Table 2.

Overview of the included studies

General information		Study aims, design & methods	Participants	Mobility intervention	Evidencea
(A) direct interventions to promote and maintain the mobility of nursing home residents
PED Project	Brett et al. 2018 [49] Australia	Aim: to gain insights into ▪ staff & family carers’ views, attitude, opinions of physical exercise ▪ the feasibility of conducting a physical exercise intervention for individuals living with dementia in nursing homes Study design: ▪ qualitative study (following an effectiveness RCT) Methodological/theoretical approach: ▪ interpretive description Methods: ▪ semistructured interviews	Sites: ▪ nursing homes (n = 2) Study population: ▪ staff (n = 10) ◦ registered nurses (n = 3) ◦ lifestyle & recreational officers (n = 3) ◦ direct care workers (n = 2) ◦ physical therapy assistant (n = 1) ◦ occupational health and safety representative (n = 1) ▪ family carers (n = 9)	Intervention: ▪ physical exercise Target population: ▪ individuals living with dementia in nursing homes	2
	Gomaa et al. 2020 [50] Australia	Aim: to elucidate the benefits, challenges, and facilitators/barriers to the implementation of music-cued therapeutic dancing in residential aged care Study design: ▪ qualitative approach Methodological/theoretical approach: ▪ realist theoretical framework Methods: ▪ semistructured interviews	Sites: ▪ 60-bed high-dependency residential aged care setting (n = 1) Study population: ▪ dance instructor (n = 1) ▪ music therapist (n = 1) ▪ physiotherapists (n = 2) ▪ class assistant (n = 1) ▪ facility manager (n = 1) ▪ lifestyle program coordinator (n = 1)	Intervention: ▪ music-cued dancing: ◦ 12 sessions over 8 weeks with 5–8 participants ◦ 30-min movement component + 5-min warm up & cool down ◦ dancing movements/steps matched to the abilities/preferences of residents ◦ genres: tap dance, tango, salsa, modern, jazz, creative dance Target population: ▪ frail older people living with or without dementia in residential aged care	2
	Horn et al. 2019 [48] Germany	Aim: to identify and analyze ▪ facilitators to and barriers of the implementation of a physical activity program ▪ challenges to its continuation Study design: • scientific evaluation Methodological/theoretical approach: • not reported Methods: • semistructured/problem-centered interviews, observations, analysis of documents, standardized collection of health data, standardized data collection of structural characteristics and culture of the participating organizations	Sites: • inpatient care facilities** Study population: ▪ management** ▪ quality management** ▪ nursing staff** ▪ trainers**	Intervention: ▪ ‘Lübeck Worlds of Movement Model’ ◦ group intervention (6–12 participants ◦ 2 sessions lasting 60 min per week ◦ trained group leader ◦ close to everyday life exercises ◦ accompanying individual training program based on a group program Target population: ▪ nursing home residents	2
Aging and new media	Juul et al. 2019 [47] Australia	Aim: to investigate the role of touchscreen technology in facilitating increased physical activity and stimulating social interaction in RACFs in order to decrease social & physical inactivity Study design: • case study design Methodological/theoretical approach: • qualitative ethnographic fieldwork Methods: • observation, targeted informal conversations, video ethnography, in-depths semistructured interviews	Sites: • residential aged care facility (n = 1) Study population: • residents** • staff** • visitors (residents’ family & friends)**	Intervention: • Touchscreen technology ◦ multiple user interactions using the device at the same time ◦ 165-cm interactive portable touch screen ◦ interactive physical activity video – sitdance -uploaded and projected onto the screen ◦ sitdance: seated dance tutorial specially designed for older people; not only an exercise program but also designed to support older people’s memory & encourage social interaction Target population: ▪ residents	2
	Kazana & Pencak Murphy 2018 [44] USA	Aim: to describe the development of a walking program including process, outcomes, and lessons learned at the LTC facility that was the project site Study design: • quality improvement project Methodological/theoretical approach: • not reported Methods: • logs, reports, chart review, observations	Sites: • inner-city skilled nursing and living center (n = 1) Study population: • residents (n = 13)	Intervention: • walking program ◦ based on individual walking goals ◦ walking activity provided at least 5 x/week ◦ assigned & provided by certified nursing assistants & restorative staff Target population: residents	1 & 2
