Implementing digitally enabled rehabilitation: implementation strategies delivered as part of a hybrid type II feasibility randomised controlled trial
Background: Recent research has demonstrated improvements in mobility in people undertaking rehabilitation when using digital devices such as virtual reality videogames, activity monitors and handheld computer devices in addition to usual rehabilitation. A next step is to understand how best to implement these devices into clinical practice and whether similar mobility outcomes can be achieved.
Aims: To describe the implementation strategies being tested as part of a feasibility study.
Methods: A feasibility hybrid type II implementation-effectiveness randomised controlled trial is being undertaken at Prince of Wales Hospital, Sydney. Physiotherapists working on the rehabilitation ward are recruited to receive the implementation strategies and 30 people undertaking inpatient rehabilitation will be randomised to receive digital devices for mobility exercises in addition to usual care or usual care alone. The implementation strategies have been informed from previous research and developed using the Capabilities, Opportunities, Motivation- Behaviour (COM-B) model of behaviour change. Implementation strategy usage is recorded using a study-specific log.
Results: The implementation strategies include: i) enablement (loaning of devices, resources); ii) clinical champion who is a physiotherapist at the site; iii) education (face-to-face or online); iv) training in device use; v) facilitation (clinical reasoning sessions) and audit and feedback of dosage recorded on practice sheets. To date 14 physiotherapists and 36 students have received implementation strategies. Implementation challenges thus far include IT support, staff turn-over and recording of dosage.
Conclusions: Implementation in a large public hospital is challenging and therefore testing strategies to overcome implementation challenges are crucial in translational research.