Can we enhance neurorehabilitation through regional implementation of group-based telerehabilitation? A mixed-methods evaluation of NeuroRehabilitation OnLine (NROL)

Objectives To determine whether neurorehabilitation can be enhanced through regional implementation of group-based telerehabilitation, we implemented the NeuroRehabilitation OnLine (NROL) innovation regionally and evaluated scale-up from a systems perspective. Design Observational, exploratory service evaluation using a mixed-methods convergent parallel design. Setting Stroke and neurological rehabilitation services from four organisations across a regional healthcare system in the UK. Participants Therapy staff from community-based services and patients with a stroke or neurological condition receiving active community rehabilitation including NROL from April 2022 to March 2024. Intervention A regional multidisciplinary group-based neurological telerehabilitation innovation (NROL). Outcome measures Selected Proctor’s implementation outcomes, to establish system-level adoption, acceptability and sustainability of the regional NROL innovation. Results NROL was adopted by all intended organisations and continues as part of usual care with participation growing. It was acceptable to therapy staff and patients across the region, well-used, valued and supported increased therapy provision. For sustainability, staffing and travel efficiencies were identified through effective collaborative regional systems working. The importance of continued wide stakeholder engagement, robust evaluation and alignment was highlighted. Conclusions NROL was successfully embedded into real-world practice at a system level and enhanced neurorehabilitation. Looking forward, longer-term sustainment of this innovation will require a compelling business case and value proposition for decision-makers, addressing economic, equality and operational efficiency considerations.