Stakeholder perspectives on implementation of internet-delivered cognitive behaviour therapy in physical medicine rehabilitation setting using the Consolidated Framework for Implementation Research.
Swati Mehta, Ujjoyinee Barua, Marcie Nugent and 8 others
PMID 39810475WHAT IT FOUND
Stakeholders supported internet-delivered CBT for spinal cord injury rehabilitation due to its convenience and evidence base.
Major barriers were lack of funding, clinician time for referrals, and leadership failing to create concrete implementation plans. End-users also cited digital literacy and self-efficacy as obstacles.
Key findings
01Stakeholders viewed the relative advantage of virtual care, specifically avoiding travel and wait-times, as a primary facilitator for adoption.
02Lack of available resources was the most frequently cited barrier, driven by insufficient funding for mental health services and high clinician caseloads that prevent time for referrals.
03Leadership engagement was a significant barrier because, despite acknowledging the priority of mental health care, leaders failed to develop specific plans for adoption.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used convenience sampling with a small sample size (n=25), which limits the generalizability of the perspectives and prevented analysis of differences between stakeholder groups. The use of the CFIR framework meant that themes not included in the pre-existing codebook may have been missed. Participants with cognitive impairments were excluded, so the findings do not reflect the perspectives of patients who may struggle most with the digital literacy requirements of ICBT. The study relied on self-reported perceptions and did not measure actual implementation outcomes or patient health results.
Declared interests
The research was supported by funding from the Craig H. Neilsen Foundation. The authors declared no other conflicts of interest.
The easy way to misread this
Do not interpret these findings as evidence that ICBT improves patient outcomes. This study reports stakeholder perceptions of implementation factors, not clinical efficacy. The facilitators identified, such as relative advantage and evidence strength, are beliefs held by participants about why the programme might be adopted, not measurements of its success in treating spinal cord injury-related distress.