"This patient is not appropriate": Perspectives of physiotherapy students and clinical educators on exposing students to patients with complex needs during clinical practice placements.

BACKGROUND: Clinical practice placements play an important role in preparing students for challenging areas of clinical practice. Little is known about student learning needs for working with patients with complex needs during clinical practice placements, and clinical educator decision-making that underpins this exposure. PURPOSE: To explore the perspectives of physiotherapy students and clinical educators on exposing students to working with and learning from patients with complex needs during clinical practice placements across Queensland and New South Wales, Australia. METHODS: Six semi-structured focus groups with pre-registration physiotherapy students undertaking clinical practice placements (n = 19) and semi-structured one-on-one interviews with clinical educators (n = 20). Data were analyzed using reflexive thematic analysis. RESULTS: Four overarching themes were generated following analysis: 1) Complexity is challenging; 2) Tension between student exposure and patient care; 3) Variance in expectations; and 4) Readiness for complexity. CONCLUSION: Physiotherapy students and clinical educators recognize the challenges and importance of exposure to patients with complex needs. Student learning experiences are influenced by clinical educator decision-making, which is often unclear, leading to varying opportunities. This study highlights the need for enhanced support from clinical educators to prepare students for working with patients with complex needs.

Identifying and navigating suspected serious pathologies: New-graduate physiotherapists' perspectives and developmental needs.

BACKGROUND: Physiotherapists in Australia play a vital first-contact role in identifying suspected serious pathologies and navigating their management pathways. Current literature highlights challenges faced by physiotherapists including implications of ineffective identification and management of suspected serious pathologies, yet the perspectives of new-graduate physiotherapists related to this area of practice remain unknown. OBJECTIVE: The aim of this study was to explore new-graduate physiotherapists' perspectives and developmental needs related to identifying suspected serious pathologies and navigating their management pathways in patients with musculoskeletal complaints. DESIGN: and Method: A qualitative study using a reflexive thematic analytical approach was undertaken. Eighteen semi-structured interviews were conducted. Thematic analysis was utilized on the interview data. RESULTS: Four key themes were generated: (1) Physiotherapists as advocates; (2) Navigating uncertainties and complexities; (3) Safe and accessible workplace support builds confidence; and (4) Importance of direct learning opportunities. CONCLUSION: New-graduate physiotherapists recognize their imperative role as first-contact practitioners in identifying and navigating suspected serious pathologies yet also experience significant uncertainties. The findings highlight key developmental needs, including supportive workplaces, established referral frameworks and direct learning opportunities during pre-professional training.

Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students.

Literature regarding simulation for learning interprofessional collaborative practice (IPCP) indicates a need to include a range of health professions and to focus on students' development of team communication and conflict resolution skills in day-to-day healthcare delivery. This study evaluated the impact of interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students on interprofessional collaboration competencies, specifically collaborative communication and conflict resolution during day-to-day interactions, and their intention for IPCP during placement. A series of simulations featuring the potential for interprofessional conflict and involving explicit coaching on communication and conflict resolution were conducted. A single cohort pre-test post-test design included the Students' Perceptions of Interprofessional Clinical Education Revised (SPICE-R), the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and an open response survey question on future intended practice. A total of 237 students participated in the simulation experience. Overall scores and scores on all IPCP competencies in the ICASS (n = 193) and SPICE-R (n = 226) improved for all professions post-simulation. The mean score of the ICCAS increased for 98% of the respondents and similarly the mean score of the SPICE-R increased for 71% of the respondents. Open-ended responses indicated students' intentions to pursue self-leadership in IPCP. Students who participated in an interprofessional simulation reported perceived improvements in IPCP competencies and were encouraged to initiate IPCP when on placement in the practice setting.

Writing for the role: A qualitative exploration of new graduate physiotherapists' transition to practice of clinical documentation.

