Table V.

Evaluation of Rehab-Toolkit implementation initiative using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework

RE-AIM domains	Key factors	Pre-implementation	Implementation	Post-implementation	Impact of programme
Reach	Target population to be included in the initiative	Target population included all patients admitted to inpatient wards as a part of ongoing Enhanced Recovery After Surgery (ERAS®) programme Target population also included staff (medical, nursing, and AH)	Rehabilitation staff incorporated Rehab-Toolkit into routine clinical care and participated in implementing clinical change process	Assessed patients for rehabilitation service provision (e.g., referral, goal setting, discharge planning etc.)	Good reach of interventions to eligible populations
Effectiveness	Impact of intervention on important outcomes	Barriers and facilitators to subacute service provision identified	Patient assessments on admission and discharge using Rehab-Toolkit Staff education Patient information	Increase in functional assessment for rehabilitation needs of patients; triaging, service provision, & improved team communication	Good impact on the provision of rehabilitation interventions and referrals. Longer-term studies required to evaluate patient outcomes post-discharge, including QoL
Adoption	Adoption of intervention by staff and services	Exploration of staff barriers and facilitators to rehabilitation service provision using interdisciplinary group meetings	Initiation of structured patient assessments and information delivery to patients by staff, provision of referral systems, triaging and improved team communication, complex discharge planning	Rehab input well received by patients, with no unwanted effects or staff burden Ward discharge coordinators and patient flow services supported rehab team and were motivated to overcome barriers	Overall positive attitude of acute cancer care clinicians towards initiative suggests good adoption, consistent with post-implementation results of the study
Implementation	Extent to which the initiative is delivered as intended in real-world settings rather than clinically controlled research settings	Examine intervention reliability and feasibility	Delivery of education and information sessions to staff (medical, nursing, AH) & interdisciplinary forums Provision of rehabilitation information brochures to patients on admission to the ward Provision of Rehab-Toolkit on the ward for easy accessibility and embedding assessment forms into medical records	Variable consistency of ‘Rehab-Toolkit’ use. Staff fidelity was gauged from the contents of assessments recorded in medical records Ward staff changes – need for continuous reminder system for rehabilitation referral and follow-up systems	Positive short-term impacts (admission to discharge) of Rehab-Toolkit on outcomes measured, demonstrated feasibility of the programme in real-world clinical practice Further larger and follow- up studies are required to demonstrate the true effect of these in the longer term The contents of the assessment tool can be reviewed regularly to remain relevant
Maintenance	Long-term effects of intervention on individual and settings	Plan maintenance and dissemination of the rehabilitation toolkit	No additional resources were allocated as the study involved rehabilitation staff who assessed patients as per routine care	Incorporation of functional assessment of patients into routine practice undertaken by staff	Widespread implementation of Rehab-Toolkit is beyond the scope of study and limited to some inpatient wards only Future broader programme is planned including the inclusion of the Rehab-Toolkit in EMR. Cost analysis was not within the scope of this study' cost-effectiveness analysis would be important if widespread imple-mentation of Rehab-Toolkit was to be considered

Adapted from: Song et al. (25).