The MOTIVATE study will take place in Singapore with participants recruited through
hospital-based stroke clinics, rehabilitation facilities, and stroke support
organizations via posters, email, word of mouth, and social media. Potential participants
can sign up by self-registering on the study URL link or through referrals from
healthcare professionals and study members. Participants will be screened for eligibility
via telephone using the inclusion and exclusion criteria and the Get Active
Questionnaire. Participants. Those who have not engaged in regular exercise are required
to obtain medical clearance. Informed consent will be taken by a study team member.
This trial will use a 1:1 concealed randomisation, to allocate participants with chronic
stroke to an intervention group (n= 60) or control group (n = 60). Between-group
comparisons will be made at 3 time points: months 1, 3 and 6.
The control group will receive usual care, which consists of 3 face-to-face sessions on
general physical activity recommendations, lasting 30 to 60 minutes each during months 1,
3, and 6. Participants will be given an information sheet on the importance and benefits
of physical activity after a stroke and general guidelines on how to start to be active.
The general guidelines on how to be active include engaging in 150 minutes of
moderate-intensity physical activity per week. The information sheet will also include
links to publicly accessible online resources.
The intervention group will receive a behavioural change intervention, in addition to
usual care. Information sheet about general guidelines on physical activity will be
handed to the intervention group, as per control group. Each participant will receive up
to 6 sessions of tailored behavioural change intervention during months 1 to 3 and there
will be no intervention during months 4 to 6. Of the 6 sessions, 3 are face-to-face and
another 3 will take place using telehealth methods such as phone, text messaging and
videoconference. The tailoring of the intervention allows participants to decide the
location during face-to-face sessions, how many sessions and how the sessions are spaced
out during the 3-month intervention period and which sessions are face-to-face or
telehealth. The preferred meeting location may include exercise spaces within home,
common spaces just outside their homes and under their housing blocks, outdoor fitness
zones or parks near home and residential or inclusive public gyms. The behavioural change
intervention consists of physical activity counselling and prescription of a personalized
physical activity plan. The first session will be conducted in-person, to allow the study
physiotherapist to identify the participant's physical function, safety concerns and the
impact of medical, social, environmental and resources on mobility. During the initial
visit, the venue, frequency and mode of support (face-to-face or virtual) for subsequent
sessions will be established. The study physiotherapist will provide physical activity
counselling, set goals and discuss action plans to enhance moderate intensity physical
activity, problem solve barriers on physical activity and prescribe a personalized
physical activity plan. Subsequent sessions can include (1) training on physical activity
modification to accommodate the weak arm and / leg at the participant's preferred
exercise location, (2) taking videos of the personalized adapted exercises using the
participant's phone when meeting face-to-face and (3) in-person or virtual support
sessions to review physical activity progress and action plans.
A process and cost-utility evaluation will be embedded into the study design and
conducted concurrently.