	Slaughter & Estabrooks 2013 [51] Canada	Aim: to assess the effect of the sit-to-stand activity (evidence) on the mobility outcomes of nursing home residents, the effect of an audit-and feedback intervention (facilitation) on the uptake of the sit-to-stand activity by healthcare aides, and the contextual factors influencing the uptake of the activity (context) Study design: • quasi-experimental pilot study Methodological/theoretical approach: • Promoting Action on Research Implementation in Health Services (PARIHS) framework Methods: • documentation of resident performance of the sit-to-stand activity, interview-based survey, Alberta Context Tool (56-item survey instrument)	Sites: • nursing homes (n = 2) Study population: • residents (n = 45) • health care aides (n = 56)	Intervention: ▪ ‘Sit‐to‐stand mobility activity’: ◦ health care aides prompt residents to repeatedly stand up & sit down on 4 occasions during daily functional activities (2 × per day & evening shift) ◦ number of repetitions vary according to residents’ ability and fatigue ◦ activity is to be integrated into usual care routines ◦ timing & location at the discretion of the health care aide Target population: residents	1 & 2
MOVE study	Slaughter et al. 2018 [46] Canada Study protocol: Slaughter et al. 2011 [54] Canada	Aim: to evaluate the processes & perceived outcomes of 8 knowledge translation interventions in a study that introduced a mobility innovation into the daily care practices of healthcare aides Study design: • mixed methods process evaluation Methodological/theoretical approach: • not reported Methods: • interviews, focus groups, ranking exercise	Sites: • long‐term care facilities (n = 3) Study population: • healthcare aides (n = 27) • leaders (n = 4)	Intervention: ▪ ‘Sit‐to‐stand mobility activity’: ◦ health care aides prompt residents to repeatedly stand up & sit down on 4 occasions during daily functional activities (2 × per day & evening shift) ◦ number of repetitions vary according to residents’ ability and fatigue ◦ activity is to be integrated into usual care routines ◦ timing & location at the discretion of the health care aide Target population: ▪ residents	1 & 2
START study	Slaughter, et al. 2020 [45] Canada Study protocol: Slaughter et al. 2013 [55] Canada	Aim: • to determine the effectiveness of a novel knowledge translation intervention, the peer reminder, compared to a standard paper reminder intervention • to examine reminder intensity and reminder frequency on the 1- year sustainability of care aides completing and documenting a mobility intervention with residents living in care facilities Study design: • cluster randomized controlled trial, using a stratified factorial design Methodological/theoretical approach: • not reported Methods: • recording of the conduct of the sit- to-stand activity; questionnaires to assess frequency, duration, content, deviations, modifications of the reminders as well as additional reminders; direct observation to assess the fidelity of the paper reminder intervention	Sites: • long-term care facilities (n = 8) • assisted living facilities (n = 15) Study population: • residents (n = 349) • care aides (peer reminder) (n = 54)	Intervention: ▪ ‘Sit‐to‐stand mobility activity’: ◦ health care aides prompt residents to repeatedly stand up & sit down on 4 occasions during daily functional activities (2 × per day & evening shift) ◦ number of repetitions vary according to residents’ ability and fatigue ◦ activity is to be integrated into usual care routines ◦ timing & location at the discretion of the health care aide Target population: ▪ residents	1 & 2
	Kagwa et al. 2018 [43] Canada	Aim: • to explore the experience of healthcare aides encouraging residents living in residential care facilities to complete the sit-to-stand activity • to identify the strategies healthcare aides use to integrate this activity into their work routines Study design: • qualitative substudy of the START study (cluster randomized controlled trial) Methodological/theoretical approach: • not reported Methods: • semistructured interviews	Sites: • long-term care facilities (n = 2) • assisted living facilities (n = 5) Study population: • health care aides (n = 7)	Intervention: ▪ ‘Sit‐to‐stand mobility activity’: ◦ health care aides prompt residents to repeatedly stand up & sit down on 4 occasions during daily functional activities (2 × per day & evening shift) ◦ number of repetitions vary according to residents’ ability and fatigue ◦ activity is to be integrated into usual care routines ◦ timing & location at the discretion of the health care aide Target population: residents	2
	Tworek et al. 2019 [42] Canada	Aim: to examine the effect of two knowledge translation interventions, informal walkabouts and documentation information sessions, on supporting initial care aide adoption of a new evidence-based practice, the sit-to-stand activity Study design: • quantitative pre-post-substudy of the START study (cluster randomized controlled trial) Methodological/theoretical approach: • not reported Methods: • analysis of documentation sheets/resident charts	Sites: • long-term care facilities (n = 8) • assisted living facilities (n = 15) Study population: • residents (n = 227)	Intervention: ▪ ‘Sit‐to‐stand mobility activity’: ◦ health care aides prompt residents to repeatedly stand up & sit down on 4 occasions during daily functional activities (2 × per day & evening shift) ◦ number of repetitions vary according to residents’ ability and fatigue ◦ activity is to be integrated into usual care routines ◦ timing & location at the discretion of the health care aide Target population: ▪ residents	1
