Exploring rehabilitation technology adoption in clinical practice in the UK: introducing the RiTe model.

Abstract

Background: Digital health technologies (DHT) comprise a broad range of applications such as telehealth, wearable devices and smart-phone and tablet applications (apps). However, whilst national and international policies present ambitious plans for DHT to revolutionize healthcare, there has been little consideration of how they can be successfully integrated into healthcare systems and processes. This is important as many reports show that even well designed DHT fail to be adopted or are quickly abandoned in clinical practice, meaning that their potential to transform healthcare and patient outcomes are lost. Explicit recognition of the key challenges and facilitators of rehabilitation technology implementation in clinical practice is vital to ensure that technology adoption can be planned and evaluated and that technologies are selected, utilized and adopted sustainably. To our knowledge, there are no rehabilitation technology specific implementation models that are available to support this process. Therefore, the aim of this work was to develop a comprehensive model to guide rehabilitation technology implementation. To do this, it is important to understand both 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 rehabilitation

Methods: A multi-faceted methodology was utilized. Systematic, scoping and hermeneutic reviews were undertaken to identify existing implementation models, theories, frameworks and individual factors that have been used to underpin adoption of rehabilitation technology in neurological conditions and stroke. Stakeholder analysis identified a range of people and roles who had influence upon technology adoption. These comprised clinicians, patients, managers, organization leads, innovation groups, digital developers who produced the technology, Information technology and information governance roles. After ethical approval, individuals based in the UK were interviewed using a schedule developed from Normalization Process Theory. Interviews were transcribed and analyzed 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.

Results: The literature reviews identified over 10 broad models and a range of individual reviews and studies of factors influencing rehabilitation technology implementation. Qualitative interviews generated more than 300 codes, which were assimilated into initial 15 themes and then grouped into 5 overarching themes, supported by existing models and factors found in the literature. These themes comprised factors centered around: the Team, Organization, Users, Technology and Evidence. This produced the Rehabilitation Technologies (RiTe) Implementation Model. 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

Conclusions: To our knowledge, the RiTe model is the first specific implementation model to support rehabilitation technology adoption into clinical practice. We hope that it will be used to support and evaluate rehabilitation technology use, avoid costly failed adoption and enable more patients to benefit from technologies in their rehabilitation.

Whilst this model was generated solely from UK focused interviews, we anticipate many of the factors will 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.