PhD Viva Flashcards

Question

General: What is the next logical step(s) for this research?

Answer 1

Some recommendations include: 1. Further high quality RCTs, which include objective measures of physical activity, long-term follow-up and bigger sample sizes. 2. A larger definitive trial is needed to assess the effectiveness of the Accessercise app in terms of increasing physical activity. 3. To identify solutions to increase recruitment and retention of a diverse sample of adults with physical disabilities in mHealth interventions, that better reflects the population of the UK and internationally. 4. To identify better solutions to improve access to mHealth interventions for people with disabilities and identify ways to overcome social exclusion, marginalisation, and disability stigma. 5. To investigate whether delivering different physical activity interventions for manual wheelchair users with SCI via different modes of delivery (e.g., telephone, counselling, weekly video conferencing) can result in long term benefits.

Answer 2

Whilst healthcare professionals (e.g., Doctors, Nurses, Physios) have limited involvement in physical activity promotion due to a lack of knowledge, confidence and time), the findings reported in my thesis can be used as guidance within healthcare professionals practice. For instance, healthcare professionals working in physical activity for people with disabilities may use these findings to help people with disabilities make more sustained changes to their physical activity behaviour using mHealth interventions.

Answer 3

Based on the MRC Framework for designing and evaluating interventions, we followed step 2 and undertook a feasibility study.

Answer 4

My main focus of my PhD was to understand how to increase physical activity in adults with physical disabilities. Specific aims of my PhD were the following: 1. Undertook a systematic review assessing the effectiveness of physical activity interventions for manual wheelchair users with SCI. 2. Assess the theoretical underpinning of a novel mHealth app, Accessercise that aims to increase physical activity in those with disabilities. 3. Examine the usability of the Accessercise application using concurrent Think-Aloud interviews. 4. Undertake a feasibility study of the Accessercise application before progressing onto a full-scale trial.

Answer 5

Ma & Ginis (2018) - Meta-Analysis

Answer 6

A PhD is the highest qualification

Answer 7

It would have been good to have had Prof. Vicky Tolfrey involved more in my project due to her knowledge on PA for people with SCI. Also, it would be great to have some involvement from scholars out in Canada such as Kathleen Martin Ginis.

Answer 8

Disability and Rehabilitation? PLOS Digital Health?

Answer 9

There are 3 reasons why I chose to structure my thesis by publication: 1. Loughborough University have been recently changing their formats and prefer students to undertake this approach. 2. I followed the MRC Framework for designing/evaluating interventions and because these follow different stages, it made more sense to structure each stage I did as a research article. 3. As I want an academic career, the opportunity to work on manuscripts, attempt to publish these during/after my PhD has developed my experience to be ready for this type of career.

Answer 10

I used a variety of approaches such as word of mouth, used social media (e.g., X and Facebook), contacted National Governing Body Organisations (e.g., WheelPower) and by contacting participants that shared an interest in previous studies.

Answer 11

I have learnt many things during my PhD. Examples include: 1. Undertaking a systematic review, usability and feasibility studies, which were new experiences to me which I have never undertaken as an UG and PG. 2. Developed my planning and teaching skills 3. Invigilating 4. Marking 5. Supervising

Answer 12

I can provide a detailed answer for this.

Answer 13

I have no questions

Answer 14

The advantages of think-aloud interviews are that participants’ thoughts and needs can be elicited during testing, and the ongoing verbalised information collected allows the researcher to better identify the source of possible problems

Answer 15

Understanding how to increase physical activity in adults with physical disability

Answer 16

I used a pragmatist methodology. This followed a mixed-methods approach. The reason for this was because the Accessercise team approached the research team and wanted a series of studies to be completed. By following the MRC framework, which involves different qualitative/quantitative steps, a mixed-methods methodology was deemed most suitable.

Answer 17

Understanding how to increase physical activity in adults with physical disability.

Answer 18

I have managed to publish the following: 1. Study 2 (Assessing the theoretical underpinnings of the Accessercise application) 2. I have two papers under review (Studies 3-4 Usability and Feasibility)

Answer 19

I have presented my research nationally and internationally. For example, 1. I have presented my research at different events across the UK (e.g., Loughborough annual conference, pint of science, summer showcase, Peter Harrison Event) 2. I have also presented my research internationally (e.g., in Canada 2022-2023 and across several Canadian Universities such as Queens, McGill, Laval).

Answer 20

Yes, based on following the MRC Framework for developing and evaluating a novel mHealth intervention, it made sense to follow the different phases, which involved a mixed methods approach using a pragmatist methodology.

Answer 21

Kathleen Martin Ginis, Jasmin Ma, Byron Lai, Sonja De Grott, Amy Latimer-Cheung, Shane Sweet.

Answer 22

Studies 3 and 4 - I enjoyed working with people with disabilities to test them physiologically and to support them with using a novel intervention (i.e., Accessercise).

Answer 23

Kathleen Martin-Ginis

Answer 24

People specialising in the area of physical activity for people with disabilities, researchers, students, healthcare professionals etc.

Answer 25

Disability must be considered as a role between the interaction between an individual’s impairment and an unbending society.

Answer 26

1. It was developed to critique several limitations of the Medical Model 2. Attempt to better represent the views of people with disabilities and the urge to tackle such biological and reductionist views.

Answer 27

The social model considers disability as a socially constructed concept which results from a society that fails to listen to the voice of functionally diverse people. Even though the medical model might view a wheelchair user as disabled due to their diagnostic label, the social model would suggest a wheelchair user is disabled because of inaccessible environments or discriminatory guidelines. The society must change not the individual.

Answer 28

Medical model believes that an individual is disabled because of their condition and that their condition makes them disabled. On the other hand, the social model believes an individual is disabled because of society making them disabled such as an inaccessible building, inaccessible public transport.

Answer 29

Lack of inclusion, poverty, badly designed buildings, inaccessible information, inaccessible public transport.

Answer 30

1. Attitudinal barriers 2. Physical barriers 3. Informational/communication

Answer 31

Attitudinal barriers are making assumptions about an individual’s capabilities which may not be true. For example, these are assumptions about individuals with disabilities that restrict them from participating fully in society. Such as if a person who uses a mobility scooter will also have a cognitive impairment even though this may not be the case. Attitudinal barriers are ways that individuals with disabilities are labelled, classified, grouped, or disregarded by individuals that do not have a disability. These attitudinal barriers normally arise from individuals such as friends, family, educators, carers, critics and the people with disabilities themselves.

Answer 32

Physical barriers are tangible components of the physical environment within for example sports centres, gyms, hospital and offices. These barriers restrict people with disabilities from participating in many activities in life. Physical barriers are normally related to the architectural and design features of an environment. Examples of physical barriers include Narrow doors, stairs, curbs, inaccessible buildings, lack of handrails and lack of ramps. However, physical barriers involve more then just architectural barriers the also involve natural physical barriers. Examples of natural physical barriers include Hill terrain, weather conditions (e.g., snow, rain) and rocky paths that for example, make it challenging.

Answer 33

The Social Model of Disability

Answer 34

Policies (e.g., sidewalk maintenance) Assistive technology (e.g., powered wheelchairs) Strong support networks (e.g., friends to push, encourage you)

Answer 35

Information and communication barriers restrict people with disabilities from communicating and obtaining relevant information. Information Barriers: Refer to difficulties in accessing information when it is unavailable or irrelevant. Communication Barriers: Commonly occur due to limited knowledge regarding different styles and alternative modes of communication (e.g., verbal, written, picture, or sign).

Answer 36

1. Accused of failing to address impairment, known as fundamental to the experience of disability. 2. This model does not fully account for the lived experience of the disabled individual it seeks to help and assumes that all disabilities can be helped through changing societies. 3. The social model struggles to acknowledge many individual differences (e.g., physical and psychological conditions). 4. It labels disabilities as one homogenous group instead of people who vary in gender, age, ethnicity, race, sexuality and limitations. 5. Social Model has been criticised as being too simplistic and universalising to thoroughly understand the problems of disability.

Answer 37

The International Classification of Functioning Disability and Health (ICF) Model

Answer 38

Developed to provide a standard language and universal classification for describing functioning and disability across all individuals and health conditions.

Answer 39

Bio-psycho-social model

Answer 40

It integrates parts of the Medical and Social Model to produce a coherent viewpoint of disability

Answer 41

The ICF model acknowledges that disability is neither merely a ‘medical issue’ nor a ‘social issue’ but rather a complex phenomenon

Answer 42

With more then 1,400 categories in the ICF framework, the classification system is too extensive and detailed to be used in daily practice. 1,400 categories involved a significant investment of time, and categories may be discovered that do not offer information or are not relevant in some cases. Therefore, it requires specific training allocation of further resources for it’s use.

Answer 43

Over 1 billion people (15%) of the world’s population This equates to 1 in 7 people or 1 in 4 households

Answer 44

Adults accounts for between 110 and 190 million (3.8%)

Answer 45

1. Ageing population 2. Increased life expectancy 3. Continuing growth in people with chronic diseases

Answer 46

Between 1.71$ trillion and $2.23 trillion per year

Answer 47

1. Direct Costs 2. Indirect Costs

Answer 48

Direct costs relate to the visible costs associated with the resources used for the diagnosis and treatment of illnesses within the health systems (e.g., medical costs) and the costs of non-healthcare resources (i.e., non-medical costs)

Answer 49

Diagnostic testing, in-patient care, medications, and other medical supplies.

Answer 50

These costs represent transportation and costs of a special diet

Answer 51

These refer to loss of productivity because of reduced force participation, presenteeism and reduced job performance while at work.

Answer 52

1. Disability 2. Premature death 3. Disease or injury

Answer 53

1. Physical 2. Sensory 3. Intellectual 4. Neurological

Answer 54

Physical disabilities

Answer 55

Physical disability refers to the lack of physical functioning, mobility, dexterity, or stamina that inhibits daily tasks.

Answer 56

1. Multiple Sclerosis 2. Spinal Cord Injury 3. Amputation

Answer 57

Spinal Cord Injury

Answer 58

1. Traumatic Spinal Cord Injury 2. Non-Traumatic Spinal Cord Injury

Answer 59

1. Car accident 2. Fall 3. Sports-related injury

Answer 60

Occurs instantly after the injury occurs

Answer 61

Happens a few minutes after the injury has occurred

Answer 62

A non-traumatic SCI is when a disease directly impacts the spinal cord, such as a tumour, infection, or degenerative disk disease.

