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. 2026 May 7;21(5):e0348682. doi: 10.1371/journal.pone.0348682

Use of implementation science models, theories, and frameworks in pediatric rehabilitation: Protocol for a scoping review

Bayley Levy 1,2, Dorothy Luong 1,3, Shauna Kingsnorth 1,4, Iveta Lewis 1,3, Gillian King 1,5, Evdokia Anagnostou 3,6, Nadia Lise Tanel 3, Brayden Levillard 7, Gillian Molzon 2, Himanshi Elugoti 8, Mariam Jawad 9, Sarah Munce 1,3,4,5,10,*
Editor: Udoka Okpalauwaekwe11
PMCID: PMC13152174  PMID: 42096437

Abstract

Introduction

Implementation science frameworks – including process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks – are increasingly used to guide the translation of evidence-based interventions into practice. In paediatric rehabilitation, where interventions are complex and often require multidisciplinary collaboration, these frameworks can support systematic and context-sensitive implementation. However, the extent to which these frameworks have been used has not been comprehensively reviewed.

Objective

Determine the extent, nature, and specific contexts of the existing literature on the use of implementation science models, theories, and/or frameworks (MTFs) in paediatric rehabilitation.

Methods

This scoping review will follow the Joanna Briggs Institute (JBI) methodological guidance for scoping reviews. A comprehensive search strategy will be developed with a health sciences librarian and applied across multiple electronic databases: MEDLINE (Ovid), Embase, CINAHL, PsycINFO, ACM Digital Library, Web of Science, the Cochrane Central Register of Controlled Trials, PEDro, and RehabData. We will search English language articles published since 2006. Studies will be included if they report on the application of implementation science MTFs in the context of paediatric rehabilitation. Screening of titles and abstracts and full texts will be performed independently and in duplicate using Covidence. Discrepancies will be resolved through discussion or a third reviewer. Data will be extracted using a standardized form. Quantitative data will be summarized using numerical counts. Qualitative data will be analyzed using content analyses.

Results

This review will report on the use of implementation science MTFs in paediatric rehabilitation, identifying trends on the specific types applied, highlight gaps and/or underutilization across domains or developmental stages, and potentially uncover emerging frameworks. Finally, the results may inform the development of future implementation strategies and capacity-building initiatives within the field.

Introduction

Paediatric rehabilitation is a highly specialized and continually evolving field that requires complex diagnostic and therapeutic modalities in treating children and youth with diverse developmental, physical, and cognitive disabilities. The prevalence of childhood disability has steadily increased since the 1990s [1], and as of 2025, approximately 1 in 6 children are living with a disability requiring short and/or long-term services [2]. Paediatric rehabilitation interventions are inherently complex due to the interplay of multiple intersecting factors across the individual, organizational, and community levels [3]. These interventions involve coordination across multi- and inter-disciplinary healthcare teams, providing care across dynamic settings such as the home, clinic, hospital, school, and within the community [2–4]. Furthermore, these interventions have varying targets/aims, including but not limited to social support, education, improving functioning, increasing participation, promoting patient autonomy, among many others. However, a persistent issue in paediatric rehabilitation services is the fragmentation of care; although children may be under the care of multidisciplinary teams, treatment plans lack a “whole-child perspective” [4], which are limited in the integration of shared decision-making and patient-specific interventions. Consequently, disjointed care may result in poorer health outcomes for paediatric rehabilitation patients, such as missed opportunities in development, reduced engagement in services, increased caregiver burden, and negative impacts on the quality-of-life of the paediatric patient and family/caregivers.

Implementation science remains underutilized in the field of paediatric rehabilitation despite its potential, for example, improving the uptake of evidence-based interventions using a systematic, coordinated, and context-sensitive approach [3,4]. More specifically, the application of implementation science models, theories, and/or frameworks (MTFs) can help to bridge the gap between evidence-based interventions and effective mobilization into clinical practice [2,5]. Implementation science MTFs can help identify barriers and facilitators to implementation at various levels (e.g., patients, clinicians, organization), evaluate not only what works, but also how and why it works (or does not), and help identify what factors influence sustainability (e.g., leadership support, workflow fit).