INTRODUCTION: Clinical documentation is an integral component of effective physiotherapy practice. Minimal research has explored how new graduate physiotherapists transition to practice of documentation. OBJECTIVE: To understand new graduate physiotherapists' experiences and support needs for transitioning into this professional role, from the perspectives of new graduates and clinical supervisors. METHODS: This study utilized the qualitative methodology of reflexive thematic analysis, situated within a critical realist framework and informed by Duchscher's stages of transition theory. Semi-structured interviews of 16 new graduate physiotherapists (less than two years post-graduation) and seven clinical supervisors (of new graduate physiotherapists) were subjected to inductive analysis, where codes were organized into themes and subthemes. RESULTS: Three overarching themes were generated with associated subthemes. Variable preparedness for documentation identified that new graduates were equipped with the basics of documentation, yet challenged by unfamiliarity and complexity. Documentation practices evolve over time outlined experiences of new graduates developing a "written voice" and improving documentation efficiency. Workplace support is necessary irrespective of preparedness, discusses: i) opportunities to practice, reflect and refine skills, ii) protected time for documentation, and iii) access to templates and examples. CONCLUSION: New graduate physiotherapists enter the workforce with variable levels of preparedness for clinical documentation, and may experience challenges when facing unfamiliar contexts and clinical complexity. Understanding expectations and engaging in opportunities to improve documentation skills were perceived as beneficial for enhancing new graduate practice of clinical documentation across workplace settings. Implications for workplace support to promote safe and effective practice of documentation are discussed.

The role of lung ultrasound for detecting atelectasis, consolidation, and/or pneumonia in the adult cardiac surgery population: A scoping review of the literature.

OBJECTIVES: Postoperative pulmonary complications (PPCs) frequently occur after cardiac surgery and may lead to adverse patient outcomes. Traditional diagnostic tools such as auscultation or chest x-ray have inferior diagnostic accuracy compared to the gold standard (chest computed tomography). Lung ultrasound (LUS) is an emerging area of research combating these issues. However, no review has employed a formal search strategy to examine the role of LUS in identifying the specific PPCs of atelectasis, consolidation, and/or pneumonia or investigated the ability of LUS to predict these complications in this cohort. The objective of this study was to collate and present evidence for the use of LUS in the adult cardiac surgery population to specifically identify atelectasis, consolidation, and/or pneumonia. REVIEW METHOD USED: A scoping review of the literature was completed using predefined search terms across six databases which identified 1432 articles. One additional article was included from reviewing reference lists. Six articles met the inclusion criteria, providing sufficient data for the final analysis. DATA SOURCES: Six databases were searched: MEDLINE, Embase, CINAHL, Scopus, CENTRAL, and PEDro. This review was not registered. REVIEW METHODS: The review followed the PRISMA Extension for Scoping Reviews. RESULTS: Several LUS methodologies were reported across studies. Overall, LUS outperformed all other included bedside diagnostic tools, with superior diagnostic accuracy in identifying atelectasis, consolidation, and/or pneumonia. Incidences of PPCs tended to increase with each subsequent timepoint after surgery and were better identified with LUS than all other assessments. A change in diagnosis occurred at a rate of 67% with the inclusion of LUS and transthoracic echocardiography in one study. Pre-established assessment scores were improved by substituting chest x-rays with LUS scans. CONCLUSION: The results of this scoping review support the use of LUS as a diagnostic tool after cardiac surgery; however, they also highlighted a lack of consistent methodologies used. Future research is required to determine the optimal methodology for LUS in diagnosing PPCs in this cohort and to determine whether LUS possesses the ability to predict these complications and guide proactive respiratory supports after extubation.

Systematic review of distributed practice and retrieval practice in health professions education.

To determine the effect of distributed practice (spacing out of study over time) and retrieval practice (recalling information from memory) on academic grades in health professions education and to summarise a range of interventional variables that may affect study outcomes. A systematic search of seven databases in November 2022 which were screened according to predefined inclusion criteria. The Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E) were used to critically appraise eligible articles. A summary of interventional variables includes article content type, strategy type, assessment type and delay and statistical significance. Of 1818 records retrieved, 56 were eligible for inclusion and included a total of 63 experiments. Of these studies, 43 demonstrated significant benefits of distributed practice and/or retrieval practice over control and comparison groups. Included studies averaged 12.23 out of 18 on the MERSQI and averaged 4.55 out of 6 on the NOS-E. Study designs were heterogeneous with a variety of interventions, comparison groups and assessment types. Distributed practice and retrieval practice are effective at improving academic grades in health professions education. Future study quality can be improved by validating the assessment instruments, to demonstrate the reliability of outcome measures. Increasing the number of institutions included in future studies may improve the diversity of represented study participants and may enhance study quality. Future studies should consider measuring and reporting time on task which may clarify the effectiveness of distributed practice and retrieval practice. The stakes of the assessments, which may affect student motivation and therefore outcomes, should also be considered.

