Implementation of digital health interventions in rehabilitation

Abstract

The demand for rehabilitation is growing, driven by global health trends and increasing disability

prevalence. Consequently, interest in leveraging digital rehabilitation interventions is rising.

However, understanding of implementation remains poor, with sluggish digital adoption among

clinicians and rehabilitation organisations, exacerbated by a mismatch between the pace of

research and rapid technological advancements. This thesis aimed to investigate the

implementation of digital health interventions in rehabilitation, with a focus on allied health

clinician perspectives. The scoping review in Chapter 2 summarises implementation frameworks,

outcomes, determinants and strategies currently used, alongside recommendations for future

research in the field. The best-worst scaling choice experiment in Chapter 3 demonstrates that

rehabilitation allied health clinicians prioritise device attributes related to patient needs and

practical use and are predominantly influenced by the context in which they work (i.e. country, or

private versus public work sector). The practice-embedded observational cohort study in Chapter

4 found allied health clinicians used advanced technologies 4,208 with 269 patients over one year.

Findings detail device usage by patient diagnoses and rehabilitation setting, goals related to

advanced technology use, and therapy dosage provided with devices. The 63 interviews with 25

clinicians in the longitudinal qualitative study in Chapter 5 highlighted that technology adoption

involves cognitive and emotional labour for clinicians. Additionally, successful technology

uptake, implementation and sustainment relies upon addressing contextual factors and shared

priorities across the organisation, including retaining human interactions at the heart of digital

rehabilitation. Overall, this thesis provides important insights alongside practical strategies to

address the complexities involved with implementing digital health interventions in rehabilitation.