Implementation strategies and behavior change techniques in sustained and unsustained implementation efforts in physio- and occupational therapy: A scoping review.

This scoping review aimed to explore which implementation strategies and behavior change techniques, categorized according to the COM-B system, were used in studies reporting sustained and unsustained changes in the clinical behavior of PTs and OTs.

We carried out a scoping review following the framework described by Levac et al. Six databases were searched. We included studies that evaluated changes in the clinical behavior of PTs or OTs before and at least 6 months after an implementation intervention. We excluded qualitative studies, study protocols, reviews, and conference abstracts, as well as studies focusing on undergraduate students or studies evaluating only knowledge and attitudes. Two authors independently conducted screening and data extraction using the Covidence platform and a descriptive analysis of the data from all included studies. We identified implementation strategies and behavior change techniques, and categorized them according to the COM-B system.

We screened a total of 5130 studies and included 29 studies. Twenty-one studies reported sustained results, and 8 studies reported unsustained results. The studies reporting sustained clinical behavior used in median of 7 implementation strategies and 6 behavior change techniques. Twenty-two implementation strategies were identified among the included studies: 9 targeting capability, 8 targeting opportunity and 5 targeting motivation. Twenty-two behavior change techniques were identified among the included studies:  10 targeting capability, 5 targeting opportunity, and 7 targeting motivation. The most commonly used implementation strategies and behavior change techniques in the included studies, i.e., the strategies/techniques used in at least 50% of the studies, targeted capability and none targeted motivation. The most common implementation strategies and behavior change techniques in studies reporting sustained results also targeted opportunity, but not in studies reporting unsustained results.

Studies reporting sustained results commonly used implementation strategies and behavior change techniques categorized to both capability and opportunity compared to studies reporting unsustained results that used implementation strategies categorized to only capability. Implementation strategies categorized to motivation were seldom used in the studies. 

The findings of this review compare implementation strategies resulting in sustained and unsustained changes in PT’ and OTs’ clinical behavior. Our results highlight the importance of well-described and reported implementation studies to improve the comparability of the interventions and the interpretation of the results. Well-described strategies also facilitate the adaptation of effective implementation and sustainability strategies in clinical settings.