{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T18:07:23Z","timestamp":1779127643030,"version":"3.51.4"},"reference-count":118,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Advanced Fellowship","award":["NIHR302926"],"award-info":[{"award-number":["NIHR302926"]}]},{"name":"National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre","award":["NIHR203327"],"award-info":[{"award-number":["NIHR203327"]}]},{"name":"National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and Leicester NIHR BRC","award":["NIHR203327"],"award-info":[{"award-number":["NIHR203327"]}]},{"name":"British Heart Foundation (BHF) Research Excellence Award","award":["RE\/24\/130031"],"award-info":[{"award-number":["RE\/24\/130031"]}]},{"name":"Leicester NIHR Biomedical Research Centre","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Welsh Government via Health and Care Research Wales","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"NIHR Newcastle BRC and is Co-Chair of the Multiple Long-Term Conditions Cross-NIHR Collaboration","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/501100020013","name":"NIHR Leicester BRC","doi-asserted-by":"crossref","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100020013","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NIHR ARC EM, NIHR Global Research Centre for Multiple Long-Term Conditions, NIHR Cross NIHR Collaboration for Multiple Long-Term Conditions, NIHR Leicester BRC and the BHF Centre of Excellence","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Maintaining function and participation through tailored 24-hour movement behaviours for people living with multiple long-term conditions (MLTC) and frailty (The PERSONAL-AGILITY study) is a research programme which aims to develop and evaluate a complex behaviour change intervention. The intervention uses a range of approaches tailored for individuals living with MLTC and frailty, and their carers, incorporating novel technology to improve 24-hour movement behaviours and, consequently, quality of life and physical function. This paper outlines the protocol for a randomised controlled trial (RCT) evaluating the feasibility and acceptability of the PERSONAL-AGILITY intervention, study design and procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A feasibility RCT, with 2:1 allocation to the PERSONAL-AGILITY intervention or usual care control. The primary outcome is the feasibility and acceptability of a future definitive RCT investigating the effectiveness of the PERSONAL-AGILITY intervention, assessed against prespecified progression criteria, including eligibility, recruitment, retention, and outcome measure completion rates. The trial will be conducted at the University Hospitals of Leicester and comprise a 24-week tailored behaviour change intervention delivered by members of the PERSONAL-AGILITY research team. A target sample of 50 people with MLTC and frailty, and their carer (optional), will be recruited. A range of secondary outcomes including body composition, blood pressure, physical activity, sleep, physical function, and quality of life will be assessed at baseline, 12, and 24 weeks to help identify the primary or co-primary outcomes for participants with MLTC and frailty and their carers. A mixed methods process evaluation will examine the acceptability, feasibility and fidelity of intervention delivery and trial procedures. This study will inform the feasibility and design of a future definitive RCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      The trial has been approved by South Central Oxford B Research Ethics Committee (Ref: 24\/SC\/0367). Participants will be asked to provide consent to take part in the PERSONAL-AGILITY study by a trained member of the research team. Findings will be disseminated via peer reviewed journals, presentations and communications with health care professionals, patients and the public. Trial registration: International Standard Randomised Controlled Trial Number 14362764. URL to registry record:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN14362764\" xlink:type=\"simple\">https:\/\/www.isrctn.com\/ISRCTN14362764<\/jats:ext-link>\n                      . Date of registration: 25\n                      <jats:sup>th<\/jats:sup>\n                      November 2024.