Answer 63

SCI can be classified into complete or incomplete or tetraplegia or paraplegia

Answer 64

Complete SCI injury refers to the complete loss of motor and sensory function below the level of injury

Answer 65

An incomplete spinal cord injury occurs whenever an injury survivor retains some feeling below the site of the injury.

Answer 66

Central Cord Syndrome (CCS)

Answer 67

An impairment in the cervical segments of the spinal cord (i.e., bottom of the neck to the bottom of the feet).

Answer 68

An impairment in the thoracic, lumbar or sacral segments of the spinal cord (i.e, lower half of the body from waist to bottom of the feet).

Answer 69

They would normally use the AISA Impairment Scale normally within 72 hours by a trained personal such as a doctor.

Answer 70

250-500k new people worldwide each year, adding to the 2.5 million people around the world living with the condition.

Answer 71

Young males between the ages of 18-35.

Answer 72

1. Car crashes 2. Sports Injuries

Answer 73

1. Tripping 2. Falling

Answer 74

Physical activity (PA)

Answer 75

It’s meant to alleviate or prevent numerous health and well-being complications resulting from SCI. PA can help people with SCI from developing diabetes, heart disease, cancer, stroke. PA has been recommended in people with SCI as it provides numerous benefits such as improved fitness, developing cardiometabolic health and enhancing the quality of life.

Answer 76

Following the recommended guidelines of 40 minutes of moderate to vigorous intensity aerobic physical activity each week for cardiorespiratory advantages and at least 90-minutes per week for cardiometabolic benefits.

Answer 77

No, they struggle to meet the recommended guidelines of 40 minutes of moderate to vigorous intensity aerobic physical activity each week

Answer 78

Due to intrapersonal (e.g., employment, psychological factors), interpersonal (e.g., social support), and policy-related factors (e.g., funding, transportation).

Answer 79

Identify ways to successfully promote physical activity in adults with SCI to minimise participation inequality.

Answer 80

Yes, changing behaviours are difficult as they are highly variable.

Answer 81

Health behaviours are difficult to change because they are habitual, normative and preventive.

Answer 82

These behaviours are undertaken automatically without much consideration

Answer 83

These behaviours bear the weight of tradition and approval

Answer 84

These behaviours commonly lack a salient immediate outcome

Answer 85

Yes, using behaviour change theory has been identified as a valuable strategy to increase the effectiveness of interventions.

Answer 86

Set of ideas with specifications of how phemnomena are associated with one another

Answer 87

Behaviour Change Theories are important to help us understand behaviour change and provide an organised framework for effective interventions.

Answer 88

Some theories overlap with one another making it difficult to decide on one. Also, only some theories consider interpersonal, intrapersonal and environmental factors. Therefore, to overcome limitations of existing models and to improve intervention development, the Behaviour Change Wheel (BCW) was developed that incorporates multiple theories of behaviour change.

Answer 89

The BCW can inform all phases of behaviour change from assessing barriers and facilitators to designing and evaluating interventions. BCW integrates 19 different behaviour change frameworks The BCW implies that researchers must understand the target behaviour, identify intervention options and then identify content in the form of behaviour change techniques when designing an intervention. The BCW consists of 3 layers: (1) COM-B model, (2) intervention functions, and (3) and policy categories.

Answer 90

The COM-B model proposes that for any behaviour to occur, an individual must have the capability, opportunity and motivation. Each component can be broken down further..

Answer 91

Capability refers to an individual’s ‘physical’ or ‘psychological’ abilities to enact the behaviour. This means an individual should hold the right psychological and physical capability to engage in the required specific behaviour. Physical capability: Physical capability refers to the degree to which a person can participate in the necessary behaviour, for instance, if restricted by a medical illness. Psychological capability: Psychological capability refers to whether an individual can participate in the right cognitive processes, comprehension, and reasoning to undertake the target behaviour. For example, this includes the knowledge of the behaviour and the ability to comprehend information and to reason.

Answer 92

Opportunity refers to having the ‘physical’ and ‘social’ context that makes it affordable, appropriate, and easy to perform the behaviour. Physical opportunity: Physical opportunity refers to opportunities supported by the environment (e.g., time, resources, places) Social opportunity: Social opportunity relates to the social factors that influence how we think about things (e.g., social clues).

Answer 93

Motivation relates to an individual’s psychological processes that can trigger and direct behaviour including ‘reflective’ and ‘automatic’ motivation. Reflective motivation: Refers to an individual’s evaluations and plans to engage in the desire behaviour, which includes analytical decision making. Automatic motivation: Refers to the brain processes that strengthen and direct behaviour such as habitual processes.

Answer 94

Nine intervention functions

Answer 95

Intervention functions help to explain how an intervention seeks to change behaviour

Answer 96

Modelling, environmental restricting and restrictions

Answer 97

A BCT is a strategy that helps an individual change their behaviour to promote better health (e.g., setting goals, packing your gym kit the evening before). BCTs are the “active components” of behaviour change interventions.

Answer 98

The BCTTv1 is an extensive and agreed list of BCTs which offer standardised definitions, labels, and examples of each BCTs that can support in designing interventions.

Answer 99

Over 50 behaviour change experts from different countries. It comprises 93 BCTs that are hierarchically organised into 16 clusters.

Answer 100

The final layer comprises of seven policy options that can be used to help deliver the intervention functions. These include service provision, communication/marketing, fiscal measures, regulation, guidelines, legislation and environmental/social planning.

Answer 101

BCW allows intervention designers to consider (1) what behaviours need to be addressed? (COM-B model) (2) How will I successfully change the behaviour and what component does the intervention require, and (3) what needs to be put in placed for the intervention to be provided?

Answer 102

Mobile Health (mHealth)

Answer 103

mHealth refers to the use of mobile technologies to support the success of health objectives such as physical activity.

Answer 104

Widespread availability of wireless network infrastructure and smartphone technologies

Answer 105

1. Fitbit 2. Nike+ 3. MyFitnessPal 4. Strava

Answer 106

1. mHealth apps provide real-time feedback 2. Apps can track activities (e.g., how many steps you have done) 3. Remind users to undertake physical activity 4. Easy way to socialise with other users (if that function is available) 5. It can help tailor interventions to the needs of users or specific groups 6. Can undertaken physical activity in nearly all environments (e.g., inside, outside)

Answer 107

1. Could support people with disabilities to overcome numerous physical activity related barriers 2. In-person barriers could be difficult for people with disabilities to undertake, so mHealth related interventions could be an effective solution. 3. Delivering an intervention through mHealth can reduce transportation and built environment barriers to access physical activity that are significant for people with physical disabilities. 4. mHealth apps may be more affordable rather than having to use a gym and pay for gym membership. 5. mHealth interventions can provide tailored content for people with disabilities Overall, the above shows the possible benefits of using mHealth forms (e.g., smartphone apps) to provide physical activity interventions to those with physical disabilities.

Answer 108

Although people with disabilities have access to mobile technology at the same rates as the general population, people with disabilities are 20% less likely than the general to own a smartphone.

Answer 109

1. Focuses on multiple disabilities (e.g., SCI, Amputee) unlike some other apps 2. Content is shaped around the disability that you select on the app, which no other app has. 3. Is a new app in the UK and has yet to be evaluated

Answer 110

A framework that helps to design and evaluate effective health behaviour change interventions. To maximise the effectiveness of new interventions for people with disabilities, these should be comprehensively designed and evaluated. To this end, the UK Medical Research Council (MRC) has provided updated guidance outlining how this can be best achieved.

Answer 111

The MRC framework outlines a five-stage conceptual framework to support the development and evaluation of complex interventions within healthcare settings that incorporate the following stages: 1. Development (or identification of the intervention) (Stage 1) 2. Feasibility/piloting (Stage 2) 3. Evaluation (RCT – Stage 3) 4. Implementation (Stage 4) Each phase includes sub-stages which require applications to follow closely to develop, evaluate and implement an intervention appropriately. Stage 1 (Development): Identifying the evidence base – Commonly through a systematic review), identifying appropriate theory, and modelling process and outcomes. Stage 2 (Feasibility/Piloting): Testing procedures, testing sample size, testing equipment, estimating recruitment/retention. Step 3 (Evaluation): Assessing effectiveness, acknowledging change processes and evaluating cost-effectiveness Step 4 (Implementation): Dissemination, surveillance and monitoring, and long-term follow-up.

Answer 112

In this thesis, we focus on the development (stage 1) and feasibility/piloting (stage 2) phases of the MRC framework, using a triangulation of quantitative and qualitative methods.

Answer 113

As we were contacted by the Accessercise team to conduct a formal evaluation of their newly developed app, which necessitated a combination of empirical studies, we felt that a mixed-methods approach was most suitable.

Answer 114

Pragmatism

Answer 115

Due to the world-leading expertise on SCI at the Peter Harrison Centre at Loughborough University, as well as people with SCI being at the lowest end of the spectrum, promoting physical activity in this population is imperative. However, while Chapters 2-3 focus on addressing physical activity issues for adults with SCI, SCI patients have individual needs, problems, limits, minority issues and demographic distribution concerns. That said, recruiting participants with SCI was challenging. These individuals normally face difficulties participating in the community due to accessibility, affordability, and acceptability issues.

Answer 116

The overall aim of this PhD thesis is to understand how to increase physical activity in adults with physical disabilities. Specific aims were to: 1. Assess the effectiveness of existing physical activity interventions in manual wheelchair users with SCI. 2. Examine the theoretical underpinning of a novel mHealth physical activity intervention, Accessercise, using the BCW. 3. Qualitative evaluate the usability of the Accessercise intervention using concurrent Think-Aloud interventions in adults with different physical disabilities. 4. Undertake a feasibility RCT assessing Accessercise in adults with physical disabilities prior to undertaking a full-scale trial.

Answer 117

This research contributes to the field of physical activity, behaviour change and physical disabilities by understanding how to increase physical activity in adults with disabilities. Through this research, we evaluate a novel mHealth intervention. By doing this, we can understand the theoretical underpinning to facilitate physical activity in this population. Most of all, this research can help intervention designers develop their knowledge of the effectiveness of existing intervention and appropriate ways of designing and evaluating physical activity behaviour change interventions. Ultimately, this research can help with the overall goal of improving physical activity, quality of life and reducing sedentary behaviour in adults with physical disabilities.

Answer 118

The aim of this study was to assess the effectiveness of interventions to increase physical activity in adult manual wheelchair users with spinal cord injury.