Implementation science MTFs include five categories of theoretical models: process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks, which are based on the taxonomy proposed by Nilsen (2015) [5]. Process models outline sequential steps for translating research into practice, such as the Knowledge-to-Action (KTA) Framework [6] and the Knowledge Model of Knowledge Translation [7]. Determinant frameworks identify multilevel barriers and facilitators that influence implementation outcomes, though they often lack causal explanations [8,9]. Classic theories, drawn from disciplines like psychology and sociology, describe mechanisms of change but are considered “passive” as they do not directly guide implementation efforts [5]. In contrast, implementation theories, such as the Normalization Process Theory [10], offer specific insights into the integration of new practices. Finally, evaluation frameworks, such as RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) provide structured approaches for assessing implementation outcomes [5] and are useful in assessing implementation success and providing outcome categories/criteria for evaluation.

In a recent scoping review, Ghahramani et al. in 2025 [2] summarized the characteristics, implementation strategies, and outcomes of implementation studies in paediatric rehabilitation. Their findings highlighted the significant underutilization of implementation strategies, noting that nearly half of the 44 included studies used the implementation strategy, “train and educate key informant” while 19 studies adopted “use evaluative/iterative strategies”. However, the review did not explore a broader application of implementation science MTFs in paediatric rehabilitation.

Indeed, across the existing literature, findings highlight the need for more structured, system-level approaches that leverage implementation science frameworks to support effective knowledge mobilization in paediatric rehabilitation [11–13]. Educational strategies remain the most frequently employed, as previously shown, and while they can enhance provider knowledge, skills, and attitudes, they often fall short in facilitating the broader system-level changes required to support the uptake of emerging interventions [2]. Lazarowitz et al. (2025) demonstrated the inconsistent reporting and limited use of MTFs in paediatric rehabilitation, while emphasizing the importance of multifaceted strategies in supporting successful uptake of interventions [11]. Anaby et al. (2021) highlighted the critical role of knowledge user collaboration in their study examining factors in accelerating the uptake of interventions into clinical paediatric rehabilitation practice [12]. Gefen et al. (2024) also described the limited reporting and underutilization of implementation science MTFs, as previously stated, while also bringing attention the need for more system-level approaches, and the coordination of diverse knowledge users to support successful implementation strategies [13].

Despite the recognized importance of implementation science frameworks in translating evidence into practice, these MTFs are not being leveraged to their full potential in the field of paediatric rehabilitation [14]. Without a clear understanding of how and which implementation science MTFs are applied, opportunities to improve the uptake of clinical interventions and sustainability for long-term goals may be missed. Thus, the objective of this scoping review is to determine the extent, nature, and specific contexts of the literature on the use of implementation science MTFs within paediatric rehabilitation.

Methods

Design

The scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. The development of this scoping review protocol follows the JBI “best practice guidance and reporting items for the development of scoping review protocols” [15]. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [16,17]. The protocol has been registered with Open Science Framework (osf.io/fn9ku) [18].

This scoping review will capture and align with the core elements of the Population, Concept, and Context (PCC) framework of inclusion criteria [16]. The population of interest involves paediatric patients (age 18 years of age and younger) with physical and cognitive disabilities, including but not limited to: congenital brain injuries, cerebral palsy, spina bifida, attention-deficit hyperactivity disorder, autism spectrum disorder, communication disorders, intellectual and motor disabilities, and learning disabilities. Additionally, studies involving the families of paediatric patients with disabilities and healthcare professionals/providers working within paediatric rehabilitation are of interest. The context of interest is paediatric rehabilitation. Finally, the concept of this scoping review is the use of implementation science MTFs.