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348372","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:21:27Z","timestamp":1779124887000},"page":"e0348372","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maintaining function and participation through tailored 24-hour movement behaviours for people living with multiple long-term conditions and frailty (The PERSONAL-AGILITY study): Protocol for a randomised controlled feasibility trial"],"prefix":"10.1371","volume":"21","author":[{"given":"Martha","family":"Thomas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louisa Y.","family":"Herring","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9987-9371","authenticated-orcid":true,"given":"Melanie J.","family":"Davies","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucina","family":"Wilde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicky","family":"Hall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura J.","family":"Gray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharlene A.","family":"Greenwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Hadjiconstantinou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malak","family":"Hamza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Harris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jemma","family":"Hawkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamlesh","family":"Khunti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Maddocks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atulkumar","family":"Rajpara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1463-697X","authenticated-orcid":true,"given":"Alex","family":"Rowlands","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla","family":"Sarkar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avan A.","family":"Sayer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8335-7018","authenticated-orcid":true,"given":"Sam","family":"Seidu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Yates","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4249-9060","authenticated-orcid":true,"given":"Hannah M. L.","family":"Young","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"pone.0348372.ref001","unstructured":"The Academy of Medical Sciences. Multimorbidity: a priority for global health research. 2018."},{"issue":"3","key":"pone.0348372.ref002","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/ageing\/afx201","article-title":"Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model","volume":"47","author":"MODEM project","year":"2018","journal-title":"Age Ageing"},{"issue":"1","key":"pone.0348372.ref003","doi-asserted-by":"crossref","first-page":"72","DOI":"10.7861\/clinmedicine.11-1-72","article-title":"The frailty syndrome","volume":"11","author":"A Clegg","year":"2011","journal-title":"Clin Med (Lond)"},{"issue":"11","key":"pone.0348372.ref004","article-title":"Sociodemographic intersections and risk of multiple long-term conditions: A systematic review","volume":"20","author":"MD Han","year":"2025","journal-title":"PLoS One"},{"issue":"9868","key":"pone.0348372.ref005","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people","volume":"381","author":"A Clegg","year":"2013","journal-title":"Lancet"},{"issue":"6","key":"pone.0348372.ref006","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1111\/jgs.17096","article-title":"Examining early and late onset of multimorbidity in the Canadian Longitudinal Study on Aging","volume":"69","author":"K Nicholson","year":"2021","journal-title":"J Am Geriatr Soc"},{"key":"pone.0348372.ref007","article-title":"Briefing: Understanding the health care needs of people with multiple health conditions","author":"M Stafford","year":"2018","journal-title":"London: Health Foundation"},{"issue":"6","key":"pone.0348372.ref008","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1093\/ageing\/afx150","article-title":"New horizons in multimorbidity in older adults","volume":"46","author":"AJ Yarnall","year":"2017","journal-title":"Age Ageing"},{"key":"pone.0348372.ref009","article-title":"The association between sedentary behaviour, moderate-vigorous physical activity and frailty","author":"J Blodgett","year":"2014","journal-title":"Dalhousie University"},{"key":"pone.0348372.ref010","doi-asserted-by":"crossref","first-page":"102599","DOI":"10.1016\/j.eclinm.2024.102599","article-title":"Evidence for exercise-based interventions across 45 different long-term conditions: an overview of systematic reviews","volume":"72","author":"GO Dibben","year":"2024","journal-title":"EClinicalMedicine"},{"issue":"10191","key":"pone.0348372.ref011","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","article-title":"Sarcopenia","volume":"393","author":"AJ Cruz-Jentoft","year":"2019","journal-title":"The Lancet"},{"issue":"12","key":"pone.0348372.ref012","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1007\/s00125-022-05787-2","article-title":"Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"65","author":"MJ Davies","year":"2022","journal-title":"Diabetologia"},{"key":"pone.0348372.ref013","article-title":"Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep","volume":"45","author":"R Ross","year":"2020","journal-title":"Appl Physiol Nutr Metab"},{"issue":"11","key":"pone.0348372.ref014","article-title":"Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions and their informal carers: a scoping review and stakeholder consultation","volume":"53","author":"HML