Answer 119

Self reported physical activity, behavioural physical activity and functional fitness.

Answer 120

Adverse effects, physiological health, psychological wellbeing, general health-related QoL, Feasibility (acceptability, usability and adherence).

Answer 121

Downs and Black (1999) checklist

Answer 122

Risk of Bias 2 Assessment of risk of bias is regarded as an essential component of a systematic review on the effects of an intervention.

Answer 123

6 studies were included in the meta-analysis demonstrating that self-reported physical activity significantly improved in the intervention vs the control group.

Answer 124

Meta-analyses were not possible due to heterogeneity of outcome measures, but similar patterns of improvement were found for functional fitness, behavioural physical activity, physiological measures, psychosocial wellbeing, adverse effects and quality of life.

Answer 125

Interventions that aim to improve physical activity in manual wheelchair users with SCI appear to be effective, at least in the short term. Future research should investigate whether delivering different interventions via different modes can result in longer-term benefits.

Answer 126

1. We used a mixed-methods approach using qualitative and quantitative techniques. It enabled more research gaps to be addressed within one body of work. For example, the feasibility study, the qualitative data offered further insight into the quantitative findings, as well as participants' acceptability of the intervention by understanding what they liked or disliked about the trial. 2. We followed the MRC framework for designing and evaluating interventions as it's more likely to lead to success. 3. We followed numerous reporting frameworks (e.g., TiDieR, CONSORT, PRISMA). 4. We used the Behaviour Change Wheel!

Answer 127

Since the COVID-19 pandemic, the use of smartphones development of mHealth apps on the market has expanded, with the use of apps increasing among the disabled population. Additionally, since people with disabilities struggle to participate in physical activity interventions in-person, the use of a smartphone app like Accessercise overcomes barriers and offers people with disabilities with an easier format to undertake PA, socialise and to monitor physical activity performance.

Answer 128

People with SCI are physically inactive and are at the lowest spectrum of the physical activity continuum. People with SCI are at increased risk of developing numerous health complications because they are inactive. People with SCI are not meeting the recommended physical activity guidelines to achieve such health benefits (e.g., reduced risk of depression, better QoL).

Answer 129

This reduced levels of physical activity in individuals is likely to be explained by the numerous barriers to physical activity that this population experience.

Answer 130

Lack of transportation, lack of time, negative attitudes towards physical activity and exercise, lack of funding for programmes, expensive equipment, limited coach/person with a SCI knowledge of what opportunities exist, increased cost to participate.

Answer 131

Home-and strength-based training (delivered in-person), (over the phone) or (online through video conferencing software).

Answer 132

Suitable behaviour change theories.

Answer 133

Theory of Planned Behaviour, Social Cognitive Theory, Health Belief Model

Answer 134

The MRC Framework recommend that the development and evaluation of complex health interventions should incorporate suitable theory to improve the likelihood that they will lead to behaviour change.

Answer 135

No, it has been inconsistent.

Answer 136

Yes, a couple of interventions exist (e.g., Ma & Ginis, Watson, 2023).

Answer 137

These studies found that interventions significantly increased physical activity in this population. Watson also found that interventions were more effective when they incorporated specific behaviour change techniques (BCTs).

Answer 138

Ma and Ginis (2018) and Watson et al (2023) included studies that recruited heterogenous SCI populations, including ambulatory, as well as manual wheelchair users and powered wheelchair users. However, most (80%) individuals with SCI use a manual wheelchair for mobility. Manual Wheelchair Users with SCI are among the least physically active population groups with only 13-16% of SCI Manual Wheel Users with SCI undertaking any form of physical activity. Therefore, this systematic review addresses this gap and aims to investigate the effectiveness of physical activity interventions exclusively in this population (e.g., effectiveness of physical activity interventions for manual wheelchair users with SCI).

Answer 139

PROSPERO is an international database of prospectively registered systematic reviews in health and social care

Answer 140

PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) is the standard format for reporting systematic reviews. This approach helps with structuring the methods and for ensuring the systematic review is done correctly.

Answer 141

To define a researchable question, the most commonly used structure is PICO, which specifies the type of Patient or Population, type of Interventions (and Comparisons if there is any), and the type of Outcomes that are of interest.

Answer 142

Children and Adults experience different physiological adaptations.

Answer 143

Behaviour change interventions are 'Coordinated sets of activities designed to change specified behaviour patterns'.

Answer 144

Mainly peer reviewed articles: Randomised Controlled Trials (RCTs), Non-RCTs, pre-post, before and after studies were included.

Answer 145

Non-peer reviewed articles: Case reports, case studies, conference abstracts, posters and book chapters were excluded.

Answer 146

APA PsychINFO, MEDLINE, PubMED, ISRCTN, ClinicalTrials, SportDiscuss, Scopus, Web of Science and Cochrane Library.

Answer 147

April 2021 and I completed them all in 1 day!

Answer 148

The world's leading software for managing and streamlining your systematic review

Answer 149

Risk of Bias 2

Answer 150

Each study was assessed using RoB2 which rates such as 'low' or 'high risk' or having 'some concern' of bias across five domains: randomisation process, deviatations from the intended interventions (including blinding), missing outcome data, the measurement of outcomes, and the selection of the results.

Answer 151

These were not included in the meta-analysis and are at risk of bias due to the lack of a control group.

Answer 152

A funnel plot is a simple scatter plot of the treatment effects estimated from individual studies against a measure of the study size. It helps check for publciation bias between the studies.

Answer 153

We used GRADE GRADE rates studies as high, moderate, low and very low quality (e.g., an RCT would be 'high' whereas a before and after study may be 'low').

Answer 154

The Downs and Black (1998) checklist consists of 28 questions. The total score you can achieve 28. Based on your answers, you compare this action a quality schedule (e.g., excellent 24-28 points, good 19-23 points, fair 14-18 points or poor <14). The checklist asks a list of questions such as whether the interventionist randomised participants, whether there is a hypothesis included, whether the author is clear about the outcomes they measure.

Answer 155

Study characteritics, intervention characteristics, mode of delivery, BCTs and Behaviour Change Theory!

Answer 156

We used the BCT taxonomy version 1(BCTTv1)

Answer 157

Is a tool/guide that helps to provide transparency when reporting of interventions in clinical trials.

Answer 158

Mixture of questionnaires - LTPAQ-SCI (leisure Time Physical Activity Questional for People with SCI) - PARA-SCI (Physical Activity Recall Assessment for People with SCI) - PASIPD (Physical Activity Scale for Individuals with Physical Disabilities)

Answer 159

1. Had to be an RCT 2. Outcomes were similar 3. We used the measure immediately post-intervention as this likely reflects the largest intervention effect.

Answer 160

I found that self-reported physical activity significantly improved in the intervention group compared to the control group.

Answer 161

A forest plot is a figure of the findings of multiple studies that investigated the same research question and measured the same outcome.

Answer 162

A meta-analysis combines the results of multiple studies to give us a more reliable result as to whether physical activity interventions are effective in manual wheelchair users with SCI.

Answer 163

Accelerometric monitors (wrist/body worn) or attached to the participants wheelchair and wrist.

Answer 164

Due to the heterogeneity (i.e., difference) in outcome measures assessed or research designs. For example, some studies did not look at behavioural physical activity or were not RCT, so it was impossible to include pre-post data in the forest plot.

Answer 165

1. Isometric Strength 2. Aerobic Endurance

Answer 166

I did not do a meta-analysis for functional fitness because of the heterogeneity in outcome measures/study design.

Answer 167

Physical activity significantly improved in the intervention relative to the control groups.

Answer 168

For isometric strength and aerobic endurance, improvements were found post-intervention.

Answer 169

1. Shoulder Pain 2. Fatigue 3. Upper extremity

Answer 170

Significant reduction post-intervention.

Answer 171

No significant changes were found.

Answer 172

Significant main effect was found post-intervention.

Answer 173

1. Aerobic Fitness (Vo2 peak) 2. Cardiometabolic Health (blood lipids, blood glucose and blood pressure) 3. Body composition

Answer 174

3 studies found statistically significant improvements in aerobic fitness post-intervention.

Answer 175

Blood lipids and blood pressure found improvements.

Answer 176

3 studies found no improvements post-intervention.

Answer 177

1. Depression 2. Anxiety 3. Self-Efficacy

Answer 178

All studies showed improvements in psychosocial wellbeing across all the domains (self-efficacy, depression and anxiety) post-intervention.

Answer 179

All studies except for 2 found improvements in Health-Related QoL post-intervention.

Answer 180

1. Adherence 2. Retention 3. Satisfaction 4. Engagement

Answer 181

All outcomes were rated highly post-intervention.

Answer 182

No significant findings were found for any study or intervention characteristic moderators on self-reported physical actvity. [I NEED TO COME BACK TO THIS]

Answer 183

The Q value did not differ significantly between studies that used theory compared to those that did. Smaller effects were reported for those that used theory.

Answer 184

Intervention group

Answer 185

The review highlights that PA interventions have the potential to result in a broad range of beneficial outcomes in manual wheelchair users with SCI.

Answer 186

Due to heterogeneity of outcomes and research designs, meta-analyses were not possible for all outcomes. However, a narrative synthesis suggested that behavioural physical activity, functional fitness, physical health, psychosocial wellbeing and QoL generally favoured the intervention relative to the control group. All together, because of risk of bias and study quality varied across studies, we cannot conclude with certainty that PA interventions can improve such outcomes in manual wheelchair users with SCI. As a result, further high quality research is needed in this area.

Answer 187

Several studies were fine as they were RCTs However, some studies were reported as high risk of bias because they did not mention about randomisation, what the procedure was etc.

Answer 188

Several of the included studies were underpinned by theory (e.g., health belief model, SCT). Health behaviour change theories help to design effective behavioural interventions. Theory can improve the presentation of information by enhancing one's physical activity intentions, motivation and behaviour.

Answer 189

While several studies used theory when designing their PA interventions the number of studies that consistently included BCTs was limited WITH several BCTs not included in any reviews. Consequently, these BCTs could be included in future interventions to determine their effectiveness at increasing PA in manual wheelchair users with SCI.

Answer 190

Rather then suggesting that the use of theory is ineffective, this finding could be down to the relatively small number of studies included. Therefore, further high-quality research in this area is NEEDED so that the impact of these factors can be assessed.

