Factors Influencing Adoption and Sustained Use of Rehabilitation Technologies in Clinical Practice: A Scoping Review
Lim, Xiao Min Lilian
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Background: In response to a growing recognition of the potential of rehabilitation technologies (RT) to improve efficiency in and outcomes from rehabilitation the purchase of RTs were prioritised in the author’s practice setting. However, after the initial few months of use these devices were often abandoned and no longer routinely used in rehabilitation practice. These incidences in the author’s clinical context mirror poor uptake of RT and abandonment of such devices. This scoping review sought to investigate the factors influencing adoption and sustained use of RT in clinical practice with a particular focus on patient and therapist perspectives. Method: This scoping review followed Arksey and O’Malley's five-stage methodology framework, advanced by Levac et al.. Eight electronic databases were searched from inception to April 2021. A total of 5486 unique papers were returned and screened by abstract and title. Data was analysed in two phases: Phase 1: Qualitative data exploring adoption found in the reviewed articles (including systematic reviews of quantitative research and qualitative research, scoping reviews and narrative reviews) was extracted and analysed through a six-step inductive thematic analysis process as described by Braun and Clarke. Subsequently, a thematic map was developed. Phase 2 involved the analysis of data pertaining to sustained use through an abductive approach where the codes generated were mapped onto existing themes developed in Stage 1. New themes emerged related to sustained use and there was an extension of themes that had been identified from the adoption literature. The results of the scoping review were then mapped to the current decision-making processes within the author’s practice context to identify potential gaps in the process, serving as a roadmap to guide the revision of the evaluation and decision-making processes within the author’s organisation. Results: Thirty-six studies were included in the scoping review, of which 28 review articles explored factors influencing adoption, six looked at factors influencing both adoption and sustained use while two primary research papers explored sustained use only. In Stage 1 four key themes were identified as influencing the adoption of RT in clinical practice; “knowledge”, “device design”, “patients’ and therapists’ circumstances and characteristics” and “person-centred approach”. In Stage 2 an additional theme, “wider systemic conditions” was identified and subthemes in existing four themes were modified, expanded or added. This included: (i) modifying subthemes of “(therapist’s) attitudes and beliefs”, “perception of self and societal values” and “ease of set-up and operation” (ii) expanding subthemes of “how to operate the device”, “how to tackle problems and access to support”, “demographic characteristics” and “supporting workload” and (iii) adding a subtheme on “individual preferences”. The themes prompted the generation of recommendations for the revision of the evaluation and decision-making processes within the author’s organisation, and to improve the adoption and sustained use of RT in the practice setting. Conclusion: There is limited research exploring the factors influencing sustained use of RT in clinical practice. The research to date provides sign posts for therapists, patients and carers, designers and developers of RT, management and decision makers of RT purchases and funders of the purchases, which may inform the development, evaluation and implementation of RT. Further research is required to facilitate continuous usage of RT within the clinical setting.