Therapist perceptions of a rehabilitation research study in the intensive care unit: a trinational survey assessing barriers and facilitators to implementing the CYCLE pilot randomized clinical trial

Abstract

BackgroundRehabilitation interventions, including novel technologies such as in-bed cycling, could reduce critical illness-associated morbidity. Frontline intensive care unit (ICU) therapists often implement these interventions; however, little is known about their perceptions of engaging in clinical research evaluating these technologies.ObjectiveTo understand frontline therapist perceptions of barriers and facilitators to implementing a pilot randomized controlled trial (RCT) of early in-bed cycling with mechanically ventilated patients in the ICU and outcome measures (CYCLE Pilot RCT; NCT02377830).MethodsWe developed a 115-item, self-administered, electronic survey informed by 2 complementary knowledge translation (KT) models: the Capability-Opportunity-Motivation-Behaviour (COM-B) system and the Theoretical Domains Framework (TDF). We included demographics and 3 sections: Rehabilitation Practice and Research, Cycling, and Physical Outcome Measures. Each section contained items related to the COM-B system and TDF domains. Item formats included 7-point Likert-type scale questions (1 = strongly disagree, 7 = strongly agree) and free-text responses. We invited therapists (physiotherapists, occupational therapists, and therapy assistants) who participated in the international, multi-center, CYCLE Pilot RCT to complete this cross-sectional survey. We descriptively analyzed results by survey section, COM-B attribute, TDF domain, and individual question within and across sections. We identified barriers based on items with median scores < 4/7.ResultsOur response rate was 85% (45/53). Respondents were from Canada (67%), the USA (21%), and Australia (11%). The majority had a physiotherapy background (87%) and previous research experience (87%). By section, Rehabilitation Practice and Research (85%; 95% confidence interval (CI) [82%, 87%]) was higher than Cycling (77%; 95% CI [73%, 80%]) and Outcome Measures (78%; 95% CI [75%, 82%]). Across the 3 sections, Motivation was lower than Capability and Opportunity. The most common Motivation barrier was the emotion TDF domain, related to the time required to conduct cycling and outcome measures (median [1st, 3rd quartiles] 3/7 [2, 6]).ConclusionsFrontline ICU therapists had positive perceptions of research engagement. However, we identified barriers related to Motivation, and concerns regarding time to implement the research protocol. Our results can inform specific KT strategies to engage frontline ICU therapists and optimize protocol implementation in critical care rehabilitation research.

The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative

“…Knowledge and motivation have been identified as barriers to rehabilitation planning, and a systematic approach may help overcome this. 24,25 Despite the emergency measures for information governance during the pandemic, we remained cautious about any identifiable data. As a result, the disease severity and characteristics of patients were not collated centrally.…”

A qualitative investigation of influences on occupational therapists’ research involvement in Ireland

“…Furthermore, a goal of this SWAT’s design was to advance the relevant literature, wherein views of occupational therapists were limited to those who had already been ‘recruited’ or actively engaged with a research program (e.g., (Di Bona et al, 2017; Du Toit et al, 2010; Eriksson et al, 2020; Finlayson et al, 2005; Majnemer et al, 2001; Reid et al, 2019; Waine et al, 1997), which presents the potential for bias in the opposite direction and also highlights a lack of research exploring the attitudes of occupational therapists who did not participate in research. With that, given the specificity of this research with respect to occupational therapists in Ireland and their perspectives in light of one particular intervention, target outcome and chronic illness, it can also be argued that the inclusion of occupational therapists actively taking part in the treatment arm may have provided a more diverse and comprehensive perspective.…”

“…However, past research has identified important issues that require consideration for occupational therapists to engage in research activities (i.e. consistent with other healthcare professions) such as those related to time (Di Bona et al, 2017; Finlayson et al, 2005; Majnemer et al, 2001; Reid et al, 2019); support (Di Bona et al, 2017; Eriksson et al, 2020; Finlayson et al, 2005; Majnemer et al, 2001); cost (Finlayson et al, 2005; Majnemer et al, 2001); attitude towards and relationship with research (Di Bona et al, 2017; Finlayson et al, 2005; Majnemer et al, 2001; Waine et al, 1997); influence of the organisation and management (Di Bona et al, 2017; Finlayson et al, 2005; Majnemer et al, 2001); and more practical issues, such as administrative duties (Di Bona et al, 2017; Eriksson et al, 2020). Conversely, such research has also identified factors that enable engagement in research – though less commonly reported – which include personal motivation to engage in research, management support, protected research time, peer support, research as an institutional priority, and funding.…”

Increasing chronic disease preventive care in community mental health services: clinician-generated strategies

“…The Theoretical Domains Framework (TDF) is one such framework that has been recommended as a tool to facilitate comprehensive investigation of factors influencing existing behaviours and guiding intervention development and implementation strategies for clinician behaviour change [ 23 , 24 ]. The TDF covers 14 theoretical domains that incorporate factors at individual as well as broader systems and environmental levels (see Table 1 ) [ 23 ], and has been used in diverse contexts to identify and prioritise barriers and facilitators to implementation [ 25 – 27 ]. The TDF has also been used to guide researchers and practitioners to select intervention strategies to target the identified barriers and facilitators e.g., to increase shared decision-making in maternity care [ 28 ] and to improve cardiovascular health among childhood cancer survivors [ 29 ].…”