Answer 191

1. We included a range of different study designs in our study (e.g., RCTs, non-RCTs, before/after) whereas a previous systematic review only included RCTs. Unfortunately, despite RCTs being the "gold standard" for evaluating intervention effectiveness, they have limited external validity because participants may not be representative of the general clinical population. Therefore, to fully accommodate the evaluation of research topics, such as assessing the effectiveness of interventions then MORE than one study should be included.

Answer 192

1. Most primary and secondary outcomes were assessed using different scales (e.g., PASIPD, LTPAQ-SCI). Providing results from different scales may provide inaccurate estimates of the overall effect reducing certainty in the findings. Future Recommendation: Future researchers should ensure greater consistency in how outcome measures are assessed allowing them to be more reliability synthesised for direct comparison. 2. The review search was limited to only papers written in English due to a lack of resources (e.g., professional translators). This could also explain why most studies were undertaken in North America (e.g., Canada, USA). Unfortunately, studies that exclusively focus on studies published in English may miss necessary information on health interventions. Future recommendation: Researchers should consider collaborating with researchers who are fluent in other languages to help expand the inclusion of studies in a review. 3. Most of the studies included in the review did not report effects beyond 12 months, with the average intervention period being 5.5. Future research: Future researchers should consider employing longer follow-up duration's greater than 12 months to provide better estimates of potential long-term benefit.

Answer 193

We found that manual wheelchair users can become more physically active, health and fitter through the help of physical activity interventions. Also, as our review has shown that PA interventions can lead to improvements in functional fitness, psychosocial wellbeing, health-related QoL, adverse effects then our findings should be implemented within the rehabilitation community. However, all the findings we have reported today should be interpreted with caution due to the high risk of bias and heterogeneity in outcomes and study designs. Future research: High quality RCTs to address potential confounds of the existing evidence-based, as well as ensure greater consistency in the measured outcomes (i.e., using the same questionnaires to measure self-reported PA). Altogether, the current review provides a foundation that may be useful to guide policies and programs to improve physical activity levels and tackle the high risk of a secondary lifestyle especially in manual wheelchair users with SCI.

Answer 194

Applying the Behaviour Change Wheel to assess the theoretical underpinning of a novel smartphone application to increase physical activity in adults with spinal cord injuries.

Answer 195

3 1. Understanding the behaviour 2. Identifying intervention options 3. Identifying content and implementation options.

Answer 196

1. Problem Solving 2. Goal setting and monitoring 3. Increasing self-confidence 4. Improving access to facilities 5. Reducing stigma and negative attitudes associated with PA

Answer 197

We identified that Accessercise incorporates the necessary components for adults with SCI to be physically and psychologically capable of undertaking PA, offers social and physical opportunities to reduce sedentary behaviours and supports automatic and reflective motivation.

Answer 198

By assessing the theoretical underpinnings of Acessercise using the BCW, we have revealed the potential mechanisms of action for improving physical activity in adults with SCI. This helps to further inform intervention development, as well as high-quality effectiveness namely, RCTs, assessing whether fitness apps can improve physical and psychological health outcomes in individuals with SCI.

Answer 199

Mainly in-person or via the telephone.

Answer 200

1. Can support individuals with SCI to undertake PA in their own home. 2. mHealth interventions can help overcome transportation and built environmental barriers. 3. Smartphones make it easier to monitor, track and transmit data on health-related outcomes.

Answer 201

Limited studies have concentrated on mHealth interventions to encourage PA in adults with SCI. Despite Accessercise appearing helpful, the true effectiveness of the app in changing behaviours to increase physical activity has yet to be investigated.

Answer 202

1. Can assist in ensuring that an intervention meets the needs of the end-user and is likely to lead to long-term behaviour change 2. Behaviour change theory is vital because changing behaviour is notoriously difficult to achieve and requires a lot of work. 3. One key reason is that behaviours are habitual, normative and preventive.

Answer 203

1. Habitual Behaviours - Behaviours that occur in stable situations/contexs without much thinking. 2. Normative behaviours - Powerful forces of traditional and social approval. 3. Preventive - These normally miss a salient immediate outcome.

Answer 204

1. Theory of Planned Behaviour (TPB) 2. Social Cognitive Theory (SCT) 3. Health Belief Model 4. Transtheoretical Model of Change (TTM) 5. Self-Determination Theory (SDT)

Answer 205

1. These theories mainly focus on behavioural analysis of health issues and do not sufficiently explain variations in complex behaviours. 2. These theories can only assist in predicting behaviour and do not help explain how behaviour change occurs. 3. These models concentrate on a relatively small number of constructs and neglect more contextual and conscious processes

Answer 206

1. The BCW is different from traditional theories because it considers the role of context, an aspect of behaviour which has been under-investigated in the past. 2. The BCW has successfully informed interventions in numerous health contexts and has been viewed as helpful in charging target health behaviours.

Answer 207

The BCW synthesises 19 frameworks of behaviour change identified in the literature. 1. In the middle of the wheel is the Capability, Opportunity, and Motivation Model. This model beliefs that in order to change a behaviour reliant upon addressing three components: physical and psychological capability, social and physical opportunity and automatic and reflective motivation. 2. In the middle of the wheel is 9 Intervention functions 3. On the outside ring, comprises 7 policy options which can help support the intervention functions. The BCW links influences from the COM-B model to potential intervention functions and policy categories.

Answer 208

The app was founded by Paralympic powerlifter, Ali Jawad and world-champion sailor Sam Breary and Financial Times European Lawyer Yulia Kyrpa.

Answer 209

Most apps provide content for just a singular disability. Accessercise focuses on multiple physical disabilities and content is shaped around the users disability type. Accessercise is a novel smartphone app developed for people with physical disabilities, which aims to get users physically active by offering users several functions.

Answer 210

1. Accessercise offers users the opportunity to exercise in multiple locations (e.g., gym, home, park), which can help users to overcome PA barriers such as transportation and built environment difficulties. 2. Accessercise offers users an exercise library tailored to individual needs and impairments, which are demonstrated by a role model with the same impairment. 3. Accessercise has an accessibility function where you can put your postcode in ad find local accessible gyms. 4. The app also offers a social function, where users can follow other users and react to their workouts by commenting or reacting with an emoji. 5. Users are able to record their workouts and review them at the end of their sessions. The overarching point of the app is to offer educational knowledge, tracking ability and behavioural prompts to hopefully increase physical activity among it's users (mainly people with physical disabilities).

Answer 211

The BCW is split up into 8 steps across 3 stages. Stage 1 - Involves 4 steps which helps to understand the behaviour to influence and incorporates the COM-B model in step 4. Stage 2 - Included step 5-6 which identifies the suitable intervention options Stage 3 - step 7-8 identifies the content and implementation options.

Answer 212

Stage 1 - Step 1 looks at understanding the behaviour. Here, we undertook a systematic review to assess the effectiveness of physical activity interventions for manual wheelchair users with SCI Afterwards, we delved into the literature looking at the barriers and facilitators to PA in this population. Based on all this information, this helped us to define the problem as: How to improve physical activity in adults with SCI to meet recommended guidelines: 20 minutes of moderate to vigorous aerobic activity alongside strength training 2x per week). It was acknowledged that individuals with SCI experience physical activity in numerous locations such as home, gym or outside. Thus, the location (or context) of the problem was defined.

Answer 213

Selected the target behaviour: Here, we generated a list of 13 behaviours relevant to the problem identified in step 1 (improving PA to meet recommended guidelines to reduce sedentary behaviour) These candidate behaviours were based on the barriers and facilitators to physical activity experience by adults with SCI. The target behaviours were then prioritised by considering the following factors - Potential impact of changint the behaviour - Likelihood of shifting behaviours - Impact of change on other behaviours - Ease of measuring or monitoring the behaviour Several candidate behaviours were identified as promising or very promising across all four factors

Answer 214

1. Goal setting and monitoring 2. Action Planning 3. Reduce stigma and negative attitudes 4. Improve access to facilities 5. Improve knowledge in those delivering PA 6. Problem Solving 7. Increase confidence and motivation

Answer 215

Specify the target behaviour: Who: Improving PA for adults with SCI What: React adaptively to SCI by applying the strategies suggested by the intervention. When: On a regular basis, preferably at a time that suits them to achieve the SCI-recommended guidelines of 20 minutes of moderate to vigorous intensity aerobic PA 2x per week) Where: Any given situation (e.g., outside, inside) How often: As often as they can by ensuring that they meet the recommended guidelines of 20 minutes 2x per week of moderate to vigorous intensity PA) With whom: Individuals or as a group (e.g., with friends, family, care givers).

Answer 216

The COM-B model was used to help us to change in the individual or environment in order for the desired changes in behaviour to occur. Altogether, we identified that changes need to be made across all the components of the COM-B model (Capability, Opportunity, Motivation)

Answer 217

Physical capability (e.g., physical skills, strenght or stamina) was increasing physical abilities to undertake PA. Psychological capability (e.g., knowledge, mental stamina) would include improving problem solving as well as making suitable decisions related to PA.

Answer 218

Physical opportunity (e.g., time, resources) which may involve appropriate access to facilities, equipment and resources to undertake PA. Social opportunity (e.g., social cues) such as social support from family, friends, care givers to undertake PA.

Answer 219

Automatic (e.g., emotion reactions) could involve the completion of weekly diaries to monitor performance and set goals. Reflective (e.g., self-conscious intentions plans) such as holding beliefs that undertaking PA is achievable and will lead to positive outcomes.

Answer 220

Identify intervention options

Answer 221

Intervention Function Based on the findings from the COM-B model (Step 4), Step 5 involved using the BCW to identify the most suitable intervention functions. In order to assess the most appropriate intervention functions, we used the APEASE criteria. Overall, we identified 7/9 functions were selected as suitable intervention functions to facilitate PA in adults with SCI. These intervention functions were education, persuasion, training, modelling etc)

Answer 222

Affordability, Practicability, Effectiveness, Acceptability, Side-Effects and Equity.

Answer 223

1. Education 2. Training 3. Coercion 4. Persuasion 5. Enablement 6. Modelling 7. Incentivisation

Answer 224

Policy Categories 7 policy strategies were selected to help support and enact the intervention functions (e.g., communication/marketing, guidelines, legislation, social planning). Overall, after using the APEASE criteria to determine the most effective policy categories. We identified that 2/7 were deemed most appropriate such as Communication/Marketing (e.g., verbal, written, posters of the benefits of PA for this population) and service provision (e.g., establishing PA in numerous contexts and communities).

