IMPLEMENTATION OF DIGITAL HEALTH INTERVENTIONS IN REHABILITATION: A SCOPING REVIEW

L. Pearce^1,2, N. Costa³, C. Sherrington^1,4, L. Hassett^1,5

¹Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia, ²Royal Rehab Rehabilitation Centre, Sydney, Australia, ³The University of Sydney, Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, Australia, ⁴The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, Australia, ⁵The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia

Background: Digital health interventions have the potential to enhance rehabilitation services by increasing accessibility, affordability, and scalability. However, between rapid advancement of technology and the expedited uptake of digital interventions through the COVID-19 pandemic, current implementation of digital interventions in rehabilitation is inconsistent and poorly understood. Implementation science presents an ideal approach to rigorously guide and evaluate the adoption, implementation and sustainment of digital interventions within rehabilitation, whilst simultaneously evaluating the effectiveness of these interventions.

Purpose: To map the current implementation evidence, including strategies used to implement digital interventions in rehabilitation, to inform future research and support adoption of digital interventions into rehabilitation practice.

Methods: Comprehensive searches of nine electronic databases were performed. Search terms consisted of a combination of four concepts: rehabilitation, rehabilitation clinicians, digital health interventions and implementation science. Two reviewers screened studies against the eligibility criteria by title and abstract, followed by full text. Studies were included if they were quantitative and reported on methods used to implement digital interventions delivered by rehabilitation clinicians. Implementation science taxonomies and methods were used to guide analysis and synthesis of findings. The conduct of this review was guided by best practice recommendations and guidelines for scoping reviews.

Results: The search retrieved 11,206 papers and 19 studies were included in the review. All studies were conducted in the last decade, with no studies in low or lower-middle income countries. Digital interventions used across studies included tele-rehabilitation, computer-based therapy, wearable devices, robotics, virtual reality, tablet/smartphone apps and virtual gaming. Most studies used pre-post designs and only four studies were randomised controlled trials; larger trials were conducted in stroke or mental health rehabilitation. A total of 37 discrete implementation strategies were reported across studies. Strategies related to training and educating clinicians (89% of studies), providing interactive assistance (e.g., providing local technical assistance) (68%), and developing stakeholder interrelationships (e.g., identifying and preparing champions) (53%) were most frequently reported. However, few studies adequately described implementation strategies and methods for selecting strategies. Most studies reported implementation outcomes (95%), implementation determinants (89%) and implementation frameworks (63%). Implementation findings were variable across studies, although some common barriers and facilitators were reported.

Conclusions: The rigour of implementation methods in the field is currently poor. Without stronger evidence-based knowledge of how to implement digital interventions into rehabilitation, such interventions are unlikely to be effectively used or sustained in clinical practice. To maintain pace with rapidly advancing technology, future research on rehabilitation digital interventions should embrace implementation science methods to evaluate both the implementation and effectiveness of interventions. Researchers should use implementation reporting guidelines, standardised terminology, and rigorous methods to clearly detail, select and evaluate implementation strategies. Additionally, there is an urgent need for research in this field to be conducted in low- and middle-income countries.

Implications: The success of implementing digital interventions in rehabilitation is multifactorial and requires careful planning. Rehabilitation clinicians, managers and organisations should identify local barriers and tailor implementation strategies to address barriers and facilitate implementation.

Funding acknowledgements: This study was not funded and was undertaken as a part of Louise Pearce’s PhD.

Keywords:
Digital interventions
Rehabilitation
Implementation science

Topics:
Research methodology, knowledge translation & implementation science
Disability & rehabilitation
Innovative technology: robotics

Did this work require ethics approval? No

Reason: As this project was a systematic scoping review and did not directly involve humans, ethics approval was not required. However, the protocol for this review was registered prospectively with the Open Science Framework on 4 August 2021, before commencing our searches (https://osf.io/j5uc9).