Implementation in rehabilitation: a roadmap for practitioners and researchers

PURPOSE: Despite growth in rehabilitation research, implementing research findings into rehabilitation practice has been slow. This creates inequities for patients and is an ethical issue. However, methods to investigate and facilitate evidence implementation are being developed. This paper aims to make these methods relevant and accessible for rehabilitation researchers and practitioners.\ud METHODS: Rehabilitation practice is varied and complex and occurs within multilevel healthcare systems. Using a "road map" analogy, we describe how implementation concepts and theories can inform implementation strategies in rehabilitation. 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. We have developed a model to illustrate the journey, and four case studies exemplify implementation stages in rehabilitation settings. RESULTS AND CONCLUSIONS: Effective implementation strategies for the complex world of rehabilitation are urgently required. The journey we describe unpacks that complexity to provide a template for effective implementation, to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. It emphasizes the importance of understanding context and application of relevant theory, and highlights areas which should be targeted in new implementation research in rehabilitation. Implications for rehabilitation Effective implementation of research evidence into rehabilitation practice has many interconnected steps and a roadmap analogy is helpful in defining them. Understanding context for implementation is critically important and using theory can facilitate development of understanding. Research methods for implementation in rehabilitation should be carefully selected and outcomes should evaluate implementation success as well as clinical change. Sustainability requires regular revisiting of the interconnected steps

Development of a toolkit to enhance care processes for people with a long-term neurological condition:A qualitative descriptive study

Objective To (A) explore perspectives of people with a long-term neurological condition, and of their family, clinicians and other stakeholders on three key processes: Two-way communication, self-management and coordination of long-term care; and (B) use these data to develop a Living Well Toolkit', a structural support aiming to enhance the quality of these care processes. Design This qualitative descriptive study drew on the principles of participatory research. Data from interviews and focus groups with participants (n=25) recruited from five hospital, rehabilitation and community settings in New Zealand were analysed using conventional content analysis. Consultation with a knowledge-user group (n=4) and an implementation champion group (n=4) provided additional operational knowledge important to toolkit development and its integration into clinical practice. Results Four main, and one overarching, themes were constructed: (1) tailoring care:referring to getting to know the person and their individual circumstances; (2) involving others: Representing the importance of negotiating the involvement of others in the person's long-term management process; (3) exchanging knowledge: Referring to acknowledging patient expertise; and (4) enabling: Highlighting the importance of empowering relationships and processes. The overarching theme was: Assume nothing. These themes informed the development of a toolkit comprising of two parts: One to support the person with the long-term neurological condition, and one targeted at clinicians to guide interaction and support their engagement with patients. Conclusion Perspectives of healthcare users, clinicians and other stakeholders were fundamental to the development of the Living Well Toolkit. The findings were used to frame toolkit specifications and highlighted potential operational issues that could prove key to its success. Further research to evaluate its use is now underway

Limited conversations about constrained futures:Exploring clinicians’ conversations about life after stroke in inpatient settings

Background and aims: After stroke, people can find it challenging to look forward to the future. Hope, a critical resource for recovery, can be threatened, and can be supported or diminished through interactions with clinicians. As such, understanding how conversations can support people embarking on life after stroke is critical. Our study explored how clinicians talk about the future with patients, and considered what factors shape how these conversations occur. Design and methods: This study drew on Interpretive Description methodology, informed by principles of ethnographic inquiry. We conducted 300 hours of observations and 76 interviews with 5 people with stroke and 37 clinicians. Data were analysed using reflexive thematic analysis. Findings: We constructed three themes that reflect how clinicians talk about the future with people in inpatient stroke services. These are: (1) Constrained temporal horizons; (2) Limited talk controlled by clinicians; and (3) Opening some doors while closing others.Conclusions: Conversations about the future after stroke were constrained and limited: constrained to short-term futures, and limited in what aspects of life after stroke were discussed. Creating conversational and relational spaces where people are supported to look to the future with a sense of possibility, hope, and potential is vital for assisting people to move forward in their life after their stroke. Given its role in supporting people to move forward in life, communication must be seen as a core clinical skill and a clinical intervention in its own right

A conceptual review of engagement in healthcare and rehabilitation

Purpose: This review sought to develop an understanding of how engagement in healthcare has been conceptualized in the literature in order to inform future clinical practice and research in rehabilitation. A secondary purpose was to propose a working definition of engagement