Prescribing exercise therapy for the management of musculoskeletal pain: new-graduate physiotherapists' perceptions and perceived training needs.

BACKGROUND: Pain management is a challenging area of practice for new-graduate physiotherapists during the transition from student to clinician. The attitudes and beliefs of new-graduate physiotherapists toward the use of exercise therapy as part of the management of musculoskeletal pain remain relatively unknown. PURPOSE: The aim of the study was to investigate the perspectives of new-graduate physiotherapists toward prescribing exercise therapy in musculoskeletal pain management, and their perceptions of training and support needs in this area of practice. METHODS: A qualitative study with a general inductive approach was used to investigate new-graduate physiotherapists' perspectives. Semi-structured interviews were conducted with 16 participants. Interview data was subjected to thematic analysis. RESULTS: Four themes were generated following analysis: 1) Balancing the value of exercise with practical challenges; 2) Communication and education are inherent in exercise; 3) Influence of support and training; and 4) The benefits of direct experience. CONCLUSION: New-graduate physiotherapists acknowledge the pivotal role of exercise in managing musculoskeletal pain. Direct learning experiences in pre-professional training that develop knowledge and skills required for delivering exercise therapy were highly valued. New-graduates recognize pain management as a skill that requires further development and identify the importance of opportunities for professional development in exercise therapy.

Embarking on a cultural journey: a qualitative study of new graduate physiotherapists' experiences of working in First Nations Australian health settings.

INTRODUCTION: Internationally, there is growing momentum in the physiotherapy profession to improve the cultural safety and capabilities of physiotherapists. In Australia, this is essential given the important role physiotherapists play in the delivery of healthcare to First Nations Australians. Understanding the experiences of the newest members of the profession who work with First Nations Australians is an important step in exploring the broader professions' cultural safety journey. OBJECTIVE: To explore new graduate physiotherapists' experiences working in First Nations Australian health settings. METHODS: The study used an interpretative phenomenological approach through semi-structured interviews to explore the experiences of seven new graduate physiotherapists, in their first 2 years of practice. All participants worked within a First Nations Australian health setting for some or all of their experience as a new graduate physiotherapist. RESULTS: Three themes were generated: 1) enrichment through connection; 2) navigating challenges; and 3) a catalyst for self-reflection. CONCLUSION: New graduate physiotherapists reported positive experiences when working within a First Nations Australian health setting, underpinned by building a strong therapeutic relationship through rapport building; navigating challenges alongside their clients; and delving into critical self-reflection.

"A great tool to open your eyes": new graduate physiotherapists' perceptions and use of social media for learning.

BACKGROUND: Social media offer opportunities for informal learning and are increasingly adopted by health professionals as learning tools. However, little is known of how new graduate physiotherapists engage with social media for learning. PURPOSE: This study aimed to explore new graduate physiotherapists' perceptions and use of social media as learning tools during their transition into professional practice. METHODS: This study used a qualitative general inductive approach. New graduate physiotherapists (n = 16) were recruited through purposive snowball sampling and participated in semi-structured interviews. Data were subjected to a general inductive analytical method. RESULTS: Four themes were generated: 1) social media as tools for learning; 2) navigating and engaging with social media as a learner; 3) thinking critically about social media; and 4) relevance to practice. CONCLUSION: New graduate physiotherapists use social media as adjunct learning tools which can be positioned within several frameworks, including the Situated Learning Theory. However, new graduates voice uncertainties regarding information credibility, the importance of critical thinking skills in navigating information, and concerns regarding blurred work-life boundaries. Recommendations are made for research to further understand social media as emerging learning tools, especially for new graduates who are experiencing insufficient workplace support.

Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students.

BACKGROUND: During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS: Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS: Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION: The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.

Perceived preparedness and training needs of new graduate physiotherapists' working with First Nations Australians.

