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Bird M-L1, Bernhardsson S2, Connell L3, Fisher R4, Hayes N5, Jarvis K6, Lynch E7, Miller K8, Morris J9, Mudge S10
1University of British Columbia, Faculty of Medicine, Physical Therapy, Vancouver, Canada, 2Region Vastra Gotaland, Narhalsan Primary Care Research and Development, Gothenburg, Sweden, 3University of Central Lancashire, School of Health Sciences, Preston, United Kingdom, 4University of Nottingham, School of Medicine, Nottingham, United Kingdom, 5Auckland University of Technology, Centre for Person Centred Research, School of Clinical Sciences, Auckland, New Zealand, 6University of Central Lancashire, School of Health Sciences, Preston, United Kingdom, 7University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, Australia, 8Sunny Hill Centre for Children, Child Development & Rehabilitation Evidence Centre, Vancouver, Canada, 9University of Dundee, Nursing and Health Sciences, Dundee, United Kingdom, 10Auckland University of Technology, School of Medicine, Auckland, New Zealand
Background: Rapid developments in research in the area of rehabilitation science has meant that translating research findings into rehabilitation practice is slow and inconsistently applied. Additionally, rehabilitation practice is highly varied, multi-faceted and exists within, complex multilevel healthcare systems. Translating research evidence into rehabilitation within these systems is, unsurprisingly, challenging. However failure to implement current evidence known to improve patient outcomes into practice, , creates ethical and equity issues. To address this, there has been rapid development in the range of implementation tools that can facilitate knowledge translation in rehabilitation.
Purpose: This work sought to provide guidance from the literature to make knowledge translation methods relevant and accessible for researchers and practitioners who want to implement practice change in rehabilitation.
Methods: Using a “road map” analogy, we develop a model to describe how implementation concepts and theories can inform implementation strategies in rehabilitation. Four case studies conducted in international rehabilitation settings provide examples to describe implementation concepts and methods and make them relevant and accessible for rehabilitation practitioners and rehabilitation researchers. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation.
Results: This journey describes rehabilitation complexity to provide a template for effective implementation and to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. Key findings emerging are that A) broad definitions of evidence, not only research evidence, can inform practice B) understanding local context and its variations for implementation, influences implementation success and development of effective implementation strategies is vital C) selection of appropriate theoretical models to help to understand implementation context and strategies should be embraced by rehabilitation researchers and practitioners D) understanding key stages of implementation, using appropriate tools and developing appropriate strategies for each stage will help to address challenges E) recognition of the range of available research design and careful selection based on purpose and degree of certainty being sought F) Differentiation between implementation and clinical outcomes is necessary to specifically assess effects of implementation efforts G) Sustaining implementation requires a cyclical approach and recognition of when it is relevant to re-enter the roadmap and at what stage,. The roadmap is illustrated in an explanatory figure that can be used as a template for future implementation efforts in rehabilitation.
Conclusion(s): This work illustrates a comprehensive approach for successful implementation research and practice that demonstrates importance of understanding context and application of relevant Implementation research design, theories and strategies for successful knowledge translation. The work highlights areas in which new implementation research in rehabilitation should be targeted, acknowledging that effective evidence-based implementation strategies for the complex world of rehabilitation are still urgently required.
Implications: Understanding the local context is important for successful knowledge translation and the implementation of new evidence
Consideration and selection of appropriate research designs, theoretical models and implementation strategies are important for rehabilitation researchers and practitioners.
Effective evidence-based implementation strategies for rehabilitation are still required.
Keywords: Implementation, rehabilitation, context
Funding acknowledgements: No funding for this study was received
Purpose: This work sought to provide guidance from the literature to make knowledge translation methods relevant and accessible for researchers and practitioners who want to implement practice change in rehabilitation.
Methods: Using a “road map” analogy, we develop a model to describe how implementation concepts and theories can inform implementation strategies in rehabilitation. Four case studies conducted in international rehabilitation settings provide examples to describe implementation concepts and methods and make them relevant and accessible for rehabilitation practitioners and rehabilitation researchers. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation.
Results: This journey describes rehabilitation complexity to provide a template for effective implementation and to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. Key findings emerging are that A) broad definitions of evidence, not only research evidence, can inform practice B) understanding local context and its variations for implementation, influences implementation success and development of effective implementation strategies is vital C) selection of appropriate theoretical models to help to understand implementation context and strategies should be embraced by rehabilitation researchers and practitioners D) understanding key stages of implementation, using appropriate tools and developing appropriate strategies for each stage will help to address challenges E) recognition of the range of available research design and careful selection based on purpose and degree of certainty being sought F) Differentiation between implementation and clinical outcomes is necessary to specifically assess effects of implementation efforts G) Sustaining implementation requires a cyclical approach and recognition of when it is relevant to re-enter the roadmap and at what stage,. The roadmap is illustrated in an explanatory figure that can be used as a template for future implementation efforts in rehabilitation.
Conclusion(s): This work illustrates a comprehensive approach for successful implementation research and practice that demonstrates importance of understanding context and application of relevant Implementation research design, theories and strategies for successful knowledge translation. The work highlights areas in which new implementation research in rehabilitation should be targeted, acknowledging that effective evidence-based implementation strategies for the complex world of rehabilitation are still urgently required.
Implications: Understanding the local context is important for successful knowledge translation and the implementation of new evidence
Consideration and selection of appropriate research designs, theoretical models and implementation strategies are important for rehabilitation researchers and practitioners.
Effective evidence-based implementation strategies for rehabilitation are still required.
Keywords: Implementation, rehabilitation, context
Funding acknowledgements: No funding for this study was received
Topic: Research methodology & knowledge translation
Ethics approval required: No
Institution: University of Dundee
Ethics committee: University of Dundee
Reason not required: This paper is based on a literature review and did not recruit humans
All authors, affiliations and abstracts have been published as submitted.
