Evidence-based practice in rehabilitation: evaluating intervention effectiveness and exploring implementation

Abstract

Therapeutic exercise is important for treating physical impairments, restoring and maintaining function, increasing physical activity and improving quality of life for people requiring rehabilitation. This thesis addresses two important evidence gaps in aged care and neurological rehabilitation. The first gap is the uncertainty around the effectiveness of physiotherapy interventions in increasing muscle strength in individuals with spinal cord injury. Chapter 2 presents a systematic review, concluding that resistance training, with or without electrical stimulation, is effective at improving strength in affected muscles. The second gap concerns the lack of implementation of effective digital health interventions in clinical practice. Chapters 3 to 7 explore this. Chapter 3, a narrative review, finds that delivering extra therapeutic exercise via digital devices improves mobility and physical activity, and outlines ways to implement it through hybrid trials. Chapter 4 describes the AMOUNT_Implement trial protocol—a hybrid type II implementation-effectiveness randomised controlled trial. Phase I results of this trial (Chapter 5) show that physiotherapists can adopt digital interventions when supported by education, training, clinical champions, and audit-feedback. Phase II (Chapter 6) results of AMOUNT_implement trial demonstrates that physiotherapists can deliver extra exercises using digital devices alongside usual care, although at a reduced dosage. It also identifies key challenges and the need for further large-scale trials. Chapter 7 presents a survey of allied health clinicians in an Australian health service, showing a positive culture toward innovation but limited resources to support implementation. Overall, this thesis provides important information to guide future clinical practice and research directions for aged care and neurological rehabilitation.