Theories, models, and frameworks in implementation science in the context of rehabilitation research: a scoping review.
Maarit Karhula, Hennariikka Heinijoki, Riitta Seppänen-Järvelä
CFIR was the most-used framework in rehabilitation implementation research (36% of 121 studies), and identifying barriers and facilitators was the most common purpose.
Framework choice often did not match the study's stated aim, suggesting researchers picked what they knew rather than what fit.
Key findings
1CFIR was the most frequently applied framework (43 articles, 36%), followed by KTA (33, 27%) and TDF (15, 12%). Nearly half of the 34 different frameworks used appeared in only one study.
2The most common study purpose was identifying barriers and facilitators (66 purposes, 27% of 242 total). In those studies, determinant frameworks were used in three-quarters of cases, which matches their intended role.
3Process models were the second most common framework for identifying barriers and facilitators, and were chosen in more than half of studies evaluating implementation outcomes, despite being designed to describe stages of the research-to-practice process rather than to explain barriers or assess outcomes.
Still to come
How it was doneWhat they found
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What it does not show
The review is descriptive: it maps which frameworks are used and for what purposes, but does not judge whether any framework produced better implementation outcomes than another. The terms 'rehabilitation' and 'implementation research' are inherently ambiguous, so relevant articles may have been missed during screening. Only English-language, peer-reviewed articles were included, which may exclude relevant work in other languages or grey literature. The authors acknowledge that some relevant information may not have been fully captured during data extraction. The review covers studies up to October 2023; the field is growing rapidly (23 studies in 2021, 24 in 2022), so the picture is already shifting.
Declared interests
No conflicts of interest declared. Funded by the Social Insurance Institution of Finland (Kela), Grants 149/331/2019 and 116/1/000/2020.
The easy way to misread this
Do not read the frequency of a framework (e.g., CFIR in 36% of studies) as evidence that it is the best or most appropriate choice for your own implementation work. This review maps what researchers have done, not what works. The authors themselves note that framework selection is often driven by familiarity rather than fit to the study's purpose, and that alignment between framework and purpose was frequently poor.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →