Table 3.

Overview of the implementation strategies identified within the included studies

Study	Mobility intervention	Implementation study	Implementation strategies	Study results regarding implementation
(A) direct interventions to promote and maintain the mobility of nursing home residents
Slaughter & Estabrooks 2013 [51]	Sit-to-stand activity	Aim*: to examine the effect of an audit-and-feedback intervention on the uptake of the sit-to-stand activity by healthcare aides Study design: quasi-experimental pilot study Implementation outcome: healthcare aides’ intervention uptake Methods: documentation flowsheets and a survey-based measure	Site 1: • education sessions for healthcare aides • paper-based reminders (bedside stickers and a conference room poster) • audit-and-feedback intervention (including summary of the resident’s mobility outcomes in a poster & outcome presentation to the Director of Care, healthcare aids and other staff) Site 2: • education sessions for healthcare aides • paper-based reminders (bedside stickers and a conference room poster)	• The audit and feedback intervention was associated with increased intervention uptake over time • Uptake increased in site 1, where the initial uptake was weak. In contrast, the uptake in site 2 was higher in the beginning and remained relatively constant
MOVE study Slaughter et al. 2018 [46]	Sit-to-stand activity	Aim: to examine the perceived effectiveness of eight knowledge translation interventions to implement the sit-to-stand activity Study design: mixed methods process evaluation Implementation outcome: effectiveness of knowledge translation interventions perceived by healthcare aides and leaders Methods: interviews, focus groups, ranking	Knowledge translation interventions 1. flowsheet annotation and informal discussions 2. paper reminder system 3. focus group 4. focus group poster and strategies sheet 5. flowsheet follow-up discussion 6. leader endorsement 7. healthcare aid champions 8. audit and feedback poster	• Reminders, followed by discussion groups, were perceived as most effective by leaders and healthcare aids to sustain practice change • Champions were perceived as least effective • Leaders rated focus groups and audit and feedback posters as the knowledge translation interventions most difficult to realize
START study
Slaughter, et al. 2020 [45]	Sit-to-stand activity	Aim: to compare the effectiveness of four different reminder interventions to sustain the sit-to-stand activity Study design: cRCT, using a stratified factorial design Implementation outcome: fidelity, sustainability Methods: flowsheets, questionnaires, observations	Group 1 • monthly socially based peer reminders Group 2 • quarterly socially based peer reminders Group 3 • monthly paper-based reminders Group 4 • quarterly paper-based reminders	• Paper reminders were implemented with high fidelity (91.5% per protocol), while the peer reminders were implemented with moderate to poor fidelity (monthly 81.0%/ quarterly 51.7% per protocol) • The average sustainability after 12 months was about twice as high in the monthly socially based peer reminder group than in the others
Tworek et al. 2019 [42]	Sit-to-stand activity	Aim: to examine the effect of two knowledge translation interventions on supporting initial care aide adoption of the sit-to-stand activity Study design: quantitative pre-post-substudy of the START study (cluster randomized controlled trial) Implementation outcome: intervention uptake Methods: documentation sheets	Knowledge translation intervention during the first 4 month: • two Informal walkabouts with care aids (i.e. spontaneous short meetings in the hall) • two documentation information sessions with care aids (to clarify the flow charts used for documentation)	• After adjusting for age, sex, dementia status, location, and mobility, an increase in uptake of the sit-to-stand activity was observed over the 4-month period (day shift: 5.3% mean increase, evening shift: 6.1% mean increase) • The site size had a significant effect on the outcome (12.6% (SE = .07) increase over small sites and a 18.2% (SE = .05) increase over large sites)
Kazana & Pencak Murphy 2018 [44]	Walking program	Aim: to develop, implement, and evaluate a patient-centered walking program Study design: quality improvement project Implementation outcome: Adherence (compare actual activities against the planned ones) Methods: logs, reports, chart review, observations	• guiding coalition • environment and policy assessment • staff and supervisor education • individualized walking goals • ongoing process evaluation and feedback	• Most residents were provided walking activities 60% to 90% of the planned time over a 20-week period • Average adherence to documenting the activity: 79%
(B) organizational capacity-building interventions to promote and maintain the mobility of nursing home residents
Kuk et al. 2017 [57]	Activity innovation	Aim: to evaluate the feasibility of the TIP Toolbox to further improve the Toolbox in terms of end-user needs Study design: feasibility study with a mixed-methods design Implementation outcome: fidelity, dose, context, satisfaction, complexity, adaptations Methods: documentation analysis, questionnaires, telephone interviews, participant observations, and focus group interviews	Translating Innovations into Practice-toolbox (TIP-toolbox): implementation approach based on the “Implementation of Change Model” by Grol et al. [66] 1. formulating a proposal for change in practice including clear targets 2. assessing the nursing staff performance and existing barriers and formulating specific targets for change 3. selecting and tailoring a set of strategies together with nursing staff 4. planning the implementation process 5. integrating improvement within the normal practice routines 6. evaluating the plan Additional tools • MAINtAIn questionnaire to assess the extent to which nursing staff promote functional activity among residents and the perceived barriers and facilitators • excel-based analysis tool • overview of strategies • template implementation plan • example implementation plan • example of an innovation	• Most registered nurses completed all 6 steps of the implementation plan • The registered nurses conducted most steps according to the plan • Fidelity was affected the registered nurses’ difficulty in formulating SMART goals and a high time requirement for some steps • The registered nurses suggested several adaptations aimed at improving cooperation with others and increasing the feeling of support • Most registered nurses were satisfied with the TIP-toolbox and considered themselves capable of performing the steps, but some considered it somewhat complex and described different difficulties
Projekt ExMo Görres et al. 2016 [62]	National expert standard “Maintenance and promotion of mobility in care”	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 Implementation outcome: no information Methods: no information	In both intervention groups: • implementation materials (handbook, including a template for the documentation of the implementation process and an audit tool) • implementation strategies (e.g., formation of a project group, needs assessment, kick-offs, additional educational sessions)	Based on the results the authors conclude that the expert standard is feasible for practice use