Answer 225

Identify Content and Implementation Options

Answer 226

Behaviour Change Techniques (BCTs) This stage involved identifying the most appripriate BCTs that can deliver the intervention functions (step 5) and policy categories (step 6) 1. The most frequently used BCTs were derived from the BCT taxonomy which involve 93 BCTs organised across 16 categories. 2. The most relevant BCTs were assessed in relation to the APEASE criteria. 3. As a team, we made a final decision on the included BCTs were undertaken. 4. Based on the intervention functions selected in Step 5 (e.g., education, training, modelling, persuasion, incentivsation) the appropriate BCTs identified were for example: Goal setting, action planning, reviewing behavioural goals, social support. 5. The Accessercise app included BCTs associated with education by offering feedback on behaviour through instructional videos and modelling by demonstrating the behaviour.

Answer 227

1. Graded tasks (offering users more challenging exercises). 2. As some users may be inexperienced with PA, offering live chats/forums will help users that have numerous questions about exercising.

Answer 228

Mode of delivery

Answer 229

The most suitable mode(s) of delivery for the chosen BCTs are identified using the APEASE criteria. Most modes of delivery not suitable for our study due to the high costs for development and service provision (e.g., affordability). The mode of delivery that was identified as the most suitable was digital media (e.g., internet or smartphone s) since this mode would be low cost, allow for the BCTs to be easily delivered and would be both acceptable to and reach the end-users.

Answer 230

We used the ABACUS scale

Answer 231

App Behaviour Change Scale The scale was used to review the behaviour change potential of the app

Answer 232

The ABACUS consists of 21 items that examine potential behaviour change of an app: It focuses on key areas such as: (1) knowledge and information (2) goals and planning (3) feedback and monitoring (4) actions

Answer 233

Every question has 1 point. You add up all the answers from the 21 questions and you have a final answer. Higher score indicates more confidence of behaviour change potential

Answer 234

Accessercise included 16/21 items indicating a high number of BCTs included in the app suggesting "strong confidence" in behaviour change potential.

Answer 235

1. Offers users reminders and prompts 2. Encourage positive habit formation 3. Offer users opportunities to export data out of the app and onto social media channels. 4. Incorporate graded tasks. 5. Notifying users with a text message on a selected day/time that they are likely to exercise.

Answer 236

1. The Accessercise may be a practical approach for adults with SCI offering users the capability, opportunity and motivation to undertake PA and reduce sedentary behaviour. 2. Accessercise targets all components of the COM-B model (e.g., goal setting - capability, self-monitoring (opportunity) and reviewing goals (motivation) 3. Our findings are promising given that Accessercise was not initially developed using theory. Overall, the method of retrofitting Accessercise to the BCW framework was appropriate as it can help identify the BCTs that have been included in the app to support physical activity. Therefore, the current study could be used by other research seeking to employ similar methods in the design/evalaution of similar interventions for people with SCI. 4. Accessercise includes relevant BCTs to help people with SCI to overcome barriers to PA. 5. As Accessercise is a novel application, many users may miss the opportunity to be signed posted or to know what Accessercise can offer. Future research may consider ways to increase access to mHealth technologies. One way is by reducing social exclusion, marginalisation, and disability stigma through mainstreaming disability.

Answer 237

1. The development, evaluation and implementation of mHealth apps can be time consuming. Therefore, technology and target groups interest can quickly change and become outdated. 2. The functionality and features of Accessercise continue to expand, making it challenging to know the exact time to fully evaluate the apps behaviour change potential as this may change over time. 3. Even though the BCW can assist with designing interventions, it lacks a formal guide in translating BCTs. Consequently, translating BCTs into app features relies heavily on the expertise and and creativity of the research team and/or app developers. 4. Coding the BCTs from the app and completing the specified worksheets was time-consuming and labour-intensive. Therefore, this labour and time-consuming process could make it unfeasible for specific problems, organisations, and/or circumstances.

Answer 238

This study reveals the value of using the BCW to systematically identify the potential mechanisms of action for improving physical activity in adults with SCI, as well as the potential of a novel mHealth smartphone fitness app, Accessercise to change behaviour.

Answer 239

1. The effectiveness of Accessercise to facilitate the desired behaviour change should be assessed, such as via a Randomised Control Trial (RCT). Such high quality evidence would provide the foundation that could guide decisions concerning how to increase PA as well as health more generally, in adults with SCI.

Answer 240

Assessing the usability of Accessercise to increase physical activity in adults with physical disabilities: a qualitative think-aloud study

Answer 241

12 (10 male and 2 female)

Answer 242

Deductive Content Analysis

Answer 243

uMARS (User Version of the Mobile Application Rating Scale)

Answer 244

12 out of 15

Answer 245

The majority expressed positive views concerning most elements and features of the Accessercise app namely entertainment, customisation, tailoring to the target group, ease of use and navigation, as well as visual information. However, while some features were viewed positively, some required modification to increase their usability, credibility and relevance including the app's layout (Placing content in alphabetical order), visual appeal (in-built-colour setting), interactivity (providing real-time feedback), quality of information (number or bullet pointing content) and quantity of information (removing content such as equipment not related to a specific goal).

Answer 246

Our study is one of the first to show that a think-aloud protocol is acceptable and can be informative within the context of assessing mHealth apps to increase PA in people with disabilities. As such, this study offers an evidence-based example that app developers and researchers could use to inform their usability evaluations in this area.

Answer 247

1. mHealth interventions can support people with disabilities overcome numerous barriers to PA (e.g., transportation, high costs) 2. mHealth apps by people with disabilities can alleviate social and health disparities 3. mHealth interventions are cost-effective, can be undertaken practically anywhere and users can personalise the app based on their own needs and requirements. 4. Users are also not required to contact a personal trainer which could be costly because they can access personalised content via apps. 5. mHealth interventions appear to be promising (small-to-moderate effects) at increasing physical activity in the general population. Therefore, such results may be similar for people with disabilities.

Answer 248

1. Most of these interventions target a specific disability (e.g., amputee, spinal cord injury). For example WHEELS is aimed at wheelchair users with SCI or lower-limb amputation, while the 9zest Parkinson's Therapy app was created to promote PA in people with Parkinson's disease. 2. Very few focus on multiple disabilities, which restricts access to physical activity mHealth apps for people with disabilities, potentially increasing their risk of sedentary behaviour and lack of engagement in PA programs. Accessercise is unique because it focuses on multiple physical disabilities on one platform. Also, to our knowledge, no PA app has been developed and evaluated that provides tailored content for multiple physical disabilities via an mHealth-based platform.

Answer 249

1. You can select your own disability and the content of the app is shaped based around that impairment. 2. Exercise video library with numerous exercises which are delivered by a role model with that specific disability you have selected. 3. Accessibility/Explore Function - You can place your postcode in the search and find local facilities that are accessible. 4. Social Hub Feature - You can follow other users, follow their workouts and react and comment on their workouts to boost motivation. 5. Opportunities to build your own custom workout 6. Chance to exercise outside, in the gym or at home with many workout goals to choose from.

Answer 250

Usability is the evaluation to which a product/device is effective, efficient and viewed as satisfactory by the end-user.

Answer 251

Usability testing helps to identify possible issues with the app, to improve it's functionality and acceptance among it's users and hopefully lead to long term use.

Answer 252

Hardware issues like small screens and limited input opportunities, which can lead to low adherence or app rejection.

Answer 253

1. Think-Aloud Interviews 2. Questionnaires 3. Focus-Groups 4. Eye-Tracking 5. Interviews

Answer 254

Think-Aloud Interviews Think-Aloud interviews is commonly used for evaluating health behaviour change interventions.

Answer 255

1. Researchers can gain data on participants thoughts and needs during testing and ongoing verbalised information collected allows the researcher to identify the source of possible problems. 2. Think aloud interviews can help identify usability issues and identify improvements providing direct information on a user's thinking as they happen (real-time). 3. Think-aloud interviews help to overcome memory/recall bias of other methods (e.g., interviews, questionnaires) because Think-Aloud interviews collect real-time data as they happen while preventing the loss of data that may occur as a result of memory constraints.

Answer 256

These methods are at risk of recall/memory bias. Think-Aloud interviews allow us to get data on thought processes while they happen.

Answer 257

Our findings will help to inform future app development and hopefully improve adherence, physical activity, and health as well as providing this population a voice in and through research.

Answer 258

The current study employed think-aloud interviews to examine the usability of the Accessercise app, specifically designed for people with different physical disabilities.

Answer 259

Standards for Reporting Qualitative Research

Answer 260

This approach believes that multiple realities are socially constructed and meaning is created through the interaction between the researcher and the participants.

Answer 261

Hand-written field notes were undertaken in a reflexive diary, which included comments during and after each interview. My supervisors also acted as "Critical Friends" who debated and contested the conclusions identified in the data analysis and the final report.

Answer 262

Face-to-face interviews are better for marginalised groups (i.e., people with disabilities) to help build report.

Answer 263

Purposive sampling is when you select participants because they have characteristics that you need in your sample.

Answer 264

Think-aloud interviews allow an individual to verbalise aloud everything they think about whilst completing a task.

Answer 265

Content Analysis

Answer 266

Content Analysis involves assigning the text to one or more domains.

Answer 267

It's systematic and objective approach for identifying what content and information was contained in the discourse.

Answer 268

uMARS provides simplified reliability and a reduced number of items, which makes it easier for mHealth evaluations by individuals with different educational backgrounds, making it more of an inclusive analysis..

Answer 269

The uMARS is a simple, validated scale which assesses the overall quality of mHealth apps across four domains: Engagement, Functionality, Aesthetics and Information Quality.

Answer 270

Step 1: Created a formative categorisation matrix with four pre-set categories based on the uMARS. Step 2: Fimilarised myself with the data by re-reading all the interview transcripts and going through my reflexive diaries. Step 3: Specific relevant passages of text were highlighted and then colour coded using highlighter pens. Step 4: Colour-coded passages were clustered and a descriptive code was produced. Step 5: Any codes were then categorised based on their meanings, similarities and differences and then aligned to the pre-arranged categorisations within different themes and secon-dorder themes (higher-order themes and then second-order themes). Step 6: A content analysis map was then produced to share a view of the themes, codes and quotations.

Answer 271

Trustworthiness is one of the essential components of 'rigour' in Qualitative Research. Even though, four criteria is widely used, these have been criticised for violating the philosophical underpinnings of qualitative research. 'Reflexivity' was used. Therefore, specifically, a 'critical friends' approach was used. We also pilot tested the interview schedule All authors met three times to critically review and discuss the codes, sub themes and overall view of the content analysis. Each transcript and field note was emailed to participants to enhance trustworthiness.