Search strategy

A comprehensive literature search has been developed in collaboration with a medical librarian at Holland Bloorview Kids Rehabilitation Hospital (see search strategy in S1 Appendix A: Ovid Search in S1 File). The final search strategy also underwent peer review using the Peer Review of Electronic Search Strategies (PRESS) statement checklist [19] with another librarian. The research team engaged in consensus meetings with the medical librarian to refine the search strategy. The search terms have been carefully selected and are consistent with previous reviews conducted on this topic [2,11–13]. The search strategy will be adapted for each database utilized. A preliminary search for existing scoping reviews was conducted on the JBI Database of Systematic Reviews and Implementation Reports, Episteminokis Databases, Open Science Framework and PROSPERO in May 2025. No reviews were published or currently underway on the use of implementation science MTFs within paediatric rehabilitation.

A two-step search strategy will be utilized in this review. An initial limited search of two interfaces (1) Ovid MEDLINE and (2) CINAHL (EBSCO) was undertaken to identify articles on the topic and as a search validation procedure to ensure the comprehensiveness and reliability of our approach. The initial search strategy was developed and tested in MEDLINE using controlled vocabulary (e.g., MeSH terms) to identify additional key search terms commonly found within the titles, abstracts, and full texts of similar articles. Key search terms will include variations of implementation science, specific models, theories, and frameworks (e.g., CFIR, EPIS, Theoretical Domains Framework), and relevant conditions and populations (e.g., “paediatric rehabilitation”, “cerebral palsy”, “autism spectrum disorder”, “developmental disabilities”, “rehabilitation”, “therapy”, “brain injury”, “neurodevelopmental disorders”). This strategy was developed to ensure all relevant studies on the application of implementation science MTFs in paediatric rehabilitation are captured.

Database searches will be conducted across: MEDLINE (Ovid), Embase, CINAHL, PsycINFO, ACM Digital Library, Web of Science, the Cochrane Central Register of Controlled Trials, PEDro, and RehabData. In addition to the primary database search, the research team will conduct forward citation searching (descendancy) to identify articles that have been cited by included studies and backward citation searching (ascendancy) to screen the reference lists of included studies to ensure all relevant sources have been captured. In cases where full texts are not available or accessible, contact authors will be e-mailed to attempt to source the articles. Communication will be attempted 2–3 times, and these efforts will be reported in the final manuscript with their associated outcomes.

Evidence screening and selection

All articles retrieved from the database search will be imported into Covidence [20] and duplicates will be removed.

English studies published since 2006 will be eligible for inclusion. The year 2006 was chosen as it corresponds with the release of the Implementation Science journal, a seminal journal in the field. Studies must report on the application of an implementation science MTF in the context of paediatric rehabilitation (including studies involving the families of paediatric patients with disabilities and healthcare professionals/providers working within this field) will be included. Within the field of implementation science and elsewhere, “framework”, “model”, and “theory” are often used interchangeably; however, Nilsen (2015) provided a taxonomy to conceptualize and provide clarity amongst these structurally similar terms that have nuanced variations [5,6], as previously described. Specifically, theory refers to “a set of analytical principles or statements designed to structure our observation, understanding, and explanation of the world,” typically characterized by defined constructs, relationships between variables, and predicted outcomes; model refers to “a deliberate simplification of a phenomenon,” which is descriptive but does not explain causal relationships; and framework is defined as “a structure, overview, outline, system, or plan consisting of various descriptive categories and the relations between them,” offering a categorization of phenomena without explanatory mechanisms. For the purposes of this scoping review, we will adhere to these definitions to ensure conceptual clarity and consistency. Additionally, we have designed an inclusive search strategy that accounts for the overlap of these terms. Specifically, we have incorporated the most commonly used implementation science MTFs by name. This approach aims to optimize both the sensitivity and specificity of our search and ensure that relevant literature is accurately captured and appropriately classified. All primary study designs are eligible for inclusion, while non-primary designs (e.g., editorials, opinion pieces, commentaries, protocols, systematic reviews, scoping reviews, and meta-analyses) will be excluded.

