Embedding Telerehabilitation in Practice: Adapting NeuroRehabilitation OnLine (NROL) for a New Context Through Co-Production and Implementation Science Knowledge.

Background Delivering recommended intensity of neurorehabilitation remains a challenge, with telerehabilitation offering one solution. NeuroRehabilitation OnLine (NROL) is a multidisciplinary, group-based telerehabilitation model embedded within one region in England, showing promise and alignment with healthcare strategic priorities. The importance of scaling successful evidence-informed practices is recognised, however careful adaptation is required to ensure contextual fit and sustainability. This study describes the adaptation of NROL for implementation in a new context. Methods The four-step ADAPT guidance was applied with previously identified implementation strategies to guide the adaptation of NROL from Region 1 to Region 2. Adaptation activities were co-produced. Contextual factors were detailed using the Consolidated Framework for Implementation Research and Intervention Sustainability Assessment Tool. The adapted innovation was described using the TIDieR-Rehab checklist. Results NROL was successfully adapted for Region 2. Step 1 confirmed strategic fit but identified barriers including workforce, infrastructure and resource. Led by an adaptation team and supported by a learning collaborative, Step 2 responded to barriers, retaining core components while tailoring role configuration and materials. Step 3 demonstrated feasibility and acceptability through piloting and phased integration, and improved fit within service pathways. Step 4 focused on sustainment, supported by training, stakeholder engagement, and reporting. Discussion This study offers a transferable approach for scale-up, providing an example of context-sensitive adaptation to a new region, demonstrating how frameworks and co-production can support the adaptation of telerehabilitation models. This example has potential wider use for researchers and implementers tasked with delivering impact, though highlights the effort and resource needed.