Answer 272

Overall, our study adds to the number of limited studies that look at usability of mHealth apps. 1. This study has demonstrated that despite several troubleshooting difficulties, Accessercise can be effectively operated by various users with physical disabilities. 2. Our research has shown that Accessercise can be an effective app at supporting people with disabilities in overcoming numerous barriers to physical activity. 3. Such findings could help app developers/researchers consider ways that apps are currently designed based on user's preferences, which may in turn lead to an increase in uptake.

Answer 273

1. Several features on the app were under development during the testing phase, which could have affected the users' thoughts/feelings about the app. Therefore, future researchers should consider incorporating these functions to gain rich data on this and whether they will support usability from it's end-users. 2. Most participants were young male, Caucasians, English speaking and under the age of 58 and had sufficient mobile phone skills, which limits the generalisaiblity of our findings to other people with disabilities. Therefore, future researchers want to consider involving a more heterogeneous sample. 3. Interviewing participants in a controlled laboratory setting and audio-voice recording their responses may have lead to overly positive feedback/bias responses and may have induced or increase anxiety and impacted the participants' ability to use the app efficiently. 4. Participants completed a think-aloud interview in an unfamiliar setting, which is not how they would engage with the app in a real-world setting (e.g., at home or at the gym). Therefore, valuable data on the app's performance in a more ecologically valid environment could have been overlooked. Future researchers may want to supplement think-aloud interviews with field testing to address such issues.

Answer 274

The impact of my work is that we now know that Accessercise is a useful intervention that can increase physical activity in adults with physical disabilities

Answer 275

Assessing the effectiveness of Accessercise to improve physical activity in adults with physical disabilities: A randomised controlled feasibility trial

Answer 276

1. Feasibility 2. Attrition 3. Implementation of study delivery 4. Intervention fidelity

Answer 277

20 but only 14 completed the trial

Answer 278

We undertook qualitative interviews to assess participants experience of the RCT design

Answer 279

Feasibility was 'amber' for both adherence and attrition. Participants generally expressed happiness with the trial methods and intervention.

Answer 280

The mHealth intervention (Accessericse) appears feasible and acceptable and can proceed to a full trial but just requires a few changes. Due to moderate adherence and attrition rates, better recruitment techniques would be needed such as recruiting through the NHS and reducing the number of visits needed to the lab by completing assessments remotely, as well as reimbursing transportation costs.

Answer 281

Face-to-face and/or viva the telephone

Answer 282

mHealth refers to mobile health which is the practice of public health that is supported by mobile phones, such as smartphone apps.

Answer 283

1. They are normally free or inexpensive 2. Apps provide real-time feedback and content that can be personalised to an individual's needs 3. Can be accessed virtually anywhere (home, gym, park) 4. Apps are safe, usable and cost-effective 5. Apps can alleviate transportation and architectural barriers, which are enormous for people with physical disabilities.

Answer 284

Some of the existing apps are limited by focusing solely on several individual physical disabilities. No physical activity app has been developed and evaluated that provides tailored content for multiple physical disabilities via an mHealth-based platform.

Answer 285

Accessercise is a novel fitness and health application which was developed in 2021 by Ali Jawad and Sam Breary. The app was designed to increase physical activity for those with disabilities including those with spinal cord injuries, amputees and dwarfism. The app provides many interesting functions such as a social function, explore map function and an exercise video library.

Answer 286

The MRC framework provides 4 key phases when developing and evaluating new complex interventions

Answer 287

1. Development 2. Feasibility/piloting 3. Evaluation 4. Implementation

Answer 288

Since the Accessercise app has already been developed, it's acceptability and feasibility should now be assessed in the next stage (Step 2)

Answer 289

1. Assess the feasibility and acceptability of the intervention 2. Assess whether the outcomes, number of participants and equipment used is acceptable. 3. Assess whether parts of the intervention are good for a big trial 4. Determine whether undertaking a full-scale trial is worth it in terms of cost, time and resources.

Answer 290

1. Measure the following outcomes before and after using Accessercise: Self-reported PA, psychological health, physiological health, adverse effects, health-related QoL and usability. 2. Qualitative assess implementation of study design and intervention fidelity 3. Determine the willingness of adults with physical disabilities to take part in the trial, as well as their retention through to follow up

Answer 291

The CONSORT statement is made up of a 25-item checklist that provides the author with a solid backbone around which to construct and present an RCT.

Answer 292

1. Adult aged 18+ to 65 years old? 2. Live with a physical disability (e.g., SCI, amputee, dwarfism). 3. Have access to a compatible smartphone device to use Accessercise 4. Live within the United Kingdom (UK)

Answer 293

1. Social Media Channels (e.g., X, Facebook) 2. Word of mouth 3. National Governing Bodies (e.g., WheelPower) 4. Rehabilitation Centres 5. Contacting participants from previous studies who had provided consent to be contacted for future studies.

Answer 294

Qualtrics is an online system, which I used to place all the demographics, questionnaire questions onto to allow participants to answer them.

Answer 295

Baseline (i.e., Week 1) and post-intervention (i.e., Week 12).

Answer 296

This was down to Willingness to take part., which was down to the traffic light system to assess progression to a full-scale trial.

Answer 297

The traffic light system assess adherence (how often participants took part) and attrition (how many participants dropped out) against a green, amber and red traffic light system. Green: Proceed to a full trial Amber: Proceed to a full trial but requires amendments Red: A full trial should not be undertaken. You work out the number of participants that took part and how many dropped out and this will help determine whether it's green, amber or red.

Answer 298

1. Self-reported Physical Activity 2. Psychological Health 3. Physiological Health 4. General-Health Related QoL 5. Adverse Effects 6. Usability

Answer 299

PASIPD (Physical Activity Scale for Individuals with Physical Disabilities)

Answer 300

WEMWBS (Warwick Edinburgh Mental Wellbeing Scale)

Answer 301

1. Body Composition (Weight) 2. Waist Circumference (Tape measure) 3. Heart Rate (Heart Rate Sensor) 4. BP (Blood Pressure Monitor)

Answer 302

1. Pain was measured using BPI-SF (Brief Pain Inventory - Short Form) 2. Fatigue was measured using FSS (Fatigue Severity Scale)

Answer 303

We used the SF-36 (Short Form - 36 Questionnaire)

Answer 304

We used the uMARS (User Version of the Mobile Application Rating Scale)

Answer 305

Due to this feasibility study was not powered to test for statistically significant differences as the sample size was too small, Mann Whitney U tested were to analyse differences between groups for all secondary outcome measures.

Answer 306

To understand participants experiences of the RCT design as well as the intervention implementation and fidelity, we undertook interviews at the end of the 12-week trial.

Answer 307

1. Motives for participating 2. Possible barriers to attending 3. Research design (e.g., recruitment, randomisation, outcomes) 4. Intervention implementation and fideity

Answer 308

Reflexive thematic analysis

Answer 309

1. We found between the intervention and control groups did not differ statistically between any of the assessed measures.

Answer 310

The scores were above 3 for all subscales, suggesting acceptable usability of Accessercise across all uMARS subscales

Answer 311

1. Study adherence 2. Study testing 3. Study satisfaction 4. Researcher involvement

Answer 312

1. The feasibility relating to the willingness of participants to engage and complete the trial were satisfied (feasible) but required amendments. 2. The implementation and interview fidelity were well-perceived among participants (e.g., regarding the ranomisation, researcher involvement and outcomes) 3. However, responses regarding app usage, whether the app would be recommended to others was perceived unfavorably among participants.

Answer 313

Possibly the intervention (or app) did not meet the users' needs, goals and expectations. Participants reported that the app was not always relevant to users disability, lacked appropriate exercises and app functions were still under development. People with disabilities experience numerous barriers in research (e.g., transport) so this could have made it more difficult for them.

Answer 314

1. Costs and travel challenges involved in attending in-person sessions.

Answer 315

1. Make relevant changes to the research design to allow users to complete the assessments online rather then in-person reducing transportation, time and costs. 2. Researchers should undertake regular check-ins via phone/video calls and to perform assessments at participants' home/closer locations to overcome accessibility barriers. 3. Another solution is to involve potential users during the entitle cycle of intervention development. User-centred design is helpful for mHealth app development as it enables better designs and improves interventions.

Answer 316

1. Recruitment from GPs or the NHS could be more valuable than advertisement via mass media strategies such as leaflets or social media posts in a future large-scale trial to recruit people with physical disabilities at high risk of loneliness or social isolation.

Answer 317

1. We undertook the study following key guidelines (e.g., SRQR, CONSORT, MRC) as well as employed the "traffic light system". Following these guidelines improved the reporting of the evidence, promoted transparency, comprehensiveness, accuracy and well-written research, as well as improved the communication of the results to the scientific community. Therefore, the reliability and validity of the findings were maximised by following these guidelines. 2. The mixed methods approach (qualitative and quantitative) enabled the researches to gain a comprehensive understanding of the trial feasibility and intervention acceptability. 3. The intervention component of the trial required minimial resources, was cost-effective (free to participants) and required no additional thoughts from the researchers. 4. The Accessercise app was simple to use, can be used in any suitable location and can be personalised to the individual's needs. 5. We followed the MRC framework, by undertaking the first feasibility RCT of a novel app (Accessercise) for people with physical disabilities, which was valuable to identify potential refinements to the intervention, address any issues with the study design and assess the preliminary effects of the intervention.

Answer 318

1. As this was a feasibility RCT, it was not sufficiently powered to detect changes in quantitative outcomes pre-to-post intervention. However, it provides some useful information to help inform the design of a full-scale RCT to establish the overall effectiveness of the Accessercise app in people with physical disabilities. 2. The majority of participants were Male, White British and had a spinal cord injury. 3. Due to technical difficulties, only those that had owned a compatible smartphone device could participate, which could explain why most participants were young to middle aged. 4. Due to privacy reasons, we were unable to access data on how often participants engaged with the app and it's provided features. This is imperative because researchers should not only rely on self-reported measures because this data is often unreliable, perhaps due to poorer recall. 5. Blinding the participants and researchers was not possible due to the nature of the intervention and trial design, which could have led to bias. 6. This trial was completed in a single laboratory, which could limit the generalisability of results. 7. Interviews were only taken on those that completed the trial, which could be a sense of bias, as we don't know why some participants dropped out.