Level 1 (i.e., title and abstract) and level 2 (i.e., full text) screening will be completed in duplicate by two independent reviewers using the eligibility criteria. Prior to starting level 1 screening, the inclusion criteria will be piloted on a random sample of 10% of citations. The pilot test will be performed to confirm there is consistent interpretation and application of the inclusion and exclusion criteria. The eligibility of the defined inclusion criteria may be revised to improve the consistency, if deemed necessary by the research team, or if a low inter-rater agreement (i.e., below 70%) is observed. Similarly, a pilot test of 10% will be done prior to full level 2 screening begins. At each stage, discrepancies will be resolved by a discussion between reviewers, and in instances in which a consensus cannot be reached, a third reviewer will adjudicate.

Data extraction

Data extraction will be conducted in duplicate by two independent reviewers using the data extraction tool on Covidence. A pilot test of the full data extraction will be completed on approximately 10 articles chosen at random to ensure reliability and accuracy among reviewers. The pilot test will identify any discrepancies in the data extraction process and provide an opportunity to modify the template to enhance inter-rater consistency. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer. If appropriate, authors of papers will be contacted to request missing or additional data, where required.

Data extraction will follow an iterative approach, with the final categories being defined progressively as the authors gain a deeper understanding of the data. It is anticipated that categories will include: implementation science MTF used, type of implementation science MTF (based on Nilsen (2015)’s taxonomy) [5,6], type of paediatric rehabilitation, disability population, and study findings including implementation outcomes, as well as other study characteristics (e.g., author, year of publication, name of journal, country, study design, setting/care context, population, sample size, objective) and additional population characteristics, including PROGRESS-Plus characteristics (Cochrane Methods Equity) [21,22] (e.g., place of residence, race/ethnicity/language, occupation status, gender/sex, religion, education, socioeconomic status, social capital, personal characteristics associated with discrimination, features of relationships, time dependent relationships).

Data analysis and presentation

This scoping review will follow the 2022 JBI methodological guidance [15] to ensure best practices in data analysis and presentation. Quality and risk of bias will not be assessed. Findings will be interpreted with consideration of study design and methodological characteristics, with emphasis on mapping the extent and nature of the evidence. Descriptive numerical summaries will be conducted to present characteristics of included studies by frequency and proportion (e.g., number of studies, year of publication, and types of implementation science MTFs used). Content analysis will be used to synthesize qualitative data within the included studies [23]. This analysis will focus on: (1) types of MTFs employed (based on Nilsen’s taxonomy [5,6]; (2) how the constructs in the MTF were operationalized; (3) characteristics of target populations (e.g., children with disabilities, paediatric healthcare professionals); (4) the intervention focus (if applicable); (5) the care setting; and (6) outcomes reported (if applicable). Equity-related variables will also be analyzed descriptively using the PROGRESS-Plus framework where applicable, with outputs including summaries of reported variables and frequencies across studies. This will help identify how social determinants such as place of residence, gender, or socioeconomic factors influence the success of the implementation of the paediatric rehabilitation interventions. These insights may reveal disparities in how MTFs are applied across different contexts [19,20]. Findings from both the quantitative summaries and content analysis will be presented narratively and visually, using tables, framework maps, and charts, to clearly convey observed patterns, trends, and gaps in the literature.

Level 1 screening is currently underway and expected to be completed by the end of October 2025; with Level 2 screening completion by December 2025. Data extraction is expected to immediately follow the completion of Level 2 screening and be completed by March 2026. Data analysis and manuscript writing will occur concurrently, and we expect to produce the final manuscript by June 2026.