(B) organizational capacity-building interventions to promote and maintain the mobility of nursing home residents
	Den Ouden, et al. 2019 [61] Netherlands	Aim: to examine the feasibility of DAIly NURSE and a nursing intervention to encourage nursing home residents’ daily activities and independence Study design: • feasibility testing using a mixed-methods design Methodological/theoretical approach: • framework of Saunders et al. [64] Methods: • self-administered evaluation questionnaires, attendance lists, notes of workshops, focus group interview, MAINtAIN questionnaire [65], background data on nursing home residents and nursing staff	Sites: • nursing homes (n = 2) Study population: • residents (n = 20) • nursing staff (n = 13)	Intervention: ▪ Daily Activities and Independence by NURsing Staff Encouragement” (DAIly NURSE) ◦ multicomponent nursing intervention ◦ aims to change nursing staff behavior in a way that nursing home residents are encouraged & supported to perform their daily activities as independently as possible ◦ components: education, coaching-on-the-job and policy Target population: ▪ nursing staff	2
Projekt ExMo	Görres et al. 2016 [62] Germany	Aim: to evaluate the exemplary implementation of the draft expert standard “Maintenance and promotion of mobility in care” Study design: • cluster randomized trial & observational study Methodological/theoretical approach: • not reported Methods: • nursing records, staff survey, questionnaires, process documentation, structural data, cost data, telephone interviews	Sites: • nursing homes (n = 33) • semiresidential care/day care (n = 6) • home care (n = 6) Study population: • residents** • nursing staff **	Intervention: ▪ Intervention group A: education session on implementing the German national mobility expert standard ▪ Intervention group B: same intervention as group A in addition to an explicit mobility training for promoting the mobility of the residents Target population: ▪ care services ▪ care staff ▪ residents	1&2
	Henskens et al. 2017 [60] Netherlands	Aim: • to test the effect of movement-oriented restorative care (MRC) among NH residents with moderate to severe dementia • additionally, data was collected regarding the degree of implementation, and the barriers to the implementation process Study design: • process evaluation within a quasi-experimental study Methodological/theoretical approach: • theoretical elements from previous studies Methods: • only process evaluation: questionnaires, focus groups	Sites: • locations of a long-term care organization (n = 2) Study population: • residents (n = 61) • professionals (n = 12) ◦ nurses (n = 3) ◦ activity supervisors (n = 3) ◦ heads of departments (n = 2) ◦ physiotherapist (n = 1) ◦ occupational therapist (n = 1) ◦ ‘ambassadors’ (n = 2)	Intervention: ▪ ‘Movement-oriented Restorative Care’ (MRC) ◦ derived from the concept of function-focused care = multidisciplinary approach toward nursing home dementia care that focuses on stimulating physical activity & independent functioning ◦ key elements: educating nursing staff and families, establishing goals with each resident, administering process evaluations to determine the extent to which MRC was implemented as intended Target population: ▪ nursing home residents with dementia	2
	Kuk et al. 2017 [57] Netherlands	Aim: to evaluate the feasibility of the TIP-toolbox, an instrument developed to support nursing staff step-by-step in implementing an innovation in nursing homes in order to further improve the toolbox for the needs of its end-users Study design: • feasibility study with a mixed-methods design Methodological/theoretical approach: • Medical Research Council (MRC) guidance for process evaluation of complex interventions [25] • work by Saunders et al. [64] Methods: • questionnaires, telephone interviews, participant observations, and focus group interviews	Sites: • nursing homes (embedded in the Living Lab in Aging and Long-Term Care)(n = 3) Study population: • registered nurses (n = 12) ◦ vocationally trained (n = 9) ◦ bachelor educated (n = 3)	Intervention: ▪ ‘Translating Innovations into Practice-toolbox’ (TIP-toolbox) ◦ supports nursing staff in developing a structured and tailored implementation plan to sustainably implement an innovation in a specific setting ◦ based on implementation of change model by Grol et al. [66] ◦ paper booklet or PDF format, supplemented with electronic tools ◦ focus of this feasibility study: implementation of innovations related to the promotion of functional activity Target population: ◦ nursing staff (TIP-toolbox)	1 & 2