Young","year":"2024","journal-title":"Age Ageing"},{"issue":"3","key":"pone.0348372.ref015","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1007\/s11325-020-02061-w","article-title":"Sleep and frailty risk: a systematic review and meta-analysis","volume":"24","author":"A Pourmotabbed","year":"2020","journal-title":"Sleep Breath"},{"issue":"1","key":"pone.0348372.ref016","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1186\/s12916-020-01846-w","article-title":"Sleep disturbances and the speed of multimorbidity development in old age: results from a longitudinal population-based study","volume":"18","author":"S Sindi","year":"2020","journal-title":"BMC Med"},{"key":"pone.0348372.ref017","unstructured":"NHS E. Fit for the future: 10 year health plan for England. 2025."},{"key":"pone.0348372.ref018","article-title":"Shared decision-making: summary of NICE guidance","volume":"373","author":"Guideline Committee","year":"2021","journal-title":"BMJ"},{"issue":"3","key":"pone.0348372.ref019","article-title":"Interventions for improving outcomes in patients with multimorbidity in primary care and community settings","volume":"3","author":"SM Smith","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0348372.ref020","unstructured":"World Health Organization. Global action plan on physical activity 2018-2030: more active people for a healthier world. World Health Organization. 2019."},{"issue":"2","key":"pone.0348372.ref021","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s12529-022-10092-8","article-title":"Effect of In-Person Delivered Behavioural Interventions in People with Multimorbidity: Systematic Review and Meta-analysis","volume":"30","author":"A Bricca","year":"2023","journal-title":"Int J Behav Med"},{"key":"pone.0348372.ref022","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1146\/annurev.publhealth.27.021405.102100","article-title":"An ecological approach to creating active living communities","volume":"27","author":"JF Sallis","year":"2006","journal-title":"Annu Rev Public Health"},{"issue":"11","key":"pone.0348372.ref023","article-title":"Exercise for people living with frailty and receiving haemodialysis: a mixed-methods randomised controlled feasibility study","volume":"10","author":"HML Young","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0348372.ref024","doi-asserted-by":"crossref","DOI":"10.1177\/2235042X20981190","article-title":"The complexity of caregiving for community-living older adults with multiple chronic conditions: A qualitative study","volume":"10","author":"J Ploeg","year":"2020","journal-title":"J Comorb"},{"issue":"5","key":"pone.0348372.ref025","doi-asserted-by":"crossref","DOI":"10.1093\/geront\/gny072","article-title":"Care Recipient Multimorbidity and Health Impacts on Informal Caregivers: A Systematic Review","volume":"59","author":"A Amer Nordin","year":"2019","journal-title":"Gerontologist"},{"issue":"1","key":"pone.0348372.ref026","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1080\/08870446.2019.1626125","article-title":"Experiences and support needs of informal caregivers of people with multimorbidity: a scoping literature review","volume":"35","author":"ML Price","year":"2020","journal-title":"Psychol Health"},{"issue":"9","key":"pone.0348372.ref027","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-046187","article-title":"What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews","volume":"11","author":"GF Spiers","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0348372.ref028","article-title":"Caring for Older People As a Social Determinant of Health: Findings from a Scoping Review of Observational Studies","author":"M Stowell","year":"2024","journal-title":"JLTC"},{"issue":"12","key":"pone.0348372.ref029","doi-asserted-by":"crossref","first-page":"4574","DOI":"10.3390\/ijerph17124574","article-title":"Spousal Concordance of Physical Frailty in Older Korean Couples","volume":"17","author":"S Kang","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0348372.ref030","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.jamda.2016.01.006","article-title":"Functional and mental health outcomes of the joint effects of spousal health: the potential threats of \u201cconcordant frailty","volume":"17","author":"W-H Lu","year":"2016","journal-title":"Journal of the American Medical Directors Association"},{"issue":"3","key":"pone.0348372.ref031","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1001\/jamainternmed.2014.7554","article-title":"The influence of partner\u2019s behavior on health behavior change: the English Longitudinal Study of Ageing","volume":"175","author":"SE Jackson","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"4","key":"pone.0348372.ref032","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1080\/02701367.2018.1510171","article-title":"Spousal Concordance for Objectively