INTRODUCTION: There is a considerable and ongoing health gap experienced by First Nations Australians. Physiotherapists play an integral role in the health care of this population; however, little is known about new graduate preparedness and training needs to work in a First Nations context. OBJECTIVE: To explore the perceptions of new graduate physiotherapists regarding their preparedness and training needs for working with First Nation Australians. METHODS: Qualitative telephone, semi-structured interviews of new graduate physiotherapists (n = 13) who have worked with First Nations Australians in the last two years. Inductive, reflexive thematic analysis was used. RESULTS: Five themes were generated: 1) limitations of pre-professional training; 2) benefits of work integrated learning; 3) 'on the job' development; 4) intrapersonal factors and efforts; and 5) insights into improving training. CONCLUSION: New graduate physiotherapists perceive that their preparedness to work in a First Nations health context is supported by practical and varied learning experiences. At the pre-professional level, new graduates benefit from work integrated learning and opportunities that evoke critical self-reflection. At the professional level, new graduates express a need for 'on the job' development, peer supervision, and tailored professional development, that focuses on the unique perspectives of the specific community in which they work.

Evaluating allied health students' readiness for placement learning.

BACKGROUND: Experiential learning opportunities, such as work integrated learning placements, are often challenging for health professional students. It is therefore imperative that students are adequately prepared before engaging in placement learning. Operationalising 'readiness for learning on placement' as a construct, is necessary for providing quality student feedback and assessment. METHODS: An integrative mixed methods approach was adopted for this study, utilising a survey to canvass the perspectives of academics, students, and placement educators around the construct of readiness to inform potential assessment items. An assessment tool measuring student readiness for placement was then developed. Data from occupational therapy, physiotherapy and speech pathology programs were evaluated using Rasch analysis to explore the unidimensionality of this construct. RESULTS: The online survey was completed by 64 participants, confirming the importance and measurability of foundational skills integral to readiness for placement learning. These foundational skills were then reflected in a pilot 20-item tool covering domains of professional and learner behaviour, communication, information gathering skills and reasoning. The Rasch analysis of 359 pre-registration student assessments confirmed unidimensionality, suggesting that the skills and attributes (operationalised as assessment items) that are considered part of 'readiness for placement' are components of this construct. Together, these findings provide support that the items on this tool are relevant and representative of the skills and behaviours that indicate readiness for placement learning. Two items regarding documentation and appropriate professional dress demonstrated some lower importance scores and interpretation variance warranting further investigation. CONCLUSION: Through the exploration of the construct of readiness for placement learning, we have created and subsequently revised, an innovative assessment tool that measures novice students' pre-placement capabilities. Further research is now needed to explore the psychometric properties of the tool.

Physiotherapy students' empathy towards Australians living in rural settings: A pre-test post-test evaluation of a stand-alone rural simulation activity.

OBJECTIVE: To investigate how a rural simulation activity influenced physiotherapy students' rural empathy, and to explore students' perception of the activity. SETTING: A metropolitan university in Queensland, Australia. PARTICIPANTS: Second year undergraduate physiotherapy students. DESIGN: A single cohort pre-test post-test evaluation was undertaken to evaluate a rural simulation activity. Participants received the rural simulation activity, featuring an immersive video and telehealth simulation with a standardised patient portrayed by an actor. Participants undertook a structured debrief and guided reflection following the simulation. Outcome measures included the Rural Comprehensive State Empathy Scale (R-CSES) and the Satisfaction with Simulation Experience Scale. Group interviews were undertaken regarding participant perceptions of the activity. Wilcoxon Rank-Sum tests were used to analyse survey data, and group interview data were subject to thematic analyses. RESULTS: A total of 102 students undertook the activity, with an outcome measure response rate of 92.2% (94/102). Intra-personal rural empathy increased following the activity as demonstrated by the overall R-CSES score [pre-test: 101.5 (90-110.75) vs post-test 107 (100-120); p = <0.001; r = 0.39]. There was high satisfaction with the experience [mean SSES score = 18/21]. Two themes were generated from the group interview data: (1) effect on perceptions of rural practice and (2) feedback regarding the simulation. CONCLUSION: A rural simulation activity using an immersive video, standardised patient, and a structured debrief increased physiotherapy students' empathy towards Australians living in rural settings. Students were satisfied with the activity and felt that it improved their understanding of the challenges of rural healthcare.

