The aim of this work was to develop a comprehensive model to guide rehabilitation technology implementation. To do this, it is important to understand the theories, frameworks and models that are used to support rehabilitation technology adoption, and to capture the lived experience of people involved in rehabilitation technology in clinical practice.
A multi-faceted methodology was utilised. Firstly, systematic, scoping and hermeneutic reviews were undertaken to identify existing implementation models, theories, frameworks and factors that have been used to underpin adoption of rehabilitation technology. Secondly, stakeholder analysis identified a range of people and roles who had influence upon technology adoption. Thirdly, a review of behaviour change approaches used in digitally supported rehabilitation was undertaken. After ethical approval, these individuals were interviewed using a schedule developed from Normalisation Process Theory. Interviews were transcribed and analysed using constant comparison techniques. Codes and themes were generated and group into overarching areas, then triangulated with findings from the literature reviews. These were then assimilated into a final model.
The literature reviews identified over 10 broad models and several additional individual reviews and studies of factors influencing rehabilitation technology implementation. Forty-eight interviews with clinicians, patients, managers, organisation leads, innovation groups, digital developers, information technology and information governance experts generated more than 300 codes, which were initially assimilated into 15 themes and then grouped into 5 overarching themes. Existing models, factors and behaviour change techniques identified from the literature reviews were used to underpin these themes. These were used to generate the Rehabilitation Technologies (RiTe) Implementation Model which comprised 5 themes: the Team, the Organisation, Users, Technology and Evidence. Associated guidance and toolkits to support the use of the model in rehabilitation technology are currently being produced and will be housed on our website with the model: advancingrehab.com
To our knowledge, the RiTe model is the first implementation model to specifically designed to support rehabilitation technology adoption into clinical practice. Whilst this model was generated solely from UK focussed interviews, triangulation indicates many of the factors have relevance in other healthcare settings, most notably those with a universal healthcare structure. We are keen to work with global partners to test and refine the RiTe model for use in other healthcare settings and will continue to refine the model based upon user feedback.
The RiTe model has been developed to support adoption and evaluation of rehabilitation DHT, avoid costly failed adoption, and enable more patients to benefit from technologies in their rehabilitation.
rehabilitation
implementation