Measured Sedentary Behavior and Physical Activity Among Middle-Aged and Older Couples","volume":"89","author":"K Harada","year":"2018","journal-title":"Res Q Exerc Sport"},{"issue":"1","key":"pone.0348372.ref033","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/abm\/kaz019","article-title":"Moving in Sync: Hourly Physical Activity and Sedentary Behavior are Synchronized in Couples","volume":"54","author":"T Pauly","year":"2020","journal-title":"Ann Behav Med"},{"issue":"7","key":"pone.0348372.ref034","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/abm\/kaz061","article-title":"Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability","volume":"54","author":"CA Polenick","year":"2020","journal-title":"Ann Behav Med"},{"issue":"11","key":"pone.0348372.ref035","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1007\/s40279-017-0725-z","article-title":"Exercise for multimorbid patients in primary care: one prescription for all?","volume":"47","author":"P de Souto Barreto","year":"2017","journal-title":"Sports Medicine"},{"issue":"6","key":"pone.0348372.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0325742","article-title":"Randomised controlled trials for improving health outcomes for people living with multiple long-term conditions: Protocol for a systematic review of methodological approaches, risk of bias and reporting quality","volume":"20","author":"L Zhang","year":"2025","journal-title":"PLoS One"},{"issue":"10491","key":"pone.0348372.ref037","volume":"405","author":"AW Chan","year":"2025","journal-title":"The Lancet"},{"key":"pone.0348372.ref038","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-081660","article-title":"SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials","volume":"389","author":"A Hr\u00f3bjartsson","year":"2025","journal-title":"BMJ"},{"key":"pone.0348372.ref039","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"TC Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"pone.0348372.ref040","volume-title":"American college of sports medicine guidelines for exercise testing and prescription","author":"G Liguori","year":"2020"},{"issue":"3","key":"pone.0348372.ref041","first-page":"189","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"MF Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"key":"pone.0348372.ref042","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"K Skivington","year":"2021","journal-title":"BMJ"},{"issue":"8","key":"pone.0348372.ref043","article-title":"Guidance on how to develop complex interventions to improve health and healthcare","volume":"9","author":"A O\u2019Cathain","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0348372.ref044","volume-title":"Planning health promotion programs: an intervention mapping approach","author":"LKB Eldredge","year":"2016"},{"issue":"1","key":"pone.0348372.ref045","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40814-015-0033-z","article-title":"The person-based approach to enhancing the acceptability and feasibility of interventions","volume":"1","author":"L Yardley","year":"2015","journal-title":"Pilot and feasibility studies"},{"key":"pone.0348372.ref046","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3389\/fpubh.2019.00209","article-title":"Intervention Mapping: Theory- and Evidence-Based Health Promotion Program Planning: Perspective and Examples","volume":"7","author":"ME Fernandez","year":"2019","journal-title":"Front Public Health"},{"key":"pone.0348372.ref047","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40814-019-0425-6","article-title":"Taxonomy of approaches to developing interventions to improve health: a systematic methods overview","volume":"5","author":"A O\u2019Cathain","year":"2019","journal-title":"Pilot Feasibility Stud"},{"issue":"1","key":"pone.0348372.ref048","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.4055","article-title":"The person-based approach to intervention development: application to digital health-related behavior change interventions","volume":"17","author":"L Yardley","year":"2015","journal-title":"J Med Internet Res"},{"issue":"1","key":"pone.0348372.ref049","doi-asserted-by":"crossref","DOI":"10.2196\/aging.9025","article-title":"Coproduction of a Theory-Based Digital Resource for Unpaid Carers (The Care Companion): Mixed-Methods Study","volume":"1","author":"J Dale","year":"2018","journal-title":"JMIR Aging"},{"issue":"1","key":"pone.0348372.ref050","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12877-022-02754-9","article-title":"Planning and designing a self-compassion intervention for family carers of people living with dementia: a person-based and co-design approach","volume":"22","author":"J Murfield","year":"2022","journal-title":"BMC Geriatr"},{"issue":"21","key":"pone.0348372.ref051","doi-asserted-by":"crossref","first-page":"7949","DOI":"10.3390\/ijerph17217949","article-title":"Development of the Digital Assessment of Precise Physical Activity (DAPPA) Tool for Older Adults","volume":"17","author":"R Essery","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0348372.ref052","unstructured":"National Institute for Health and Care Research. Guidance on co-producing a research project. 