Optimizing the implementation of a multisite feasibility trial of a mind–body program in acute orthopedic trauma

Abstract

The Toolkit for Optimal Recovery (TOR) is a mind–body program for patients with acute orthopedic injuries who are at risk for persistent pain/disability. In preparation for a multisite feasibility trial of TOR at three orthopedic trauma centers, we aim to qualitatively identify barriers and facilitators to study implementation and strategies to mitigate the implementation barriers and leverage facilitators.We conducted 18 live video focus groups among providers and three one-on-one interviews with department chiefs at Level 1 trauma centers in three geographically diverse sites (N = 79 participants). Using a content analysis approach, we detected the site-specific barriers and facilitators of implementation of TOR clinical trial. We organized the data according to 26 constructs of the Consolidated Framework for Implementation Research (CFIR), mapped to three Proctor implementation outcomes relevant to the desired study outcomes (acceptability, appropriateness, and feasibility). Across the three sites, we mapped six of the CFIR constructs to acceptability, eight to appropriateness, and three to feasibility. Prominent perceived barriers across all three sites were related to providers’ lack of knowledge/comfort addressing psychosocial factors, and organizational cultures of prioritizing workflow efficiency over patients’ psychosocial needs (acceptability), poor fit between TOR clinical trial and the fast-paced clinic structure as well as basic needs of some patients (appropriateness), and limited resources (feasibility). Suggestions to maximize the implementation of the TOR trial included provision of knowledge/tools to improve providers’ confidence, streamlining study recruitment procedures, creating a learning collaborative, tailoring the study protocol based on local needs assessments, exercising flexibility in conducting research, dedicating research staff, and identifying/promoting champions and using novel incentive structures with regular check-ins, while keeping study procedures as nonobtrusive and language as de-stigmatizing as possible. These data could serve as a blueprint for implementation of clinical research and innovations in orthopedic and other medical settings.

Implementing clinical guidelines for gestational weight gain care: a novel application of Best-Worst Scaling to determine priority barriers

“…Mapping these barriers against the TDF indicates that strategies including persuasive education, delivered by credible sources which aims to increase con dence in delivering culturally appropriate care, could address such barriers. In the broad literature, implementation strategies which are tailored to contextual needs have been found to improve practices (58, 69, 70), however, studies assessing the effectiveness of implementation strategies to address site-based barriers are limited (71). There is a need to test such an approach to determine whether it is effective and warranted.…”

Research on Innovation of Translation Teaching and Translation Strategies for College Students in Multimedia Background

“…In recent years, the multimedia teaching method has shown an obvious rising trend. This method has rich teaching resources, which can ensure that translation teaching results can be visualized for the first time after problems arise []- [14]. It can fully enhance students' implicit perception ability and obtain excellent translation teaching practice results [15].…”

“…Dan Li. Applied Mathematics and Nonlinear Sciences, 9(1) (2024)[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] …”

Innovative reform strategy of artistic practice of university folk dance education based on information fusion technology

“…Miao Zhou. Applied Mathematics and Nonlinear Sciences, 9(1) (2024)[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] …”