Discussion and Conclusion

This scoping review will provide a comprehensive overview of the extent, nature, and specific contexts of the literature on the use of implementation science MTFs in paediatric rehabilitation. By mapping the current evidence, this review will identify which MTFs are most commonly applied, how they are operationalized, and where gaps exist in their application, adaptation, or development. For consistency, we will follow the definitions of MTFs outlined by Nilson (2015), where a theory is an explanatory set of principles with specified relationships and predicted outcomes; a model is a descriptive representation of a phenomenon; and a framework is a structured overview that categorizes concepts without specifying causal mechanisms [5,6].

To disseminate our findings, we will use a variety of passive and active end-of-grant knowledge mobilization approaches. Traditional knowledge mobilization will include dissemination through meetings locally, nationally, and internationally (e.g., European Implementation Conference, Annual Conference on the Science of Dissemination and Implementation in Health) and publications in a peer-reviewed journal (e.g., Implementation Science Research and Practice). Furthermore, findings from this scoping review will be used to inform an implementation science and practice pathway at Holland Bloorview Kids Rehabilitation Hospital, which in turn could be used at other paediatric rehabilitation institutions.

A strength of this study is the broad inclusion criteria, allowing for a comprehensive map of the current literature on implementation science in paediatric rehabilitation. The search strategy had undergone peer review using the PRESS statement checklist, which further strengthens the relevance, comprehensiveness, and quality of the search strategy. Furthermore, screening and extraction were conducted in duplicate, ensuring data reliability. A limitation of this study is the inclusion of articles published in English, thereby potentially excluding relevant studies published in other languages. We also acknowledge that the proposed timeline may be ambitious given the scope of the review. To mitigate potential delays, we have assembled a large team of experienced reviewers with prior expertise in conducting scoping reviews of similar scope. In addition, we will implement structured workflows, including regular team check-ins, and predefined milestones to closely monitor progress and address any delays early. Another limitation of this study is that this review focuses on studies that explicitly reference implementation science MTFs, thus it may not capture broader implementation efforts that do not formally apply these frameworks.

This scoping review findings will inform researchers, clinicians, and decision-makers about the state of implementation science in paediatric rehabilitation and guide more effective, theory-informed implementation efforts. Ultimately, this review aims to strengthen the use of implementation science in advancing the uptake of evidence-based practices, improving care delivery, and addressing the unique needs of children and families in paediatric rehabilitation settings.

Supporting information

S1 File. Appendix A: Ovid Search Strategy.

Search strategy for OVID-MEDLINE Database.

(DOCX)

pone.0348682.s001.docx (36.4KB, docx)
S2 File. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist.

PRISMA-P checklist completed for scoping review protocol.

(DOCX)

pone.0348682.s002.docx (34.1KB, docx)

Acknowledgments

We would like to thank Jessie Cunningham, a librarian at the Hospital for Sick Children, for their support in completing the PRESS Peer Review of Electronic Search Strategies for the search strategy developed for this review.

Data Availability

No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

Funding Statement

This work is supported and funded by Holland Bloorview Kids Rehabilitation Hospital Foundation. Dr. Munce holds a CIHR Implementation Science Chair in Human Development, Child and Youth Health. The funders did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.

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Decision Letter 0

Udoka Okpalauwaekwe

9 Feb 2026

-->PONE-D-25-39248-->-->Use of Implementation Science Models, Theories, and Frameworks in Pediatric Rehabilitation: Protocol for a Scoping Review-->-->PLOS One

Dear Dr. Munce,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Protocol is well developed, methodologically sound, and aligned with established scoping review standards.

1. You include a broad range of MTFs and pediatric populations, which enhances inclusivity but may also introduce conceptual heterogeneity. Consider clarifying how the team will manage conceptual overlap and variability across frameworks during synthesis to ensure interpretive coherence.

2. You state that studies must report “application” of MTFs, but the criteria for determining meaningful use versus superficial citation are not fully specified. clarify how the reviewers will distinguish substantive application from nominal or symbolic reference to frameworks.

3. While deductive content analysis is described, details regarding coding procedures, analyst reflexivity, and consensus-building are limited.