2018."},{"key":"pone.0348372.ref053","doi-asserted-by":"crossref","first-page":"942658","DOI":"10.3389\/frhs.2022.942658","article-title":"Understanding implementation research collaborations from a co-creation lens: Recommendations for a path forward","volume":"2","author":"M P\u00e9rez Jolles","year":"2022","journal-title":"Front Health Serv"},{"key":"pone.0348372.ref054","unstructured":"Agency for Healthcare Research and Quality. The SHARE Approach: Facilitator\u2019s Guide. 2024. https:\/\/www.ahrq.gov\/sites\/default\/files\/wysiwyg\/sdm\/share-approach\/share-facilitator-guide.pdf"},{"issue":"4","key":"pone.0348372.ref055","doi-asserted-by":"crossref","DOI":"10.2196\/36043","article-title":"A 3-Item Measure of Digital Health Care Literacy: Development and Validation Study","volume":"6","author":"LA Nelson","year":"2022","journal-title":"JMIR Form Res"},{"key":"pone.0348372.ref056","unstructured":"Type 2 diabetes (T2D) in 16-40 year olds: A multifactorial management intervention to address multimorbidity in early-onset T2D in adults (The M3 research programme). National Institute for Health and Care Research Funding and Awards. 2024. https:\/\/fundingawards.nihr.ac.uk\/award\/NIHR201165"},{"issue":"1","key":"pone.0348372.ref057","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1186\/s12913-025-12616-w","article-title":"Using normalisation process theory to understand implementation of effective early-onset type 2 diabetes treatment and care within England: a qualitative study","volume":"25","author":"R Chauhan","year":"2025","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0348372.ref058","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.1998","article-title":"Do participants\u2019 preferences for mode of delivery (text, video, or both) influence the effectiveness of a Web-based physical activity intervention?","volume":"14","author":"C Vandelanotte","year":"2012","journal-title":"J Med Internet Res"},{"issue":"1","key":"pone.0348372.ref059","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.apnr.2004.04.003","article-title":"Changing the tide: an Internet\/video exercise and low-fat diet intervention with middle-school students","volume":"18","author":"M Frenn","year":"2005","journal-title":"Appl Nurs Res"},{"issue":"1","key":"pone.0348372.ref060","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/meet.2011.14504801317","article-title":"Effect of Web\u2010based interactive tailored health videos on users\u2019 attention, interactivity, overall evaluation, preference and engagement","volume":"48","author":"JA Lee","year":"2011","journal-title":"Proc of Assoc for Info"},{"issue":"12","key":"pone.0348372.ref061","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1080\/10810730.2014.894597","article-title":"Using online computer tailoring to promote physical activity: a randomized trial of text, video, and combined intervention delivery modes","volume":"19","author":"KCM Soetens","year":"2014","journal-title":"J Health Commun"},{"issue":"10","key":"pone.0348372.ref062","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1123\/jpah.2025-0188","article-title":"Incorporating a Physical Activity mHealth Tool Into a Multidisciplinary Clinical Weight Management Service in England: Service Evaluation of Steps4Health","volume":"22","author":"LY Herring","year":"2025","journal-title":"J Phys Act Health"},{"issue":"3","key":"pone.0348372.ref063","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1046\/j.1440-1630.1999.00182.x","article-title":"Handgrip strength testing: A review of the literature","volume":"46","author":"E Innes","year":"1999","journal-title":"Aus Occup Therapy J"},{"issue":"4","key":"pone.0348372.ref064","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach","volume":"40","author":"HC Roberts","year":"2011","journal-title":"Age Ageing"},{"issue":"1","key":"pone.0348372.ref065","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/01823246-200819010-00005","article-title":"Outcome measures in cardiopulmonary physical therapy: short physical performance battery","volume":"19","author":"ML Puthoff","year":"2008","journal-title":"Cardiopulm Phys Ther J"},{"issue":"6","key":"pone.0348372.ref066","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/ageing\/afs099","article-title":"Performance-based physical function in older community-dwelling persons: a systematic review of instruments","volume":"41","author":"E Freiberger","year":"2012","journal-title":"Age Ageing"},{"issue":"2","key":"pone.0348372.ref067","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.berh.2017.11.008","article-title":"Measuring physical capacity and performance in older people","volume":"31","author":"SE Lamb","year":"2017","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"5","key":"pone.0348372.ref068","doi-asserted-by":"crossref","first-page":"559","DOI":"10.2522\/ptj.20070205","article-title":"Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review","volume":"88","author":"L Blum","year":"2008","journal-title":"Phys Ther"},{"issue":"2","key":"pone.0348372.ref069","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5535\/arm.240029","article-title":"Outcome Measurement in Balance Problems: Berg Balance Scale","volume":"48","author":"KL Joa","year":"2024","journal-title":"Ann Rehabil Med"},{"key":"pone.0348372.ref070","article-title":"Berg Balance Testing","volume-title":"StatPearls","author":"N Miranda","year":"2023"},{"key":"pone.0348372.ref071","doi-asserted-by":"crossref","first-page":"101703","DOI":"10.1016\/j.psychsport.2020.101703","article-title":"Assessing physical behavior through accelerometry \u2013 State of the science, best practices and future directions","volume":"49","author":"A Burchartz","year":"2020","journal-title":"Psychology of Sport and Exercise"},{"issue":"1","key":"pone.0348372.ref072","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1080\/1091367X.2021.1944154","article-title":"Comparability of Postural and Physical Activity Metrics from Different Accelerometer Brands Worn on the Thigh: Data Harmonization Possibilities","volume":"26","author":"CL Edwardson","year":"2021","journal-title":"Measurement in Physical Education and Exercise Science"},{"key":"pone.0348372.ref073","volume-title":"GGIR: Raw Accelerometer Data Analysis","author":"V van Hees","year":"2026","edition":"3"},{"issue":"10","key":"pone.0348372.ref074","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1088\/0967-3334\/37\/10\/1653","article-title":"Identifying adults\u2019 valid waking wear time by automated estimation in activPAL data collected with a 24\u2009h wear protocol","volume":"37","author":"EAH Winkler","year":"2016","journal-title":"Physiol Meas"},{"issue":"9","key":"pone.0348372.ref075","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1016\/j.jval.2025.05.012","article-title":"Validity of the EQ-5D-5L for Routine Assessment in Residential Aged Care: Results From a Feasibility Study","volume":"28","author":"L Engel","year":"2025","journal-title":"Value in Health"},{"issue":"1","key":"pone.0348372.ref076","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1186\/s12955-020-01564-0","article-title":"Measurement properties of EQ-5D-3L and EQ-5D-5L in recording self-reported health status in older patients with substantial multimorbidity and polypharmacy","volume":"18","author":"A Bhadhuri","year":"2020","journal-title":"Health and Quality of Life Outcomes"},{"issue":"1","key":"pone.0348372.ref077","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/hec.3564","article-title":"Valuing health\u2010related quality of life: an EQ\u20105 D\u20105\u2009L value set for England","volume":"27","author":"NJ Devlin","year":"2018","journal-title":"Health Economics"},{"issue":"6846","key":"pone.0348372.ref078","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1136\/bmj.305.6846.160","article-title":"Validating the SF-36 health survey questionnaire: new outcome measure for primary care","volume":"305","author":"JE Brazier","year":"1992","journal-title":"BMJ"},{"key":"pone.0348372.ref079","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1471-2318-14-12","article-title":"Psychometric properties of the Late-Life Function and Disability Instrument: a systematic review","volume":"14","author":"MK Beauchamp","year":"2014","journal-title":"BMC Geriatr"},{"key":"pone.0348372.ref080","volume-title":"Late-life FDI manual","author":"AM Jette","year":"2002"},{"key":"pone.0348372.ref081","doi-asserted-by":"crossref","DOI":"10.1590\/1518-8345.0993.2764","article-title":"The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review","volume":"24","author":"FC Rugno","year":"2016","journal-title":"Rev Lat Am Enfermagem"},{"issue":"3","key":"pone.0348372.ref082","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jcomdis.2003.09.003","article-title":"Goal attainment scaling as a clinical measurement technique in communication disorders: a critical review","volume":"37","author":"RW Schlosser","year":"2004","journal-title":"J Commun Disord"},{"issue":"10","key":"pone.0348372.ref083","doi-asserted-by":"crossref","first-page":"758","DOI":"10.47102\/annals-acadmedsg.V39N10p758","article-title":"Validity and reliability of the Zarit Burden Interview in assessing caregiving burden","volume":"39","author":"BK Seng","year":"2010","journal-title":"Ann Acad Med Singap"},{"key":"pone.0348372.ref084","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/1471-2288-10-67","article-title":"What