An Exploratory CFIR-Informed Process Evaluation Utilizing Data from a Pilot Randomized Controlled Trial of a
Kelly Krese1,2, Mary McNulty3, Catherine Justice4
1Doctor of Physical Therapy Program, Midwestern University, Downers Grove, Illinois, USA.
Objective:
To conduct a Consolidated Framework for Implementation Research (CFIR)-informed process evaluation examining implementation determinants that influenced the delivery of a yoga-based group physical therapy (PT) intervention for individuals with traumatic brain injury (TBI) in an acute inpatient rehabilitation setting, and to describe strategies used to address key implementation barriers encountered.
Setting:
Inpatient acute rehabilitation TBI unit at a tertiary rehabilitation hospital.
Intervention:
Patients diagnosed with moderate to severe TBI (n = 11) able to follow 2-step commands who were admitted to the TBI unit and participated in a 60-min yoga-based group PT intervention.
Design:
CFIR-informed process evaluation nested within a randomized controlled feasibility trial. Implementation determinants were characterized using meeting minutes from interdisciplinary clinical conferences and research team meetings conducted during intervention development and implementation.
Main Measures:
Primary outcomes were implementation determinants (barriers and facilitators) mapped to CFIR domains. Secondary outcomes included patient-specific physical and cognitive-behavioral participation implementation barriers documented during intervention sessions.
Results:
Determinants that acted as facilitators included organizational support, interdisciplinary communication, and collaboration, while those that acted as barriers included time demands, cultural factors and professional scope ambiguities.
Conclusion:
This CFIR-informed process evaluation describes contextual, organizational and professional factors that may influence the implementation of yoga-based PT group intervention in inpatient rehabilitation following TBI. Findings are exploratory and hypothesis-generating, providing preliminary insight to inform future prospective implementation research aimed at optimizing integration and sustainability of yoga-based interventions in early TBI rehabilitation. (ClinicalTrials.Gov Registration#: NCT03701594).
