Modifying exercise and physical therapy in medical rehabilitation to promote a physically active lifestyle: Protocol for a multicenter controlled hybrid type 2 effectiveness-implementation study in three German rehabilitation centers

INTRODUCTION: Since rehabilitation programs often do not enhance long-term physical activity in persons with a health condition, there is a great need to arrange rehabilitation concepts towards a stronger emphasis on sustainable physical activity promotion. In this regard, the model of physical activity-related health competence (PAHCO) offers the potential for optimizing physical activity promotion. In the context of medical rehabilitation, the STABEKO study uses a co-creation approach to modify existing exercise and physical therapy according to PAHCO and long-term physical activity promotion in three rehabilitation centers in Bavaria, Germany. The objectives of the STABEKO study are A) to evaluate the implementation of modified exercise and physical therapy and to identify influencing factors for development and implementation, and B) to determine the short- and long-term effectiveness of the modified therapy on PAHCO and physical activity of the persons undergoing rehabilitation. METHODS: As part of the STABEKO study, we will use cooperative planning as a co-creation approach for planning, developing, and implementing actions to modify exercise and physical therapy by engaging relevant actors from practice, policy, and research in an equal decision-making process. Within a multicenter controlled hybrid type 2 effectiveness-implementation study, we will simultaneously evaluate the effectiveness and implementation of modified exercise and physical therapy by collecting, analyzing, and triangulating qualitative and quantitative data at several measurement time points. DISCUSSION: The STABEKO study will provide comprehensive insights into the implementation and effectiveness of exercise and physical therapy in medical rehabilitation, modified using a co-creation approach to promote long-term physical activity of persons undergoing rehabilitation. While the implementation study will indicate which modifications could be achieved and which factors have influenced their development and implementation, the effectiveness study will investigate whether modified exercise and physical therapy lead to changes in PAHCO and physical activity in persons undergoing rehabilitation. The results of this study will determine the dissemination of long-term physical activity promotion in the German rehabilitation sector and will provide important information for modifying existing therapeutic concepts to improve their effectiveness and implementation at an international level. TRIAL REGISTRATION: The study was registered on the Open Science Framework on July 8 2024: https://doi.org/10.17605/OSF.IO/2N8UM and https://doi.org/10.17605/OSF.IO/J3KR2 .