Bridging the gap
To address the barriers to physical activity among people with mobility disabilities, a consensus activity exploring how to improve collaboration between research, clinical and community knowledge users was conducted in Quebec, Canada. A knowledge user was defined as ‘an individual who is likely to be able to use the knowledge generated through research to make informed decisions about health policies, programs and/or practices’.23 Held during a research conference to facilitate in-person participation, the half-day meeting involved an interdisciplinary group of 17 clinicians, researchers, graduate students with expertise in mobility and physical activity, and representatives of community organisations. The activity followed the Collaborative Prioritized Planning Process, which is designed to help groups achieve consensus on key challenges, solutions and action plans within their focus area. This process-based and solution-focused approach is grounded in the guiding principles of creativity, democratic collaboration and inclusivity, and includes four steps: (1) Knowledge synthesis; (2) Challenge identification and prioritisation; (3) Solution identification and consolidation and (4) Prioritisation and action planning).24 Following this four-step approach, the group identified and prioritised gaps in the literature and current challenges in clinical and community settings regarding physical activity for persons with mobility disabilities. They then proposed aligned solutions and actions to be taken.
Although the activity initially aimed to identify research priorities, it became evident during the discussions on current challenges that the need for resolution of implementation issues was more critical than the need for new research. Despite the variety of participants involved, the overarching message was unanimous: ‘physical activity is for everyone’.19 In line with the current literature, they agreed that promoting mobility and physical activity opportunities would require multisector approaches that consider how to change environment and healthcare system policies to enhance accessibility, and how to best engage knowledge users to educate and motivate the target population.22 25 26 In this way, participants of the consensus activity identified three challenges to address the barriers to physical activity promotion among people with mobility disabilities: (1) the need for a better services and communication continuum between research, clinical and community organisations, (2) an enhanced knowledge mobilisation between those settings, and (3) more education to healthcare professionals and community knowledge users regarding physical activity. Figure 1 illustrates participants’ viewpoints on how knowledge mobilisation and education could help bridge the gap in the continuum between clinical and community settings, by allowing research results to be communicated and interventions implemented. Participants of the consensus meeting proposed solutions and actions that may target the three identified challenges as described in the three action items below.
Action 1: create and optimise the continuum
As previously described, the lack of a communication and a continuum of services directly impacts health outcomes of the population.8 From an organisational standpoint, a formalised structure between the various clinical and community settings could facilitate participation in physical activity for individuals with mobility disabilities, especially after cessation of traditional rehabilitation services. Identifying current partnerships and funding opportunities for implementing interventions and programmes in local contexts were the first actions suggested by the participants. They stated it would allow to describe the current state of their continuum to identify indicators of success for the future (table 1).
Action 2: mobilise the knowledge
Participants stated that evidence from research is not commonly made accessible to the potential knowledge users (whether clinicians or community organisations), therefore limiting the implementation or optimisation of physical activity programmes. This gap directly and negatively affects people who could benefit from engaging in these programmes. Alternatively, research does not always fully value experiential knowledge of the people directly involved in community programmes and their clientele in identifying needs and possible solutions. Mobilising knowledge would imply developing an efficient bidirectional relationship between the different knowledge users and different settings to share ideas, needs and knowledge (both from research and experiential). Suggestions on how to enhance this relationship are provided in table 1.
Action 3: educate the knowledge users
Finally, the lack of education resources for healthcare professionals and community knowledge users is a major barrier to physical activity participation in this population.19 20 According to the participants, developing new education opportunities for knowledge users would allow to better adapt programmes to the needs of people with mobility disabilities (table 1). Accordingly, some educational resources have already been developed in Quebec (and across Canada) and are accessible online (table 2).
Considerations for next steps
For physical activity to be inclusive for everyone, research priorities should focus on developing, testing, and, above all, implementing interventions aiming at making physical activity accessible for individuals with mobility disabilities within the continuum between rehabilitation and community settings.19 A critical step needed is to include individuals with mobility disabilities in the development of solutions to address calls to action identified by rehabilitation and community researchers and professionals. Evidence suggests involving people who could benefit from the research results from the very start of the process, to create innovations together and better address the needs of the community.27 Programmes that are created with participatory research are more likely to be successful27 and lead to systemic change of practices28 because they involve users, their needs and context-specific knowledge from the start. In this consensus activity, the three challenges identified by the participants (continuum, knowledge mobilisation and education) were consistent with the strategies for effective participative research, including maximising communication strategies, engaging community partners in all stages of research, and creating education and training opportunities for all team members.28 This consensus activity mainly targeted researchers, clinicians and community organisation workers, who can become (unwillingly) barriers to physical activity participation for people with mobility limitations. To ensure the identified solutions and actions address the needs of people with mobility disabilities, the next consensus activity and any steps taken to answer the action items should include the voice of people with mobility disabilities.