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Understanding how newly implemented rehabilitation best practices are sustained: a realist review

  • Author Footnotes
    a Who: clinicians, clinical-managers, When: November 24th 2021, Where: Talking Research – Jewish Rehabilitation Hospital. Laval, Canada (online)
    Rebecca Ataman
    Footnotes
    a Who: clinicians, clinical-managers, When: November 24th 2021, Where: Talking Research – Jewish Rehabilitation Hospital. Laval, Canada (online)
    Affiliations
    School of Physical and Occupational Therapy, McGill University, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)
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  • Author Footnotes
    b Who: researchers, students, When: May 11th 2021, Where: McGill-Queen's rehabilitation colloquium, Virtual.
    Sara Ahmed
    Footnotes
    b Who: researchers, students, When: May 11th 2021, Where: McGill-Queen's rehabilitation colloquium, Virtual.
    Affiliations
    School of Physical and Occupational Therapy, McGill University, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), McGill University Health Center, Clinical Epidemiology
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  • Author Footnotes
    c Who: researchers, students, When: June 14-15th 2021, Where: International Conference of Knowledge Translation in Rehabilitation. Montréal, Canada (online)
    Ahlam Zidan
    Footnotes
    c Who: researchers, students, When: June 14-15th 2021, Where: International Conference of Knowledge Translation in Rehabilitation. Montréal, Canada (online)
    Affiliations
    School of Physical and Occupational Therapy, McGill University, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)
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  • Author Footnotes
    d Who: researchers, students, When: June 7-9th 2021, Where: CRIR Scientific Congress. Montréal, Canada (online)
    Aliki Thomas
    Correspondence
    Corresponding author: Aliki Thomas, Davis House, 3654 prom Sir-William-Osler, 514-398-4496
    Footnotes
    d Who: researchers, students, When: June 7-9th 2021, Where: CRIR Scientific Congress. Montréal, Canada (online)
    Affiliations
    School of Physical and Occupational Therapy, McGill University, Institute of Health Sciences Education, McGill University, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)
    Search for articles by this author
  • Author Footnotes
    a Who: clinicians, clinical-managers, When: November 24th 2021, Where: Talking Research – Jewish Rehabilitation Hospital. Laval, Canada (online)
    b Who: researchers, students, When: May 11th 2021, Where: McGill-Queen's rehabilitation colloquium, Virtual.
    c Who: researchers, students, When: June 14-15th 2021, Where: International Conference of Knowledge Translation in Rehabilitation. Montréal, Canada (online)
    d Who: researchers, students, When: June 7-9th 2021, Where: CRIR Scientific Congress. Montréal, Canada (online)

      Objective

      : We conducted a realist review to understand how (mechanism) and in what circumstances (context) evidence-based practices are sustained in rehabilitation (outcome).

      Data Sources

      : MEDLINE, EMBASE, reference lists and targeted websites.

      Study Selection

      Two independent reviewers calibrated study selection, then one reviewer screened all titles and abstracts while the second reviewer screened a random 20%. We repeated this process for full texts. We included 115 documents representing 61 implementation projects (8.9% of identified documents). Included documents described implementation projects in which physiotherapists, occupational therapists and/or speech-language pathologists were the target users of the practice.

      Data Extraction

      Two reviewers repeated the independent process described in study selection to extract basic study and sustainability characteristics, and context, mechanism, outcome and strategy text.

      Data Synthesis

      Using basic numerical analyses, we found that only 54% of evidence-based practices in rehabilitation are sustained. Furthermore, while authors who reported sustainability planning sustained the practice 94% of the time, sustainability planning in rehabilitation is rare (only reported 26% of the time). Extracted text was synthesized using the realist technique of inductive and deductive retroduction in which context, mechanism, outcome and strategy text are combined into narrative explanations of how sustainability works. To inform these explanations, we applied Normalization Process Theory and the Theory of Planned Behaviour. Collectively, the 52 identified narratives provide evidence for three patterns: 1) implementation and sustainability phases are interconnected; 2) continued use of the evidence-based practice can be interpreted as the ultimate sustainability outcome; and 3) intermediate sustainability outcomes (i.e., fit/alignment, financial support, benefits, expertise) can become contextual features influencing other sustainability outcomes.

      Conclusions

      : Implementation teams can use the narrative explanations generated in this review to optimize sustainability planning. This can sustain practice changes, and improve quality of care and patient outcomes. Future research should seek to iteratively refine the proposed narrative explanations.

      Keywords

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