June 05, 2025
Healthcare practices that are developed and studied in controlled research environments sometimes face obstacles when it's time to implement them in clinical settings. Implementation research scientists focus on assessing how quickly clinical care teams and patients adopt new evidence-based interventions, and they help identify strategies to help make that integration occur more quickly and effectively.
In a report published in 2022, The U.S. National Academies of Sciences, Engineering, and Medicine (NASEM) identified a lag in published implementation research related to the care and services provided to individuals with traumatic brain injury (TBI). To further examine this issue, researchers from Mayo Clinic and six other institutions conducted a scoping review of implementation studies related to TBI. In a review article published in the Journal of Head Trauma Rehabilitation in 2024, the investigators characterized implementation science studies that focused on TBI clinical care and rehabilitation, and they provided recommendations for future directions.
"Implementation science is a very relevant and important area of research for physical medicine and rehabilitation specialists," explains Dmitry Esterov, D.O., M.S., one of the co-authors on the review article. Dr. Esterov is a physiatrist and researcher at Mayo Clinic's brain rehabilitation program in Rochester, Minnesota, and leads Mayo Clinic's TBI Model System center.
"While clinicians in physical medicine and rehabilitation have focused on developing evidence-based rehabilitation and assessing their effectiveness, implementation science is an area of research that could help us to incorporate these practices and interventions into clinical settings in a more timely and effective manner," says Dr. Esterov.
Dr. Esterov agrees with NASEM's claim that a significant amount of evidence about rehabilitation generated by researchers simply fails to become implemented into practice and that developing a better sense of where the gaps lie is an important effort.
"Implementation science is a systematic and rigorous way to study this," says Dr. Esterov. "NASEM highlighted this as a particularly important priority in the field of TBI research, but it is also really relevant for all of rehabilitation research. It is important for leaders in the field of rehabilitation to be aware of this area of science and work to improve the translation of evidence-based practices into the clinical field."
Methods
The researchers identified 38 articles published between 2011 and 2023 and included studies that focused on the TBI population, measured at least one Proctor (2011) implementation outcome and aligned with implementation research designs. The researchers then charted the data they collected using an extraction template.
Results
"This is the first review to synthesize the implementation research studies published to date in the field of TBI clinical care and rehabilitation," says Dr. Esterov. "Our findings begin to address a critically important question regarding the extent to which researchers, practitioners and community collaborators are engaging in systematic efforts to incorporate innovations into routine TBI care."
Key data points included the following:
- More than 50% of articles used a theory, model or framework to guide the research. Fifteen studies were descriptive, 10 were qualitative, seven were mixed methods, and four were randomized controlled trials.
- Most studies investigated implementation outcomes regarding national guidelines following TBI or TBI symptom management. The most commonly studied implementation outcomes were adoption (42.1%) and fidelity (42.1%), 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. Training and education were used most commonly, followed by data warehousing techniques.
"Our findings begin to address a critically important question regarding the extent to which researchers, practitioners and community collaborators are engaging in systematic efforts to incorporate innovations into routine TBI care."
Conclusions
"Our review highlighted that while the work on this topic is increasing, the research within this field is still at a very early stage," says Dr. Esterov.
Dr. Esterov and co-authors concluded that 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, they observed that systematic, collaborative efforts between researchers, community partners, individuals with TBI and their care partners could improve the equitable translation of innovations into routine TBI care across service contexts.
For more information
Hyzak KA, et al. A scoping review of implementation science studies in the field of traumatic brain injury: State of the science and future directions. Journal of Head Trauma Rehabilitation. 2024;39:414.
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