Journal
DISABILITY AND REHABILITATION
Volume 45, Issue 26, Pages 4517-4526Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/09638288.2022.2153935
Keywords
Patient engagement; implementation science; trial design; COM-B; behavioural change
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The results of rehabilitation trials are often not fully attained when the intervention is implemented beyond the initial trial. One of the key reasons is that a patients' ability and/or capacity to take part in their own healthcare is not considered in the trial design yet has significant impact on the outcomes during the implementation phase. This article proposes a shift from a therapist-focus to patient-focus in trial design by addressing patient engagement as a core consideration. The authors argue that engaging patients in rehabilitation programs is a process of behavioral change.
BackgroundThe results of rehabilitation trials are often not fully attained when the intervention is implemented beyond the initial trial. One of the key reasons is that a patients' ability and/or capacity to take part in their own healthcare is not considered in the trial design yet has significant impact on the outcomes during the implementation phase.Body of textWe propose a shift from a therapist-focus to patient-focus in trial design, through addressing patient engagement as a core consideration in trials. We argue that engaging patients in any rehabilitation program is a process of behavioural change. Exercise prescription is used as an example to illustrate how the Behaviour Change Wheel can be applied to analyse barriers and facilitators associated with patients' capabilities, opportunities and motivations in integrating trial interventions into their daily life. We propose a framework to assist in this shift.ConclusionA core part of implementing rehabilitation interventions at the primary care level requires patient engagement. Related aspects of interventions should be identified and assessed using the COM-B model at the outset of trial design to ensure that the results are realistic, meaningful and transferable, so as to enable real impact.
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