Exploring new-graduate physiotherapists' preparedness for, and experiences working within, Australian acute hospital settings.

BACKGROUND: New-graduate physiotherapists experience a steep learning curve when transitioning from student to clinician. The acute hospital setting is known to present unique challenges for health clinicians, however, the preparedness of new-graduate physiotherapists for working within this setting remains unclear. PURPOSE: The aim of this study was to investigate new-graduate physiotherapists' experiences of working in acute hospital settings and their perceptions toward how their pre-professional training prepared them for this setting. METHODS: A qualitative study with a general inductive approach was used. Semi-structured interviews with new-graduate physiotherapists working in acute hospital settings were undertaken (n = 14). Interview data were subject to thematic analysis. RESULTS: Four themes were generated from the data: 1) multifactorial and high-pressure nature; 2) managing relationships; 3) realizing responsibility; and 4) constructing realistic experiences. CONCLUSION: The acute hospital setting presents unique obstacles and additional challenges when transitioning from student to clinician. New-graduates value the role of pre-professional training in their preparation for this context, however, new-graduates reflected on being sheltered from some areas of practice as students. Recommendations are suggested for education providers to adapt pre-professional training, and for employers to implement workplace strategies, which may support new-graduate physiotherapists in the acute hospital setting.

New-graduate physiotherapists' training needs and readiness for telehealth.

INTRODUCTION: The COVID-19 pandemic has necessitated a rapid transition to telehealth for the delivery of many Australian physiotherapy services. Little is known about new-graduate training needs in this method of service delivery.Aim.To explore the readiness and specific training needs of new-graduate physiotherapists for telehealth service delivery in Australia. METHODS: Qualitative individual telephone interviews of new-graduate physiotherapists (n = 16) and two videoconference focus groups of supervisors of new-graduate physiotherapists (n = 7) were undertaken. Thematic analysis was used. RESULTS: Two global themes each with three organizing themes were generated. The two global themes were "support needs for novice practitioners" and "how to best prepare for telehealth." DISCUSSION AND CONCLUSION: New-graduate physiotherapists and supervisors perceive that pre-professional exposure to, and practical skills training for, telehealth is essential. Elements such as undertaking physical assessments via telehealth, verbal communication, and effective clinical reasoning in telehealth assessment and treatment were highlighted as areas of need. Both stakeholder groups perceived that the rapid transition to telehealth challenged the self-efficacy of new-graduates as they did not have clinical experience to rely on. The preparation, and ongoing support of new-graduates to adopt telehealth in the workplace is considered critical given the shift in Australian healthcare to online platforms.

Competencies for entry-level rural and remote physiotherapy practice: a Delphi approach.

INTRODUCTION: Rural physiotherapy is a challenging area of practice that requires clinicians to respond to the unique factors that contribute to rurality. This study aimed to outline an introductory set of competencies that contribute to effective physiotherapy practice in rural Australia. METHODS: A three-round Delphi study was undertaken using a panel of expert physiotherapists. The panel was asked to provide open-ended responses to the following question: 'What unique knowledge, skills, abilities, attributes or other characteristics do physiotherapists need to possess, or learn in order to provide effective physiotherapy specifically in a rural or remote setting?' These responses were then thematically analysed to create competencies. The competencies were evaluated in the subsequent rounds by the Delphi panel. Consensus was set at 80%. Rural and remote experts were determined through criteria including duration of practice, established expert frameworks, and self- or peer nomination. The publicly accessible Australian Physiotherapy Association database was used to access the contact details of 222 physiotherapists working in rural and remote locations across all Australian states and territories. Seventeen expert physiotherapists met inclusion criteria and consented to participation. RESULTS: Seventeen expert physiotherapists completed round one with a 100% response rate. Analysis of the expert panel responses yielded an initial 24 competencies. The second round had a response rate of 94.1%, and the third round 93.8%. A final set of 19 competencies was established. The knowledge, skills and attributes featured in the competencies relate to responsivity to rural locality, adapting to individual community needs and problem solving in response to challenges to practising in rural and remote locations. CONCLUSION: This study has introduced a set of competencies that may contribute towards effective physiotherapy practice in the rural setting. The competencies provide a common language for physiotherapists and their employers, and may be used to guide training or mentorship in this setting.

