Table 2 Description of multi-faceted implementation strategy delivered to teams of physiotherapists mapped to behaviour change wheel [27]
Implementation strategy [18] | Mode of delivery/where/length/who delivered | Time frame | Proposed mechanism of action | Intervention content | ||
|---|---|---|---|---|---|---|
Barriers targeted | COM-B domains [27] | COM-B intervention functions | ||||
Identify and train clinical champion | Face-to-face/onsite and at University/fortnightly 3Â months/LMH, DT, and SC | Prior to implementation phase | Skill in how to use devices; solve technical issues; clinical reasoning for device choice; access to expert in device use through working day | Physical capability; automatic and reflective motivation | Education; training; enablement; and modeling | Identify and train a clinical champion who is a physiotherapist at the rehabilitation ward (NA). NA trained in use of devices prior to commencing implementation phase with clinicians |
Change physical structure and equipment | Face-to-face/on-site/length of study/LMH, DT, SC, NA | Prior to implementation phase | Access to a range of devices; technical problems impact patient and therapist motivation; time taken to turn on and set up devices | Physical and social opportunity | Restructure the environment | Loaning of required equipment to the hospital. Set up devices in collaboration with hospital IT department in rehabilitation gym. Develop processes for setting up equipment each day |
Education | Face-to-face and remote/onsite and via zoom/1–2 h/LMH | Two workshops at beginning phase I 3 months apart and throughout study | Understanding of potential benefits of device use to patient and therapist; knowledge of current evidence of effectiveness | Psychological capability; reflective motivation | Education; Persuasion | Provision of education on current evidence of using digital devices in physiotherapy including results of AMOUNT rehabilitation trial; case studies from the AMOUNT trial |
Conduct ongoing training (make training dynamic) | Face-to-face/onsite/as needed/NA, SC, LMH | First workshop and throughout study | Access to hands-on training and resources to support use; skill in how to use different devices and select games/exercises; optimize use for outcomes and ensure safety | Physical and psychological capability; automatic and reflective motivation; physical opportunity | Training; persuasion; enablement | Hands-on practical session using different devices led by clinical champion. Scheduled and ad hoc sessions |
Facilitation | Face-to-face/onsite/45–90 min sessions/NA, LMH, DT | Throughout study | Access to training and resources to support use; clinical reasoning for device choice | Psychological capability; reflective motivation; physical and social opportunity | Education; enablement; modeling; persuasion | Clinical reasoning and journal club sessions in a team setting, access to resources (AMOUNT intervention protocol, cheat sheets device use) |
Audit and provide feedback | Face-to-face/onsite/1Â week recording/NA, LMH, SC | Twice during implementation phase | Habit of recording dosage of practice; lack of understanding use of dosage data for clinical and research purposes; not routinely done by team | Psychological capability; social opportunity; reflective and automatic motivation | Education; modeling; persuasion | Audit recording of dosage on exercise practice sheets for a 1-week period. Provide individual feedback to therapists and summary feedback to the team by clinical champion |