is a pilot or feasibility study? A review of current practice and editorial policy","volume":"10","author":"M Arain","year":"2010","journal-title":"BMC Med Res Methodol"},{"issue":"2","key":"pone.0348372.ref085","doi-asserted-by":"crossref","first-page":"171","DOI":"10.5014\/ajot.2013.006270","article-title":"Nuts and bolts of conducting feasibility studies","volume":"67","author":"L Tickle-Degnen","year":"2013","journal-title":"Am J Occup Ther"},{"key":"pone.0348372.ref086","doi-asserted-by":"crossref","DOI":"10.1097\/CCM.0b013e3181920e33","article-title":"The design and interpretation of pilot trials in clinical research in critical care","volume":"37","author":"DM Arnold","year":"2009","journal-title":"Crit Care Med"},{"issue":"3","key":"pone.0348372.ref087","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.jclinepi.2011.07.011","article-title":"The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency","volume":"65","author":"J Sim","year":"2012","journal-title":"J Clin Epidemiol"},{"issue":"4","key":"pone.0348372.ref088","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/pst.185","article-title":"Sample size of 12 per group rule of thumb for a pilot study","volume":"4","author":"SA Julious","year":"2005","journal-title":"Pharmaceutical Statistics"},{"issue":"2","key":"pone.0348372.ref089","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j..2002.384.doc.x","article-title":"Design and analysis of pilot studies: recommendations for good practice","volume":"10","author":"GA Lancaster","year":"2004","journal-title":"J Eval Clin Pract"},{"key":"pone.0348372.ref090","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2288-10-1","article-title":"A tutorial on pilot studies: the what, why and how","volume":"10","author":"L Thabane","year":"2010","journal-title":"BMC Med Res Methodol"},{"key":"pone.0348372.ref091","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"GF Moore","year":"2015","journal-title":"BMJ"},{"key":"pone.0348372.ref092","doi-asserted-by":"crossref","first-page":"104705","DOI":"10.1016\/j.ijnurstu.2024.104705","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"154","author":"K Skivington","year":"2024","journal-title":"Int J Nurs Stud"},{"key":"pone.0348372.ref093","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1748-5908-4-29","article-title":"Development of a theory of implementation and integration: Normalization Process Theory","volume":"4","author":"CR May","year":"2009","journal-title":"Implement Sci"},{"key":"pone.0348372.ref094","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1741-7015-8-63","article-title":"Normalisation process theory: a framework for developing, evaluating and implementing complex interventions","volume":"8","author":"E Murray","year":"2010","journal-title":"BMC Med"},{"issue":"1","key":"pone.0348372.ref095","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/bjhp.12394","article-title":"Developing quality fidelity and engagement measures for complex health interventions","volume":"25","author":"H Walton","year":"2020","journal-title":"Br J Health Psychol"},{"issue":"1","key":"pone.0348372.ref096","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s12160-013-9486-6","article-title":"The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions","volume":"46","author":"S Michie","year":"2013","journal-title":"Ann Behav Med"},{"key":"pone.0348372.ref097","doi-asserted-by":"crossref","DOI":"10.1111\/j.1752-7325.2011.00233.x","article-title":"The Assessment, Monitoring, and Enhancement of Treatment Fidelity In Public Health Clinical Trials","volume":"71","author":"B Borrelli","year":"2011","journal-title":"J Public Health Dent"},{"issue":"3","key":"pone.0348372.ref098","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.sapharm.2012.04.004","article-title":"Interrater agreement and interrater reliability: key concepts, approaches, and applications","volume":"9","author":"N Gisev","year":"2013","journal-title":"Res Social Adm Pharm"},{"issue":"5","key":"pone.0348372.ref099","first-page":"360","article-title":"Understanding interobserver agreement: the kappa statistic","volume":"37","author":"AJ Viera","year":"2005","journal-title":"Fam Med"},{"issue":"3","key":"pone.0348372.ref100","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0173904","article-title":"Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies-A systematic review","volume":"12","author":"H Doherr","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pone.0348372.ref101","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s12874-016-0236-x","article-title":"Measurement of adherence in a randomised controlled trial of a complex intervention: supported self-management for adults with learning disability and type 2 diabetes","volume":"16","author":"L