NeuroRehabilitation OnLine (NROL): Description of a multidisciplinary group telerehabilitation innovation for stroke and neurological conditions using the TIDieR checklist

ABSTRACT ObjectiveProviding recommended amounts of rehabilitation for stroke and neurological patients is challenging. Telerehabilitation is viable for delivering rehabilitation and an acceptable adjunct to in-person therapy. NeuroRehabilitation OnLine (NROL) was developed as a pilot and subsequently operationalised as a regional innovation embedded across four National Health Service (NHS) Trusts. The aim of this paper is to describe the NROL innovation to assist future implementation and replication efforts. MethodsThe Template for Intervention Description and Replication (TIDieR) checklist, with guidance from the TIDieR-Telehealth extension, was used to describe NROL. The description was developed collaboratively by clinical academics, therapists, managers, and researchers. Updated Consolidated Framework for Implementation Research domains were used to describe the context in which the innovation was delivered. ResultsNROL delivers online group-based real-time neurorehabilitation with technology assistance provided, incorporating multidisciplinary targeted therapy and peer support. Procedures, materials and structure are detailed to demonstrate how NROL is embedded within a healthcare system. NROL uses existing NHS therapy workforce alongside dedicated NROL roles, including an essential technology support role. Selection of NROL groups is dependent on patient need. The NROL innovation is modified over time in response to patient and staff feedback. NROL described here is situated within a regional stroke and neurorehabilitation network in North-West England, aligns with local and national strategies, and capitalises on an existing clinical-academic partnership. ConclusionThis comprehensive description of a regional NROL innovation, and clarification of core components, should facilitate other healthcare settings to adapt and implement NROL for their context. Continuous evaluation alongside implementation will ensure maximal impact for neurorehabilitation. STRENGTHS AND LIMITATIONSA systematic development process was undertaken using the TIDieR checklist, and TIDieR-Telehealth extension, allowing a principled method for clear and user-friendly description of a complex intervention to assist future implementation and replication efforts.Stakeholder engagement was integral to the collaborative development of the NROL innovation and its description, ensuring informed decision-making representing multiple perspectives.The TIDieR checklist provides a succinct description of an intervention at a point in time but may not capture the implementation complexities and evolutions. However, the TIDieR checklist allows reporting on modifications and tailoring which can help mitigate these limitations.The TIDieR checklist does not include an item on context, which is important to fully understand interventions, hence in this article context it is deliberatively reported to help situate the innovation.