	Resnick et al. 2006 USA [53]	Aim: • to explore with nursing assistants their feelings and experiences related to restorative care nursing activities after participating in the implementation of a restorative care program Study design: • qualitative study Methodological/theoretical approach: • not reported Methods: • focus groups	Sites: • nursing home (n = 1) Study population: • nursing assistants (n = 13)	Intervention: • Res-Care Pilot Intervention ◦ 2-tiered intervention focused on motivating nursing assistants to engage in restorative care activities and teaching them how to motivate the residents to do likewise Target population: nursing assistants	2
	Resnick et al. 2008 [59] USA	Aim: • to explore nursing assistants’ experience in participating in a restorative care intervention study Study design: • qualitative study Methodological/theoretical approach: • not reported Methods: • focus groups	Sites: • nursing homes (n = 6) Study population: • nursing assistants (n = 93)	Intervention: • Res-Care Intervention ◦ 2-tiered intervention focused on motivating nursing assistants to engage in restorative care activities and teaching them how to motivate the residents to do likewise Target population: • nursing assistants	2
(A) direct interventions & (B) organizational capacity building interventions to promote and maintain the mobility of nursing home residents
OPERA study	Ellard et al. 2014 [56] UK	Aim: to explore potential explanations for the lack of effect of the intervention in the OPERA cluster randomized trial Study design: ▪ mixed methods approach Methodological/theoretical approach: ▪ phenomenological approach for all qualitative work Methods: ▪ quantitative data from all the study homes (organizational characteristics, process data questionnaires) ▪ quantitative and qualitative data from a purposive sample of eight case study homes (observations, interviews, focus groups, checklists)	Sites: ▪ care homes (n = 78) Study population: ▪ residentsb ▪ care staffb ▪ managersb ▪ OPERA research staffb	Direct mobility intervention: ▪ twice-weekly, moderate intensity, progressive group exercise sessions led by a physiotherapist Target population: ▪ care home residents Organizational capacity building intervention ▪ activities aimed at changing the culture of the homes so that residents would be supported and encouraged to be more active: ◦ physiotherapy assessments and exercise prescriptions for all residents ◦ advice for staff on ways to safely increase the mobility of the residents ◦ provision of simple aids to maximize individuals’ mobility ◦ formal care home staff training on recognizing depression and the potential importance of promoting physical activity in residents Target population: ▪ care home staff	2
	Finnegan et al. 2015 [52] UK	Aim: to determine individual and ‘home-level’ predictors of attendance at physiotherapy led exercise groups Study design: ▪ cohort study nested into a cluster-randomized controlled trial (OPERA study) Methodological/theoretical approach: ▪ not reported Methods: ▪ used quantitative data from the RCT: attendance rates & predictive factors at resident level (e.g., number of chronic conditions, depression, lower limb function, social engagement, fear of falling) & and on home level	Sites: ▪ residential homes (n = 25) ▪ nursing homes (n = 9) Study population: ▪ residents (n = 428)	Direct mobility intervention: ▪ twice-weekly, lower level or moderate intensity, progressive group exercise sessions led by a physiotherapist Target population: ▪ care home residents	2
	Turpie et al. 2017 [58] Scotland, UK	Aim: • to report on the implementation of a physical activity (PA) scheme – Let’s Motivate (LM) • to provide an insight into the different factors which might contribute to its success and further Study design: • qualitative case study design Methodological/theoretical approach: • a series of theoretical resources Methods: • one-to-one semistructured interviews	Sites: • private care homes (n = 2) Study population: • key staff from each care home (n = 6) ◦ support workers (n = 5) ◦ senior support worker (n = 1) • regional manager of the care homes (n = 1) • LM training instructor (n = 1)	Intervention: • Let’s Motivate (LM) initiative ◦ aims to improve the health, wellbeing and quality of life of older adults in care homes by developing opportunities for them to be more physically active ◦ aspires to transform the very nature of the care home “setting”, making it more conducive to physical activity ◦ recognizes staff as a key resource ◦ staff training as key element of the initiative ◦ simple and undemanding activities provided to residents Target population: care home staff (training), residents (physical activity)	2

^aevidence reported with regard to the review research questions: 1 = implementation strategies, 2 = barriers/facilitators to implementation; ^b(n) not or not comprehensibly reported