Author Affiliations: Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, Ohio (Drs Hyzak and Bogner); Department of Communication Sciences & Disorders, University of Maine, Orono, Maine (Dr Riccardi); Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado (Dr Kinney); Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Kinney); Department of Physical Medicine and Rehabilitation, Mayo Clinic, Minnesota (Dr Esterov); Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts (Dr Bogdanova); and Veterans Affairs Boston Healthcare System, Boston, Massachusetts (Dr Bogdanova).
J Head Trauma Rehabil. 2024;39(6):414-424. doi: 10.1097/HTR.0000000000000990. Epub 2024 Nov 4.
Implementation research is essential to accelerating the public health benefits of innovations in health settings. However, the US National Academies of Sciences, Engineering, and Medicine 2022 report identified a lag in published implementation research applied to traumatic brain injury (TBI). Our objectives were to characterize implementation science studies published to date in TBI clinical care and rehabilitation and provide recommendations for future directions.
A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Articles published between 2011 and 2023 were identified (MEDLINE, PubMed, PsychInfo, and Web of Science), and included if the study focused on the TBI population, measured at least one Proctor (2011) implementation outcome and aligned with implementation research designs. Data were charted using an extraction template.
Of the 38 articles, 76% were published between 2018 and 2023. About 37% of articles were in the pre-implementation phase, and 57.9% were in the implementation phase. Over half of articles used a theory, model, or framework to guide the research. Fifteen studies were descriptive, 10 were qualitative, 7 were mixed methods, and 4 were randomized controlled trials. Most studies investigated implementation outcomes regarding national guidelines following TBI or TBI symptom management. Adoption (42.1%) and fidelity (42.1%) were the most commonly studied implementation outcomes, followed by feasibility (18.4%), acceptability (13.2%), and penetration (10.5%). Only 55% of studies used or tested the effectiveness of one or more implementation strategies, with training and education used most commonly, followed by data warehousing techniques.
Future research should prioritize the selection and investigation of implementation strategy effectiveness and mechanisms across contexts of care and use implementation research reporting standards to improve study rigor. Additionally, collaborative efforts between researchers, community partners, individuals with TBI, and their care partners could improve the equitable translation of innovations across service contexts.
实施研究对于加速医疗环境创新带来的公共卫生效益至关重要。然而，美国国家科学院、工程院和医学研究所 2022 年的报告指出，在创伤性脑损伤（TBI）方面，已发表的实施研究滞后。我们的目标是描述迄今为止在 TBI 临床护理和康复中发表的实施科学研究，并为未来的方向提供建议。
采用系统评价和元分析扩展的首选报告项目进行范围综述。在 2011 年至 2023 年期间，确定了发表的文章（MEDLINE、PubMed、PsychInfo 和 Web of Science），如果研究侧重于 TBI 人群，测量了至少一个 Proctor（2011）实施结果，并与实施研究设计一致，则纳入研究。使用提取模板记录数据。
在 38 篇文章中，76%的文章发表于 2018 年至 2023 年期间。约 37%的文章处于实施前阶段，57.9%的文章处于实施阶段。超过一半的文章使用理论、模型或框架来指导研究。15 项研究为描述性研究，10 项为定性研究，7 项为混合方法研究，4 项为随机对照试验。大多数研究调查了 TBI 后或 TBI 症状管理方面的国家指南实施结果。采用（42.1%）和保真度（42.1%）是最常研究的实施结果，其次是可行性（18.4%）、可接受性（13.2%）和渗透（10.5%）。只有 55%的研究使用或测试了一种或多种实施策略的有效性，最常用的是培训和教育，其次是数据仓库技术。
未来的研究应优先选择和调查实施策略在不同护理环境下的有效性，并使用实施研究报告标准来提高研究的严谨性。此外，研究人员、社区合作伙伴、TBI 患者及其护理人员之间的合作可以改善创新在服务环境中的公平转化。
