|COM-B||Survey section||TDF domain||Barrier||Proposed strategy|
|Capability||In-bed cycling||Memory/attention/decision processes||I would not cycle with a study patient if I believed other rehabilitation activities were a higher priority for them.||Education re: ethical imperative to deliver randomized intervention. Also related to time barrier (see strategies under “Motivation” attribute below).|
|Outcome measures||Skills||I required assistance from another person to transcribe data on research forms during outcome measure assessments.||Training on data form completion. Consider enlisting help from RC to transcribe data during OM assessments, especially for patients in isolation (when unable to bring data forms into room due to infection control limitations).|
|Opportunity||Outcome measures||Environmental context||Patients’ functional capacity or fatigue limited conduct of cycling and outcome measures on the same day.||Consider conducting OM before cycling, as more active participation required for OM. Consider use of OM as routine care, instead of a separate session.|
|Motivation||Rehabilitation practice and research||Beliefs about consequences||Implementing the CYCLE protocol presented challenges to providing equitable service for all patients (i.e., patients not enrolled in CYCLE).||Lack of consensus on types of rehabilitation interventions therapists should administer with patients. More local context from therapists is needed to properly address this barrier.|
|In-bed cycling||Professional role||If cycling improved outcomes and became recommended standard practice, ICU OTs should not be primarily responsible for implementing this intervention.||Consider OT availability and roles in ICU setting.|
|In-bed cycling||Emotion||I felt overwhelmed by the time required to conduct cycling sessions.||Researchers* designing trials include budget for additional therapist time to conduct the research intervention.|
Therapists support colleagues’ caseloads when a patient is enrolled.
Hospital management** incorporating dedicated research time into budgets.
|Outcome measures||Emotion||I felt overwhelmed by the time required to collect outcome measures.||See suggestions under “cycling”. In addition, researchers could consider hybrid model of research whereby therapists conduct cycling and research personnel conduct OM.|
Therapists could consider using OM as the routine care intervention on days when patients are eligible.