Skip to main content

Table 3 Overview of TDF barrier domains (organized by COM-B attribute) and potential strategies

From: Therapist perceptions of a rehabilitation research study in the intensive care unit: a trinational survey assessing barriers and facilitators to implementing the CYCLE pilot randomized clinical trial

COM-BSurvey sectionTDF domainBarrierProposed strategy
CapabilityIn-bed cyclingMemory/attention/decision processesI would not cycle with a study patient if I believed other rehabilitation activities were a higher priority for them.Education re: ethical imperative to deliver randomized intervention. Also related to time barrier (see strategies under “Motivation” attribute below).
Outcome measuresSkillsI required assistance from another person to transcribe data on research forms during outcome measure assessments.Training on data form completion. Consider enlisting help from RC to transcribe data during OM assessments, especially for patients in isolation (when unable to bring data forms into room due to infection control limitations).
OpportunityOutcome measuresEnvironmental contextPatients’ functional capacity or fatigue limited conduct of cycling and outcome measures on the same day.Consider conducting OM before cycling, as more active participation required for OM. Consider use of OM as routine care, instead of a separate session.
MotivationRehabilitation practice and researchBeliefs about consequencesImplementing the CYCLE protocol presented challenges to providing equitable service for all patients (i.e., patients not enrolled in CYCLE).Lack of consensus on types of rehabilitation interventions therapists should administer with patients. More local context from therapists is needed to properly address this barrier.
In-bed cyclingProfessional roleIf cycling improved outcomes and became recommended standard practice, ICU OTs should not be primarily responsible for implementing this intervention.Consider OT availability and roles in ICU setting.
In-bed cyclingEmotionI felt overwhelmed by the time required to conduct cycling sessions.Researchers* designing trials include budget for additional therapist time to conduct the research intervention.
Therapists support colleagues’ caseloads when a patient is enrolled.
Hospital management** incorporating dedicated research time into budgets.
Outcome measuresEmotionI felt overwhelmed by the time required to collect outcome measures.See suggestions under “cycling”. In addition, researchers could consider hybrid model of research whereby therapists conduct cycling and research personnel conduct OM.
Therapists could consider using OM as the routine care intervention on days when patients are eligible.
  1. COM-B Capability-Opportunity-Motivation-Behaviour system, TDF Theoretical Domains Framework, RPR rehabilitation practice and research, OM outcome measures, RC research coordinator, ICU intensive care unit, OT occupational therapist
  2. *Researchers should consider an integrated approach and collaborate with ICU therapists and individual sites in the design stage. By engaging local expertise at the outset, teams can identify relevant strategies to optimize implementation
  3. **Hospital leaders and management could consider their role in facilitating research; in addition to budget considerations, conveying a positive attitude towards research encourages multidisciplinary coordination and teamwork to conduct the study