Adoption and Implementation of a Recovery Ruler for Disorders of Consciousness: Insights from Rehabilitation Practitioners

Research Objectives: To evaluate the reach, adoption, and implementation of the Recovery Ruler, a tool that visualizes assessment information about patients with disorders of consciousness (DoC). To identify facilitators and barriers to using the Recovery Ruler in clinical practice.

Design: Explanatory sequential mixed methods study.

Setting: Four inpatient DoC programs.

Participants: Twenty-six rehabilitation practitioners (RPs; including occupational therapists, physical therapists, speech language pathologists, and neuropsychologists) completed 12 weekly surveys followed by 3 monthly surveys to assess reach, adoption, and implementation. 14 RPs participated in follow-up semi-structured interviews to examine barriers and facilitators.

Interventions: We educated RPs in the use of the Recovery Ruler.

Main Outcome Measures: We used the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) Framework to examine: 1) Reach: % of eligible RPs who participated in the Recovery Ruler study; 2) Adoption: % of study participants who reported adopting the Recovery Ruler at least once; 3) Implementation: % of opportunities when RPs reported using the Recovery Ruler with the CRS-R. We used the Theoretical Domains Framework (TDF) to conduct a deductive framework analysis of interview data.

Results: Reach: 41% of eligible RPs (26/64) enrolled in the study. Adoption: 92% of participating RPs (24/26) adopted the Recovery Ruler at least once. Implementation: Participating RPs reported using the Recovery Ruler at 41% of opportunities (232/564). RPs described being motivated to use the Recovery Ruler to improve communication with family caregivers (TDF: beliefs and consequences). Competing demands and lack of knowledge presented barriers to implementation (TDF: environmental context and resources; knowledge).

Conclusions: Reported adoption of the Recovery Ruler was high across programs, suggesting that RPs are willing to trial innovative methods for interpreting and communicating assessment results. However, reported implementation varied across programs and over time. Barriers and facilitators elucidated in this study may support the development and testing of tailored implementation strategies to better support use of the Recovery Ruler.

Author(s) Disclosures: None.