4. You exclude formal quality appraisal, consistent with scoping review standards. However, the implications of this decision are not fully discussed. Consider briefly outlining how variation in study rigor will be considered during interpretation.

5.  Your proposed timeline is a little ambitious given the scope of databases and analytic plans. While its acceptable, a brief acknowledgment of potential timeline risks and mitigation strategies may enhance credibility.

6. Terminology related to “model,” “theory,” and “framework” could be briefly reiterated in the

7. The description of equity analysis could be slightly expanded to clarify anticipated outputs.

==============================

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-->1. When submitting your revision, we need you to address these additional requirements.-->--> -->-->Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at -->-->https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and -->-->https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf-->--> -->-->2. Thank you for stating in your Funding Statement: -->-->This work is supported and funded by Holland Bloorview Kids Rehabilitation Hospital Foundation. Dr. S. Munce holds a CIHR Implementation Science Chair in Human Development, Child and Youth Health. The funders did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. -->--> -->-->Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at ://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. -->-->Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf.-->--> -->-->3. Thank you for stating the following in the Acknowledgments Section of your manuscript: -->-->We would like to thank, Jessie Cunningham, a librarian at the Hospital for Sick Children, for their support in completing the PRESS Peer Review of Electronic Search Strategies for the search strategy developed for this review. The authors would also like to thank the Holland Bloorview Kids Rehabilitation Hospital Foundation for supporting this work.-->--> -->-->We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. -->-->Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: -->-->This work is supported and funded by Holland Bloorview Kids Rehabilitation Hospital Foundation. Dr. S. Munce holds a CIHR Implementation Science Chair in Human Development, Child and Youth Health. The funders did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.-->--> -->-->Please include your amended statements within your cover letter; we will change the online submission form on your behalf.-->--> -->-->4. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process.-->--> -->-->5. We notice that your supplementary table is included in the manuscript file. Please remove, leaving only the individual file, uploaded separately. Please ensure that each Supporting Information file has a legend listed in the manuscript after the references list.-->--> -->-->6. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Protocol is well developed, methodologically sound, and aligned with established scoping review standards.

1. You include a broad range of MTFs and pediatric populations, which enhances inclusivity but may also introduce conceptual heterogeneity. Consider clarifying how the team will manage conceptual overlap and variability across frameworks during synthesis to ensure interpretive coherence.

2. You state that studies must report “application” of MTFs, but the criteria for determining meaningful use versus superficial citation are not fully specified. clarify how the reviewers will distinguish substantive application from nominal or symbolic reference to frameworks.

3. While deductive content analysis is described, details regarding coding procedures, analyst reflexivity, and consensus-building are limited.

4. You exclude formal quality appraisal, consistent with scoping review standards. However, the implications of this decision are not fully discussed. Consider briefly outlining how variation in study rigor will be considered during interpretation.

5. Your proposed timeline is a little ambitious given the scope of databases and analytic plans. While its acceptable, a brief acknowledgment of potential timeline risks and mitigation strategies may enhance credibility.

6. Terminology related to “model,” “theory,” and “framework” could be briefly reiterated in the

7. The description of equity analysis could be slightly expanded to clarify anticipated outputs.

-->--> -->-->[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions-->

-->Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.-->

Reviewer #1: Yes

**********

-->2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.-->

Reviewer #1: Yes

**********

-->3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.-->

Reviewer #1: Yes

**********

-->4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

**********

-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Great protocol and very well written. My recommendations are:

- Adding the rationale for why a certain MTF was chosen in a paper and the fidelity of implementation of the MTF as a category for the data to be abstracted

- Consideration for analyzing the data to see if there are difference between low/medium income country vs. high income country

- Fleshing out the discussion and conclusion section - ex. adding details about how the results would be disseminated, strengths and limitations. It is currently only a paragraph

- A thought that I had when reading this protocol that it may become a case of "we don't know what we don't know". I don't know whether it is feasible to determine the extent of the literature on the use of MTFs. For example, what if someone wrote a paper detailing how they implemented a model of care, but didn't use implementation science MTF at all? I am not clear that the search strategy would pick it up.