Perspectives of older adults with chronic disease on the use of wearable technology and video games for physical activity.

BACKGROUND: There is increasing interest in technology to deliver physical rehabilitation and allow clinicians to monitor progress. Examples include wearable activity trackers and active video games (AVGs), where physical activity is required to play the game. However, few studies have explored what may influence the effectiveness of these as technology-based physical activity interventions in older adults with chronic diseases. OBJECTIVE: This study aimed to explore: 1) perceptions about wearable physical activity trackers; 2) perceptions about using technology to share physical activity information with clinicians; 3) barriers and motivators to playing games, including AVGs for rehabilitation. METHODS: Qualitative study based on semi-structured interviews with older adults (n = 19) with chronic obstructive pulmonary disease (COPD). RESULTS: Wearable activity trackers were perceived as useful to quantify activity, facilitate goal-setting, visualize long-term improvements and provide reminders. Participants generally wished to share data with their clinicians to gain greater accountability, receive useful feedback and improve the quality of clinical care. Participants were motivated to play games (including AVGs) by seeking fun, social interaction and health benefits. Some felt that AVGs were of no benefit or were too difficult. Competition was both a motivator and a barrier. CONCLUSIONS: The findings of the present study seek to inform the design of technology to encourage physical activity in older adults with chronic diseases.

Effectiveness of patient education training on health professional student performance: A systematic review.

BACKGROUND: Despite the fundamental role of patient education, concerns have been raised by health professionals, students, and professional bodies regarding student preparation for this area of practice. OBJECTIVE: To evaluate the effectiveness of patient education training on health professional student performance. METHOD: A systematic search was performed across PubMed, Cinahl, Embase, and Cochrane Library. Reference and forward citation searches of included articles were conducted. Inclusion criteria were published journal articles from 2010 to 2020 regarding patient education training for health professional students with measures relating to patient education performance. Quality appraisal of individual studies was conducted using Cochrane risk-of-bias v2 or ROBINS-I; overall appraisal was also determined. Sixteen articles met eligibility criteria. Independent data extraction was undertaken. RESULTS: Fourteen studies reported improvements in student performance following patient education training; two studies reported no significant improvements. Of different modalities examined, simulation-based learning appeared to be most effective. CONCLUSION: Patient education training enhances health professional students' performance of patient education. Future research is needed to evaluate effectiveness of pedagogically informed interventions across health professions using objective approaches to assess student performance in clinically relevant settings. PRACTICAL VALUE: This review supports the use of specific training approaches to improve student performance of patient education.

A Co-Designed Active Video Game for Physical Activity Promotion in People With Chronic Obstructive Pulmonary Disease: Pilot Trial.

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) who are less active have lower quality of life, greater risk of exacerbations, and greater mortality than those who are more active. The effectiveness of physical activity interventions may facilitate the addition of game elements to improve engagement. The use of a co-design approach with people with COPD and clinicians as co-designers may also improve the effectiveness of the intervention. OBJECTIVE: The primary aim of this study is to evaluate the feasibility of a co-designed mobile game by examining the usage of the game, subjective measures of game engagement, and adherence to wearing activity trackers. The secondary aim of this study is to estimate the effect of the game on daily steps and daily moderate-to-vigorous physical activity (MVPA). METHODS: Participants with COPD who were taking part in the co-design of the active video game (n=9) acted as the experiment group, spending 3 weeks testing the game they helped to develop. Daily steps and MVPA were compared with a control group (n=9) of participants who did not co-design or test the game. RESULTS: Most participants (8/9, 89%) engaged with the game after downloading it. Participants used the game to record physical activity on 58.6% (82/141) of the days the game was available. The highest scores on the Intrinsic Motivation Inventory were seen for the value and usefulness subscale, with a mean of 6.38 (SD 0.6). Adherence to wearing Fitbit was high, with participants in both groups recording steps on >80% of days. Usage of the game was positively correlated with changes in daily steps but not with MVPA. CONCLUSIONS: The co-designed mobile app shows promise as an intervention and should be evaluated in a larger-scale trial in this population.