Evaluating the implementation process of a new telerehabilitation modality in three rehabilitation settings using the normalization process theory: study protocol

ABSTRACT

Introducing innovations such as telerehabilitation (TR) into routine care involves complex changes in organizations. This study protocol aims to (1) examine the extent to which a TR platform was implemented as intended in three clinical settings and (2) identify which TR activities were becoming integrated into routine clinical practices, and which factors affect the routine use of the platform. A mixed-method prospective single-case study design with multiple embedded units of analysis will be used. Pre/post-implementation data collection will focus on implementation leaders, clinical champions, upper management, and clinical staff. Qualitative data include semistructured individual interviews with leaders, champions, and upper management as well as focus groups with clinical staff who are users and non-users of the TR platform. Quantitative data include TR use data and TR implementation questionnaires. The consolidated framework for implementation research will be used to analyze the implementation process and normalization process theory will be used to analyze the embedding of TR in routine daily practice. The project is expected to yield evidence regarding which specific TR activities are implemented in day-to-day clinical activities as well as capture threats and opportunities to normalization at a critical moment when it is expected to occur.

KEYWORDS:

• Telerehabilitation
• telemedicine
• implementation
• normalization
• knowledge translation
• technology adoption
• rehabilitation

Acknowledgements

The authors thank Patrick Lévesque, MSW, Telehabilitation program manager, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Est-de-l’Île-de-Montréal, site Institut Raymond-Dewar for facilitating the link with the clinical setting.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval: Ethics approval for this study was obtained from the institutional review board of the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal for all participating facilities (certificate number CRIR-1074-04-15). Consent to participate will be obtained from all informants during the course of the study.

Notes on contributors

Dahlia Kairy is an Associate professor at the School of Rehabilitation at Université de Montréal, Canada. She is a researcher at the Centre de recherche interdisciplinaire en réadaptation (CRIR) at the Institut de réadaptation Gingras Lindsay de Montréal site. Her areas of research include rehabilitation technology assessment and adoption in clinical practice, with a focus on telerehabilitation, as well as knowledge translation strategies for improving rehabilitation services.

Frederic Messier is a research assistant at the CRIR and a clinical research coordinator at the Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal. He holds a Masters of Social Work from the Université du Québec à Chicoutimi and is currently completing a second Masters in Clinical and Biomedical Sciences at Université Laval, Canada.

Diana Zidarov, PT, PhD is a postdoctoral fellow in the Faculty of Medicine at McGill University. She is an associate member of the School of Physical and Occupational therapy at McGill University and project co-director of Edith Strauss Rehabilitation Research Projects. She has completed a PhD in 2015 at the School of Public Health at Université de Montréal, Canada. Her current research focuses on the development and implementation of quality indicators for the management of chronic pain and the implementation of web-based patient reported outcomes for persons with spinal cord injury.

Sara Ahmed is an Associate Professor in the Faculty of Medicine, McGill University. She is an FRSQ senior research scholar and holds an appointment in the CRIR and the McGill University Health Center. Supported by federal, provincial, and private industry funds, her research includes studies that 1) develop and evaluate the impact of chronic disease computer-enabled self-management interventions integrated into electronic personal health records in chronic disease management programs, 2) evaluate knowledge exchange and transfer interventions related to best practices for chronic disease management, and 3) address the challenges of using patient reported outcomes and the use of advanced psychometric approaches for improving the precision and efficiency of outcome evaluations.

Lise Poissant is Full Professor at the School of Rehabilitation at Université de Montréal, Canada, and director of the occupational therapy program. She is also a researcher at the CRIR, at the Institut de réadaptation Gingras Lindsay de Montréal site. Her research interests are in the area of information technologies, including Web 2.0, and virtual communities of practice, aimed at improving rehabilitation services. She is also interested in evaluating stroke rehabilitation services.

Paula W. Rushton is an Assistant Professor in the Occupational Therapy Department, School of Rehabilitation, University of Montreal in Montreal, Quebec, Canada. She holds a PhD in Rehabilitation Science from the University of British Columbia and a Post Doctorate from the University of Montreal in Rehabilitation Sciences. Her research is focused on improving the wheeled mobility of children and adults.

Claude Vincent is a Full professor at the Department of Rehabilitation, Université Laval in Canada and Senior researcher at the Center for Interdisciplinary Research in Rehabilitation and Social Integration. She holds a Ph.D. in Public Health from Université de Montréal. Her research focuses on telehealth, technology assessment related to disabled persons, fragile elderly and caregivers.

Brigitte Fillion is currently, Clinical Pilot at the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, and is responsible for the promotion, the development and the coordination of telehealth activities within the organization. She has over 25 years of work experience the Quebec healthcare system and completed graduate studies in healthcare administration. She has experience as a registered respiratory therapist, in management, in the development of various clinical and information technology projects and in academic affairs.

Véronique Lavoie is a manager in the rehabilitation field at the Institut de Réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud de l'Île de Montréal. She holds a master’s degree in speech-language pathology as well as in public organization management.

ORCID

Frédéric Messier http://orcid.org/0000-0002-3983-8471

Additional information

Funding

The Quebec Rehabilitation Research Network, a network funded by the Fonds de recherche du Québec – Santé.