Answer 319

1. We have found that Accessible is feasible and can proceed to a full-trial with some amendments. 2. The intervention implementation and fidelity are acceptable and deliverable among participants and the adherence and drop outs are moderate based on the traffic light system. However, with moderate adherece and drop-out rates, further refinements are needed to enhance users' engagement before a full-trial. 3. Therefore, the next step is to undertake a full-scale RCT which could indicate whether Accessecise can effectively increase PA in adults with disabilities. 4. Future researchers may also want to use the findings I have found in my study to improve feasibility (e.g., recruiting through the NHS, undertaking assessments online and performing regular check-ins) to overcome accessibility barriers when designing similar RCTs in the future.

Answer 320

1. David acted as a "critical friend" by meeting with James regularly to discuss any field notes that he produced. 2. The interview schedule was pilot tested with the first participant to assess and refine question order and wording etc. 3. Interview transcripts were emailed to participants for comments/corrections to maximise transparency and trustworthiness of the datasets (I.e., member checking) with no amendments made to the final transcripts.

Answer 321

The principal aim of this thesis were to understand how to increase physical activity in adults with disabilities. To answer this research question, 4 small research aims were undertaken: 1. To evaluate the effectiveness of physical activity interventions in manual wheelchair users with SCI. 2. To assess the theoretical underpinnings of a new mobile health application (or app), Accessercise, using the Behaviour Change Wheel (BCW) 3. To qualitatively examine the usability of the Accessercise application using concurrent Think-Aloud interviews. 4. To determine the feasibility of undertaking a full-scale evaluation of the Accessercise app

Answer 322

Before evaluating a behaviour change intervention, which we do in Chapter 3-5, a systematic review and meta-analysis were undertaken in accordance with the Medical Research Council (MRC) framework for developing and evaluating complex interventions.

Answer 323

To examine the effectiveness of physical activity interventions in manual wheelchairs users with SCI.

Answer 324

Eleven studies were included in the review with 6 being included in the meta-analysis. It was found that post-intervention that self-reported physical activity significantly improved in the intervention group relative to the control group.

Answer 325

Unfortunately, due to heterogeneity in outcome measures and research designs we were unable to perform a meta-analysis for these outcomes. However, based on a narrative synthesis we found similar patterns of improvements in behavioural physical activity, functional fitness, adverse effects, physiological, psychosocial wellbeing and quality of life were found.

Answer 326

Given that behaviour change theories are imperative when evaluating interventions, based on the MRC guidance, the next step following this study, is to begin to develop a new intervention and/or identify interventions that already exist. During the PhD, the research team were contacted by the Accessercise team who sought a formal evaluation of their newly developed app. Given the apps alignment to the current work (i.e., aims to improve physical activity for people with disabilities), we first assessed the theoretical underpinning using the BCW.

Answer 327

Using the BCW, we have identified that Accessercise offers users the physical and psychological capability (goal-setting) to improve physical activity, offers users the physical and social opportunity (feedback) to reduce sedentary behaviour and offer users automatic and reflective motivation (reviewing goals). Also, Accessercise was found to have high behaviour change potential, which indicates that Accessercise should be able to support people with spinal cord injuries to increase their physical activity levels.

Answer 328

While Accessercise seems to be a strategic approach for increasing physical activity, little is known about its usability and how this might impact physical activity in people with physical disabilities. Therefore, the next study (Chapter 4) assessed the usability of the Accessercise app.

Answer 329

Currently, there is a limited number of usability studies of mHealth apps which focuses on changing behaviours in people with physical disabilities, such as physical activity.

Answer 330

We qualitatively examined the usability of the Accessercise app that aims to increase physical activity in people with disabilities by using concurrent Think-Aloud interviews.

Answer 331

We used Deductive Content Analysis using the uMARS scale.

Answer 332

The findings revealed high acceptance and potential for the Accessercise app to provide people with physical disabilities with an easy-to-use, accessible intervention to increase physical activity.

Answer 333

These findings provided insight into the usability of the app, which may help support developers to refine mHealth interventions specifically targeted at this population.

Answer 334

Since smartphone have become an integral part of life/society with over 3.5 billion users worldwide, smartphone may be a suitable intervention to increase physical activity in adults in with physical disabilities. However, few studies have evaluated mHealth physical activity interventions in this population. This final study extends the findings of Chapter 4 and builds onto the next phase of the MRC framework (i.e., feasibility/piloting) before undertaking a large-scale RCT.

Answer 335

20 participants with only 14 participants completing the trial.

Answer 336

Overall an RCT design assessing the effectiveness of Accessercise was considered feasible in terms of fidelity, acceptability, and adherence, with the next stage being to progress to a full-scale RCT with some amendments.

Answer 337

mHealth is a potential and promising strategy to increase physical activity in marginalised problems, including adults with physical disabilities. However, despite the Accessercise having high behaviour change potential, including 22 BCTs, and being viewed as usable, feasible and acceptable, it is unlikely that just an app alone even if it's specific for people with disabilities, will increase their PA levels.

Answer 338

Interventions should be multi-component. For example, designing interventions that incorporate nutritional alongside education into an intervention. Overall, the empirical study chapters have highlighted that the Accessercise intervention worked for some participants but not for others, leading to difficulties in engagement.

Answer 339

Proactive involvements of stakeholders (e.g., people within the disability community, healthcare providers, family members, etc). One helpful approach is to evaluate stakeholders' ideas and experiences during all phases of the development of the intervention, therefore to ensure that intervention is person-centred and more acceptable to the target population.

Answer 340

Most interventions that aim to increase physical activity for people with disabilities are delivered in-person or over the phone. However, due to the presence of environmental barriers (e.g., lack of transportation) and architectural obstacles (e.g., inaccessible facilities) when accessing intervention settings (e.g., clinics, universities) alternative forms of remote intervention delivery (e.g., mHealth) may be more effective than face-to-face delivery for people with physical disabilities. Unlike face-to-face interventions, which require more attention from participants and may be labour intensive, mHealth interventions including Accessercise can be delivered long-distances, and have high cost-effectiveness, efficiency, and accessibility, as well as allow for easy data collection. Additionally, these interventions require minimal to no ongoing human involvement in their set-up and can be delivered automatically. These advantages may have made it more easier for participants to engage in more physical activity opportunities throughout this current research. Overall, this thesis has reported that mHealth technologies have a potential advantage in facilitating health behaviour change to support people with physical disabilities in increasing physical activity and reducing sedentary behaviour.

Answer 341

It is well known that many barriers exist when it comes to undertaking physical activity for people with disabilities. The use of mHealth has emerged as a potential and promising strategy to tackle potential barriers for individuals with disabilities, particularly those with restricted mobility, such as wheelchair users. Overall, our research has shown that mHealth may be an easy-to-use and feasible tool to overcome physical activity-related barriers for adults with physical disabilities. The Accessercise app allows users to exercise in any suitable location (e.g., home, gym, park), offers a free-to-use service, and is adapted based on users' needs. These features are effective as digital exercise platforms can overcome barriers, provide convenience and guided programs, do not require transportation, and have potential cost savings compared to traditional approaches like a gym membership or personal training.

Answer 342

The research provided in this thesis has answered the principal aim by showing that mHealth interventions can help people with disabilities overcome physical activity-related barriers, which may support people with disabilities in increasing their physical activity levels. For example, mHealth interventions can be delivered remotely reducing the need to travel, it offers users opportunities to exercise at home, and can reduce the high costs of a gym membership. Specifically, this thesis has shown that the Accessercise app could be a useful solution to support PA in people with disabilities due to its high behaviour change potential and good usability. In addition, it has been shown that a full-scale RCT assessing the effectiveness of Accessercise would be feasible. Nevertheless, before making definitive conclusions, the Accessercise app must still be tested in an RCT to determine the overall effectiveness in adults with physical disabilities.

Answer 343

We know that undertaking PA for people with disabilities is difficult. Changing behaviours is hard work. Therefore, interventions that aim to increase PA for people with disabilities need to consider using techniques to enable engagement in the target behaviour. Chapter 3 has revealed that using the BCW revealed that the BCW app incorporates opportunities for adults with SCI to be physically and psychologically capable of undertaking PA, offers opportunities to reduce sedentary behaviours and supports motivation. Interventions that are underpinned by theory are more effective then atheoretical interventions as they outline the mechanisms of behaviour change.

Answer 344

The implications of this thesis could be encouraging for the community of people with physical disabilities, as the findings have indicated that Accessercise is feasible, adhered to and was received positively among people with physical disabilities. However, although this intervention may support some individuals, it may not be supportive for others. If those who find it strategies and effective use it, this may be pivotal in overcome PA barriers and helping address the low PA rates in people with disabilities. This thesis has shown the benefits of engaging with people with disabilities in research and in product development, which may support other researchers when designing and evaluating similar PA mHealth interventions for people with disabilities.

Answer 345

Whilst most health care professionals (e.g., nurses, doctors) have limited involvement in PA promotion) due to a lack of knowledge, confidence and time, the findings reported within this thesis may be used as guidance within healthcare professionals practice. For instance, healthcare professionals working in PA for people with disabilities may use these findings to help people with disabilities make more sustained changes to their PA behaviour using mHealth interventions.

Answer 346

1. Mixed methods approach 2. Structure of studies (Systematic Review) first 3. Followed the MRC framework for developing and evaluating interviews 4. Retrofitted the BCW to the Accessercise app 5. Followed several frameworks (e.g., TIDIER, SRQR, PRISMA, CONSERT)

Answer 347

1. Most participants were Male, British, under the age of 58 and were from the East Midlands area. 2. Most outcomes in this thesis relied on self-reported outcomes (e.g., PASIPD) 3. Accessercise was under developed during testing 4. We were unable to assess the effectiveness of Accessercise (yet to establish the effectiveness of the app)

Answer 348

1. Further high quality RCTs that incorporate objective measures of physical activity, bigger sample sizes and over a longer period of time. 2. To investigate whether delivering different PA interventions for manual wheelchair users with SCI via different modes (e.g., telephone counselling, weekly video conferencing) can result in long-term benefits. 3. To identify strategies to improve access to mHealth technologies for people with disabilities and identify ways to overcome social exclusion, marginalisation, and disability stigma. 4. A large definitive trial is needed to assess the effectiveness of the Accessercise app in terms of increasing PA for people with disabilities. 5. To increase recruitment and retention of a diverse sample of adults with physical disabilities in mHealth interventions, that better reflects the population of the UK and internationally.

