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Implementing Activity-Based Therapy for Spinal Cord Injury Rehabilitation in Canada: Challenges and Proposed Solutions

Hope Jervis-Rademeye, Lovisa Cheung, Nicole Cesca, Cindy Gauthier, Kristen Walden and Kristin E. Musselman


Activity-based therapy (ABT) is a therapeutic approach with multiple benefits including promoting neurorecovery and reducing the likelihood of secondary complications in people living with spinal cord injury (SCI). Barriers and facilitators to ABT implementation for SCI rehabilitation have been studied from various perspectives through qualitative research. However, these viewpoints have not been synthesized to identify challenges of and strategies for implementing ABT across the Canadian healthcare system. Thus, the purpose of our study was to examine the current state of ABT in Canadian healthcare settings according to users’ perspectives. Our main objectives were to compare barriers and facilitators to ABT implementation across Canadian healthcare settings according to users’ perspectives and to identify optimal intervention strategies for ABT delivery across the Canadian healthcare system from acute to community care. We searched Scopus, CINAHL, OvidMedline, and other sources. Eligible articles were qualitative or mixed methods studies exploring ABT for adults with SCI in a Canadian healthcare setting. We analyzed qualitative findings through a thematic synthesis followed by a deductive content analysis. The Mixed Methods Appraisal Tool was used for critical appraisal. Nine articles were included. The thematic synthesis revealed two main themes: factors influencing acceptance and adaptation of ABT across healthcare settings in Canada and proposed solutions. The deductive analysis applied the Behaviour Change Wheel (BCW) to identify limited components of behaviour and appropriate interventions. To address ABT implementation challenges across the Canadian healthcare system, evidence-based interventions should target BCW subcategories of reflective motivation, social opportunity, and physical opportunity.

Study Design

A qualitative thematic synthesis, as outlined by Thomas and Harden, was conducted. This methodology was chosen for its capacity to integrate findings from a variety of qualitative studies while ensuring that the authenticity of the original research results was preserved. This review adhered to the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines to ensure a thorough and methodological approach. The application of this guideline reinforced methodological rigour in the reporting process 

In conclusion, to address the challenges of acceptance and adaptation of ABT across healthcare settings in Canada, we considered the proposed solutions from various key interest groups combined with the BCW framework. Specific BCTs should target restriction, environmental restructuring, enablement, modelling, training, education, persuasion, incentivization, and coercion. In turn, they will affect reflective motivation and physical and social opportunity, leading to the enhanced implementation of ABT.

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