Graham","year":"2016","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"pone.0348372.ref102","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13012-017-0552-5","article-title":"Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework","volume":"12","author":"LM Pfadenhauer","year":"2017","journal-title":"Implement Sci"},{"issue":"11","key":"pone.0348372.ref103","doi-asserted-by":"crossref","DOI":"10.1016\/j.apmr.2017.03.015","article-title":"Development and Preliminary Psychometrics of the Exercise Therapy Burden Questionnaire for Patients With Chronic Conditions","volume":"98","author":"W Martin","year":"2017","journal-title":"Arch Phys Med Rehabil"},{"issue":"13","key":"pone.0348372.ref104","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample Size in Qualitative Interview Studies: Guided by Information Power","volume":"26","author":"K Malterud","year":"2016","journal-title":"Qual Health Res"},{"issue":"2","key":"pone.0348372.ref105","article-title":"Informing efficient randomised controlled trials: exploration of challenges in developing progression criteria for internal pilot studies","volume":"7","author":"KNL Avery","year":"2017","journal-title":"BMJ Open"},{"issue":"716","key":"pone.0348372.ref106","doi-asserted-by":"crossref","DOI":"10.3399\/BJGP.2021.0325","article-title":"Identifying multimorbidity clusters with the highest primary care use: 15 years of evidence from a multi-ethnic metropolitan population","volume":"72","author":"M Soley-Bori","year":"2022","journal-title":"Br J Gen Pract"},{"issue":"1","key":"pone.0348372.ref107","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12916-020-01543-8","article-title":"Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study","volume":"18","author":"Y Zhu","year":"2020","journal-title":"BMC Med"},{"issue":"3","key":"pone.0348372.ref108","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0150205","article-title":"Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework","volume":"11","author":"SM Eldridge","year":"2016","journal-title":"PLoS One"},{"issue":"23","key":"pone.0348372.ref109","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1001\/jama.2017.18556","article-title":"Guidelines for the Content of Statistical Analysis Plans in Clinical Trials","volume":"318","author":"C Gamble","year":"2017","journal-title":"JAMA"},{"key":"pone.0348372.ref110","volume-title":"Mixed methods research","author":"JW Creswell","year":"2007"},{"issue":"2","key":"pone.0348372.ref111","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"issue":"2","key":"pone.0348372.ref112","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1002\/capr.12165","article-title":"Using thematic analysis in counselling and psychotherapy research: A critical reflection","volume":"18","author":"V Clarke","year":"2018","journal-title":"Couns and Psychother Res"},{"key":"pone.0348372.ref113","first-page":"25","article-title":"Thematic analysis","author":"G Terry","year":"2017","journal-title":"The SAGE handbook of qualitative research in psychology"},{"issue":"10","key":"pone.0348372.ref114","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1177\/1077800410383121","article-title":"Qualitative Quality: Eight \u201cBig-Tent\u201d Criteria for Excellent Qualitative Research","volume":"16","author":"SJ Tracy","year":"2010","journal-title":"Qualitative Inquiry"},{"issue":"3","key":"pone.0348372.ref115","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/0142159X.2022.2057287","article-title":"A practical guide to reflexivity in qualitative research: AMEE Guide No. 149","volume":"45","author":"FM Olmos-Vega","year":"2023","journal-title":"Medical Teacher"},{"key":"pone.0348372.ref116","article-title":"Three techniques for integrating data in mixed methods studies","volume":"341","author":"A O\u2019Cathain","year":"2010","journal-title":"BMJ"},{"issue":"11","key":"pone.0348372.ref117","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-032081","article-title":"Integrating quantitative and qualitative data and findings when undertaking randomised controlled trials","volume":"9","author":"DA Richards","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0348372.ref118","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1186\/1745-6215-14-353","article-title":"A process for Decision-making after Pilot and feasibility Trials (ADePT): development following a feasibility study of a complex intervention for pelvic organ prolapse","volume":"14","author":"C Bugge","year":"2013","journal-title":"Trials"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348372","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:21:45Z","timestamp":1779124905000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348372"}},"subtitle":[],"editor":[{"given":"Alejandro","family":"Torrado Pacheco","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":118,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0348372","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}