Answer 349

This mixed-methods PhD thesis has provided a novel insights into ways of improving physical activity for people with disabilities, an area that has been under researched. The systematic review provided an overview of the effectiveness of existing interventions to increase PA for people with disabilities, providing a rationale for the remaining chapters. Novel findings regarding the use of a novel smartphone app (Accessercise) to increase PA have been found and positively evalauted, in line with the MRC framework, with clear directions. Overall, it is anticipated that the findings reported from this thesis will propose solid evidence base of the benefits of physical activity for adults with physical disabilities and, as a result, influence the design, implementation and evaluation of future physical activity interventions that can ultimately enhance their psychological wellbeing and quality of life.

Answer 350

Loughborough has strict requirements when it comes to ethics. It's strict in terms of allowing researchers to undertake physical activity interventions in people over the age of 65. Therefore, we capped the the age at 18-65 years old only.

Answer 351

Manual Wheelchair users are among the most physically inactive population of SCI. 80% of manual wheelchair users with SCI

Answer 352

- Talk about my PhD project - My career ambitions - My experience at Loughborough (e.g., teaching, invigilating)

Answer 353

My PhD project is about understanding how to increase physical activity in adults with disabilities. To achieve this we undertook 4 research studies/aims: 1. To assess the effectiveness of physical activity interventions for manual wheelchair users with SCI. 2. To examine the theoretical underpinning of the Accessercise app aimed at increasing physical activity for people with disabilities using the BCW 3. To qualitatively evaluate the usability of a novel mHealth intervention (Accessercise) using concurrent Think-Aloud interviews 4. To determine the feasibility of the Accessercise app before undertaking a full-scale trial

Answer 354

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Answer 355

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Answer 356

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Answer 357

Due to the experience and research expertise of staff at Loughborough University and because people with SCI are at the lowest end of the physical activity spectrum for people with physical disabilities, SCI was a suitable intervention for my PhD.

Answer 358

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Answer 359

Ma and Ginis (2018) and Watson (2023) used a range of SCI populations. However, people with SCI are heterogeneous and have different requirements. Among this population, manual wheelchair users with SCI are the most physically inactive..

Answer 360

My aim of my PhD thesis was to understand how to increase PA in adults with disabilities. This was answered by answering 4 small sub-aims.

Answer 361

I felt like the introduction had clear thread to help the reader understand disability, spinal cord injury and then into why interventions are important for people with disabilities.

Answer 362

Due to the COVID-19 pandemic and the development of smartphone use of over 3.5 billion individuals, mHealth interventions have been viewed as a possible solution at helping people with disabilities in overcome physical activity barriers.

Answer 363

1. The majority of outcomes we assessed were self-reported (e.g., PASIPD, LTPAQ-SCI), which has increased risk of recall bias. 2. We only allowed studies that were written in English which reduces the number of eligible studies to be included. 3. All the interventions were no longer then 12 months. The mean length of interventions was 5.5 months, which limits the understanding on whether the interventions could lead to long-term behaviour change.

Answer 364

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Answer 365

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Answer 366

As the Accessercise app approached us, they wanted a series of research studies to be undertaken, which are mixed in various ways. Also, as we followed the MRC framework, this involved different steps and these different steps require a mixed approach.

Answer 367

1. Most popular approach to analysing qualitative data 2. Enter here

Answer 368

1. Time-Intensive: Analysing large amounts of content can be time-consuming, potentially limiting the scale of the study. 2. Limited Context: Content analysis may lack the context that could provide a deeper understanding of the material being studied. 3. Subjectivity: The interpretation of content can vary between analysts, leading to subjective results.

Answer 369

I used a combination of recruitment strategies (e.g., word of mouth, rehabilitation centres, social media, websites) to ensure that I recruited a number of suitable and reliable participants.

Answer 370

While useful software like NVIVO is helpful with analysing qualitative research, however due to limited time on the PhD and experience with this software, I reverted back to old school with using highlighters and pens to manually analyse my transcripts.

Answer 371

I'm not aware of any limitations of using RevMan but this software is valuable in helping undertake meta-analyses.

Answer 372

I had collected pre and post data on these outcomes. Step 1: I had one column for the number of participants (e.g., P1, P2, P3) followed by the next column which showed what group the participants were in either the intervention or control group. Step 2: I input the pre and post data next to the participants ID number and their group. Step 3: Once I had the pre and post data inputted, I then pressed transform, compute variable, transform, placed post minus pre and got a difference score. Step 4. Once I got my difference score, I then ran a Mann Whitney U which gave me the results I needed.

Answer 373

For each study, I checked the results for each study when it came to self-reported PA. For self-reported PA I collected pre and post-date for this outcome and placed it within the RevMan software.

Answer 374

Some limitations of mixed methods are the following: 1. Mixed methods can be challenging and time consuming to undertake if you are predominantly either a qualtiative or quantitative researcher. Researcher has to learn multiple methods and be able to know how to mix each method effectively 2. Time consuming to collect, analyse and write up the paper if you have limited experience. | 1.

Answer 375

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Answer 376

Come back to this one

Answer 377

I have accepted a 3-year postdoctoral role at the University of Chichester, where I will be teaching and working on exciting NHS project. I inspire to eventually progress onto a Lectureship with my dream of eventually being a Professor.

Answer 378

Moving forward beyond this research, there are a number of recommendations I would offer. These are the following: 1. Undertook more high-quality RCTs which included objective measures of PA (e.g., actigraphs, accelerometers), bigger sample sizes and long-time period. 2. To investigate whether deliveirng different modes of mHealth interventions (e.g., telephone counselling, weekly video conferencing) can lead to long term benefits in manual wheelchair users with SCI. 3. To examine the effectiveness of Accessercise at increasing PA in adults with physical disabilities in a full-scale trial. 4. To identify solutions to better engage people with disabilities in mHealth interventions to overcome social exclusion, disability stigma and marginalisation. 5. To identify strategies to improvement recruitment and engagement of a diverse sample of people with physical disabilities, which better represents the popualtion of the UK and internationally.

Answer 379

Usability Study (e.g., Disability and Rehabilitation, Clinical Rehabilitation, Rehabilitation Psychology) Feasibility Study (e.g., Plos Digital Health, Plos One, Health Psychology) Systematic Review (e.g., Archives of Physical Medicine and Rehabilitation)

Answer 380

(Simplified the language, worked as a care worker to make it easier) I'm going for further study (post-doc) and that I am starting to look forward for an academic career

Answer 381

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Answer 382

We did a feasibility study which is not powered to test for statistical differences. Therefore, as our sample size was small, had 2 groups etc, we decided to do a Mann Whitney U

Answer 383

1. Social Desirability Bias 2. It can be difficult to concentrate on complex thoughts when you're thinking out loud.

Answer 384

Between 12-15 participants is enough to determine usability.

Answer 385

1. Evaluating a novel physical activity app 2. Working with people with disabilities 3. Developing my knowledge of psychological theory 4. Publishing articles.

Answer 386

I am starting a post-graduate associate role in health psychology at the University of Chichester.

Answer 387

My career goals are that I inspire to be a Professor of Psychology.

Answer 388

I really enjoyed using the Think Aloud method. It's quite rare as an UG or PG to use this technique so this was a new experience for me.

Answer 389

I wanted to undertake a PhD to push the boundaries of knowledge when it came to physical activity interventions for people with disabilities.

Answer 390

By getting this PhD, I can undertake more advanced academic positions which will help me get the job of Professor of Psychology in the future.

Answer 391

Using a mixed method approach, we aimed to understand how to increase physical activity in adults with physical disabilities. In order to answer this question, we had 4 sub-aims. For example: 1. To assess the effectiveness of physical activity interventions in manual wheelchair users with SCI. 2. To evaluate the theoretical underpinning of the Accessercise application using the BCW. 3. To examine the usability of the Accessercise app in adults with disabilities using concurrent think-aloud interviews. 4. To determine the feasibility of the Accessercise app before undertaking a full-scale trial evaluation.

Answer 392

To identify ways of improving physical activity for people with disabilities in order to support them in achieving recommended guidelines, reducing risk of noncommunicable diseases and sedentary behaviour.

Answer 393

My MSc project looked at the barriers and facilitators to physical activity for young adults with sensory/physical barriers. From this study, I then wanted to develop an intervention to increase PA in these populations. Therefore, I progressed onto a PhD which looked at understanding how to increase PA in adults with physical disabilities.

Answer 394

People with disabilities are physically inactive, increasing their risk of noncommunicable diseases and placing pressure on the NHS. Therefore, we need to design, implement and evaluate physical activity interventions in this population.

Answer 395

We were approached by the Accessercise team, which seeked an evaluation of their app. In order to achieve this, we followed the MRC Framework, with the first step being the systematic review and from this study it opened up the rationales/gaps for the remaining studies.

Answer 396

We undertook many trustworthiness attempts to ensure are work is accurate. For example: 1. We pilot tested the interview schedule (Studies 3-4) 2. David Maidment acted as a "critical friend" where he would read some of my codes, themes and write up to ensure that he was happy with what I provided. 3. Member checking - I also sent my participants their transcripts to ensure that they were happy with what I included.

Answer 397

Researchers, people with disabilities, disability activists, health care professionals, students.

Answer 398

The small sample size meant the data was not normally distributed and therefore it was a non-parametric test and based on the data the Mann Whitney U test was the most suitable.

Answer 399

Loughborough have strict ethical guidelines when it comes to doing physical activity interventions for individuals over the age of 65. Therefore, we decided to cap on our participants at 18-65 because anyone older would be unethical.

Answer 400

We followed the MRC framework.. Each step requires us to design our study in a particular way (e.g., usability, feasibility, etc)..

Answer 401

Discussion section of my research..

Answer 402

Yes. In the systematic review, I was assuming that the physical activity interventions would improve as a result of using theory. However, I actually found the opposite, which may be due to a small sample size being used.

Answer 403

1. Every study has problems/limitations/some sort of bias 2. Recall bias (self-reported outcomes) 3. Overrepresentation of participants (too many SCI and too many young people) 4. Social desirability 5. Feasibility Study - No external researcher was involved in blinding or randomising the participants

Answer 404

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Answer 405

I emailed potential participants if they were interested with 12 out of 20 participants wanting to take part in this research.

Answer 406

I emailed potential participants if they were interested with 12 out of 20 participants wanting to take part in this research.

PhD Viva Flashcards

Practice for my PhD viva (459 cards)