Introduction: Implementation of evidence-based practices in cognitive rehabilitation post-acquired brain injury (ABI) is challenging, as it involves complex and individualized interventions. To foster practice change, the use of strategies that are tailored to team’s needs, multimodal, active and social is suggested. However, further efforts are needed to better understand determinants influencing implementation of best practices.

Study objective: To identify perceived facilitators and barriers to the implementation of evidence-based practices in cognitive rehabilitation post-ABI.

Methods: An implementation study was conducted with two multidisciplinary teams including occupational therapists, neuropsychologists, speech therapists and educators (Team A: n=11 and Team B: n=14). A tailored and multifaceted knowledge translation intervention, using learning tools, interactive workshops and additional exchange sessions as needed by each team was developed to implement one evidence-based practice chosen by each team. Six months following the implementation, each team participated in a focus group to elicit perceived facilitators and barriers faced during the implementation process. Content analysis was applied using a deductive approach based on the Consolidated Framework for Implementation Research, which categorize implementation determinants into 5 domains (i.e. Intervention characteristics, Outer setting, Inner setting, Characteristics of the individuals involved, and the Process of implementation).

Results: Both teams reported good motivation throughout the implementation (Characteristics of the individuals). Team A highlighted the positive influence of the implementation (Process) which fostered team mobilization and an improved interprofessional collaboration. As the new practice was highly related to their context (Intervention characteristics), the team felt that the intervention helped them to structure and deepen their clinical interventions. Organizational environment (Inner and outer setting) did not play a major role for this team. Team B appreciated the multiples meetings which kept the implementation momentum and helped them to stay involved (Process). They particularly valued the given opportunities to discuss with colleagues with whom they had little occasion to exchange before. The collaboration developed helped them to overcome the high workload, the organizational changes and the staff turnover during the project (Inner and outer setting). Nevertheless, the team managed to put the practice in place as it made sense in their practice, even though the new practice was seen as complex at the beginning (Interventions characteristics). 

Conclusion: This study suggests that the implementation of a new practice can be eased by implementing practice align with professionals’ clinical context. Moreover, it reveals that an implementation intervention using interactive workshops and exchange sessions can foster collaboration between professionals and sustained implementation momentum. It also has the potential to support the teams facing challenges, such as the organizational constraints, during implementation.

Implementation of evidence-based practices in cognitive rehabilitation: Determinants influencing implementation.