Can we enhance neurorehabilitation through regional implementation of group-based telerehabilitation? A mixed methods evaluation of NeuroRehabilitation OnLine (NROL)
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Objectives
To determine whether neurorehabilitation can be enhanced through regional implementation of group-based telerehabilitation, we implemented the NeuroRehabilitation OnLine (NROL) innovation regionally and evaluated scale-up from a systems perspective.
Design
Observational, exploratory evaluation using a mixed methods convergent parallel design.
Setting
Stroke and neurological rehabilitation services from four organisations across a regional healthcare system in the United Kingdom.
Participants
Therapy staff from community-based services and patients with a stroke or neurological condition receiving active community rehabilitation including NROL from April 2022 to March 2024.
Intervention
A regional multidisciplinary group-based neurological telerehabilitation innovation, Neuro Rehabilitation OnLine (NROL).
Primary outcome measures
Selected Proctor’s implementation outcomes, to establish system-level adoption, acceptability and sustainability of the regional NROL innovation.
Results
NROL was adopted by all intended organisations and continues as part of usual care with participation growing. It was acceptable to therapy staff and patients across the region, well-utilised, valued, and supported increased therapy provision. For sustainability, staffing and travel efficiencies were identified through effective collaborative regional systems working. The importance of continued wide stakeholder engagement, robust evaluation and alignment was highlighted.
Conclusions
NROL was successfully embedded into real-world practice at a system-level and enhanced neurorehabilitation. Looking forward, longer-term sustainment of this innovation will require a compelling business case and value proposition for decision-makers, addressing economic, equality, and operational efficiency considerations.
ARTICLE SUMMARY
Strengths and limitations of this study
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Within a clinical-academic partnership, robust mixed methods evaluation enabled comprehensive system-level insights into the scale-up of a group-based telerehabilitation innovation
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Our approach was strengthened by using established implementation science outcomes and frameworks
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Use of real-world routinely collected data was pragmatic and integral to the model’s embedded nature but limited the focus of insight predominantly to those who participated in NROL
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Decision-maker perspective was not formally captured but will be an important next step, alongside gaining opinion from those who did not participate
