentation of the program within the medical record, (c) a feedback mechanism to the therapist (e.g., a paper based or smart device tick sheet), and (d) will be actively monitored and progressed as clinically required.

The exercises and activities will be delivered to patients via the online exercise prescription program, www.physiotherapyexercises.com (PTX). Following discussion and input from the patient, the treating clinicians will log into PTX, select the exercises and activities for each individual patient, and then send the My Therapy program to the patient’s own device (for example mobile phone, iPad, or laptop) via SMS or email, or the therapist will print out the My Therapy program as a booklet.

While the My Therapy program will specify the number of repetitions and sets, the patient will decide what is done, how often and when. My Therapy can be updated as often as required. My Therapy will commence at the beginning of the rehabilitation admission. It will continue throughout the rehabilitation admission until the day of discharge, when appropriate and safe to do so.

On commencement of rehabilitation, the occupational therapist and physiotherapist will complete a full assessment of the patient and develop a rehabilitation plan that is guided by patient centred goals. The exercises and activities will be practiced with patients under therapist supervision. The program can be updated as required. It will commence at the beginning of the rehabilitation admission and continue throughout the rehabilitation admission until the day of discharge.

Under usual care conditions, some therapists may provide self-management to some patients, representing heterogeneity of clinical practice. However, it is understood that prior to the My Therapy study at the participating sites, the provision of a self-management program (or components of a self-management program) was uncommon, clinician dependent and without systematic processes or monitoring.

In this study, the provision of individual components of a self-management program is considered advice and education, not self-management. To be classified as a self-management program, as is the case for My Therapy, it must include each of the following, individual components, (a) a written program, (b) therapist documentation of the program within the medical record, (c) include a feedback mechanism to the therapist (e.g., a paper based or smart device tick sheet), and (d) be actively monitored and progressed and clinically required. 

The frequency of provision of self-management (as distinct from advice and education), under usual care conditions, will be assessed as a part of the Process Evaluation (Process Evaluation Protocol [35]).

Who provides

Registered occupational therapists and physiotherapists will complete the assessments, establish and progress the My Therapy program. They will be provided with study familiarisation, explanation and a user guide. All other members of the rehabilitation team, including nursing, medical and allied health assistants, will support the program through patient encouragement and conversation, however they will not progress exercises or supervise the practice.

Registered occupational therapists and physiotherapists will deliver usual care.

How provided

My Therapy is delivered to each patient by the occupational therapists and physiotherapists.

Usual care is individually tailored for each patient according to their rehabilitation goals and progressed throughout the rehabilitation admission.

Where (setting)

Independent practice of My Therapy can be completed in the patient’s room on the ward, the hallway, or other designated independent practice areas.

Most often completed in gyms or therapy rooms within rehabilitation hospitals.

When/how much (dose)

While a goal will be set for the amount of independent My Therapy practice, it is the patient who decides the number of sessions, the durations of the sessions and the number of repetitions.

Site-dependent, based on staff ratios and funding.

Tailoring

My Therapy is individually tailored for each patient according to their rehabilitation goals and progressed throughout the rehabilitation admission.

Usual care rehabilitation is individually tailored for each patient according to their rehabilitation goals and progressed throughout the rehabilitation admission.

Fidelity checking measures

Adherence and fidelity to the intervention will be assessed as a part of the Process Evaluation (Process Evaluation Protocol [35]).

Adherence and fidelity to usual care will be assessed as a part of the Process Evaluation (Process Evaluation Protocol [35]).