Process evaluations in neurological rehabilitation: a mixed-evidence systematic review and recommendations for future research

Abstract

ObjectiveTo systematically review how process evaluations are currently designed, what methodologies are used and how are they developed alongside or within neurological rehabilitation trials.MethodsThis mixed-methods systematic review had two evidence streams: stream I, studies reporting process evaluations alongside neurorehabilitation trials research and stream II, methodological guidance on process evaluation design and methodology. A search strategy was designed for each evidence stream. Data regarding process evaluation core concepts and design issues were extracted using a bespoke template. Evidence from both streams was analysed separately and then synthesised in a final overarching synthesis proposing a number of recommendations for future research.ResultsA total of 124 process evaluation studies, reporting on 106 interventions, were included in stream I evidence. 30 studies were included as stream II evidence. Synthesis 1 produced 9 themes, and synthesis 2 identified a total of 8 recommendations for process evaluation research. The overall synthesis resulted in 57 ‘synthesis recommendations’ about process evaluation methodology grouped into 9 research areas, including the use of theory, the investigation of context, intervention staff characteristics and the delivery of the trial intervention.ConclusionsThere remains no consensus regarding process evaluation terminology within the neurological rehabilitation field. There is a need for process evaluations to address the nature and influence of context over time. Process evaluations should clearly describe what intervention staff bring to a trial, including skills and experience prior to joining the research. Process evaluations should monitor intervention staff's learning effects and the possible impact that these may have on trial outcomes.

Implementation of Highly Challenging Balance Training for Parkinson’s disease in Clinical Practice: A Process Evaluation

“…The major strengths of this study lie in the application of existing theoretical frameworks -MRC guidelines and CFIR -that enabled a more systematic approach to data collection and analysis and also increases the replicability and generalizability of study ndings [7,37]. Additionally, triangulation of qualitative and quantitative data provides different perspectives on aspects of program implementation.…”

Implementation of Highly Challenging Balance Training for Parkinson’s disease in Clinical Practice: A Process Evaluation

“…The major strengths of this study lie in the application of existing theoretical frameworks -MRC guidelines and CFIR -that enabled a more systematic approach to data collection and analysis and also increases the replicability and generalizability of study findings [7,37]. Additionally, triangulation…”

“…Balance training interventions for people with Parkinson's disease (PwPD) have proven efficacy in terms of symptom management [3][4][5]. Although the number of intervention trials of exercise interventions in PD has grown exponentially [6], process evaluations in the field of neurological rehabilitation are less frequent [7]. There is therefore, a lack of scientific evidence to guide researchers and clinicians towards dissemination of effective programs.…”

Process evaluation within pragmatic randomised controlled trials: what is it, why is it done, and can we find it?—a systematic review

“…It is therefore useful to review process evaluation conduct in health services settings as these are likely to present some unique challenges. The few published systematic reviews of process evaluation methodology focus on specific fields of clinical practice [ 10 – 15 ] rather than outcome evaluation methods. The pragmatic RCT method is not explicitly addressed in existing process evaluation guidance, although some pertinent methodological issues are discussed, for example avoiding Hawthorne effects from patients participating in process evaluation interviews [ 4 ].…”

“…We also examine two issues identified as problematic, both from our own experience and within the process evaluation literature. Firstly, we investigate labelling, as the label ‘process evaluation’ has been applied to many types of study [ 4 ], and previous reviews noted inconsistent use of the term [ 5 , 10 ]. We have also anecdotally encountered confusion and multiple interpretations of the meaning of the label.…”