**********

-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #1: No

**********

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PLoS One. 2026 May 7;21(5):e0348682. doi: 10.1371/journal.pone.0348682.r002

Author response to Decision Letter 1

27 Mar 2026

We would like to thank the reviewer and editor for their feedback on our manuscript. Here are our responses to the feedback (and attached as a document in this resubmission).

Journal Requirements:

1. When submitting your revision, we need you to address these additional requirements.

Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Response: Thank you for your comment. We have reformatted our manuscript to meet PLOS ONE’s style requirements including file naming.

2. Thank you for stating in your Funding Statement:

This work is supported and funded by Holland Bloorview Kids Rehabilitation Hospital Foundation. Dr. S. Munce holds a CIHR Implementation Science Chair in Human Development, Child and Youth Health. The funders did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement.

Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf.

Response: We have updated our Funding Statement in our cover letter and below:

“This work is supported and funded by Holland Bloorview Kids Rehabilitation Hospital Foundation. Dr. Munce holds a CIHR Implementation Science Chair in Human Development, Child and Youth Health. The funders did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.”

3. Thank you for stating the following in the Acknowledgments Section of your manuscript:

We would like to thank, Jessie Cunningham, a librarian at the Hospital for Sick Children, for their support in completing the PRESS Peer Review of Electronic Search Strategies for the search strategy developed for this review. The authors would also like to thank the Holland Bloorview Kids Rehabilitation Hospital Foundation for supporting this work.

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

This work is supported and funded by Holland Bloorview Kids Rehabilitation Hospital Foundation. Dr. S. Munce holds a CIHR Implementation Science Chair in Human Development, Child and Youth Health. The funders did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

Response: We have revised our Funding Statement based on the above comment and removed any funding-related text from the manuscript. The updated Funding Statement has been included in our cover letter.

4. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process.

Response: This manuscript is a protocol paper, thus, no datasets were generated or analyzed. Relevant data from this study will be made available in a separate manuscript. No changes have been made to the data availability statement.

5. We notice that your supplementary table is included in the manuscript file. Please remove, leaving only the individual file, uploaded separately. Please ensure that each Supporting Information file has a legend listed in the manuscript after the references list.

Response: Thank you. We have removed S1 Appendix A from the main manuscript and have uploaded it separately.

6. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Response: Thank you.

7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Response: Thank you. We have updated the reference list to include the additional relevant citation and have incorporated it into the manuscript accordingly.

Additional Editor Comments:

Protocol is well developed, methodologically sound, and aligned with established scoping review standards.

1. You include a broad range of MTFs and pediatric populations, which enhances inclusivity but may also introduce conceptual heterogeneity. Consider clarifying how the team will manage conceptual overlap and variability across frameworks during synthesis to ensure interpretive coherence.

Response: Thank you for your comments. As this scoping review aims to map the use of implementation science MTFs in pediatric rehabilitation, we will assess heterogeneity during data synthesis, including variation in both MTFs and pediatric populations. To support consistency in categorization of the MTFs, we will use Nilsen (2015)’s taxonomy to group MTFs into the following categories: process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. MTFs that do not belong to any of these categories will be put into the “other MTFs” category when applicable. We expect limited range of implementation science MTFs to be used as well as higher usage of common implementation science MTFs (e.g., CFIR, RE-AIM), so we expect that Nilsen (2015)’s taxonomy to categorize the MTFs will be very useful.

To manage conceptual overlap and variability, we will chart how the implementation science MTFs were applied across studies and describe similarities and differences within and across categories. This approach will allow us to provide a structured overview of MTF use while being consistent with scoping review methodology.

We provide details related to Nilsen’s taxonomy on pages 4-5, lines 86-99:

“Implementation science MTFs include five categories of theoretical models: process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks, which are based on the taxonomy proposed by per Nilsen (2015) [5]. Process models outline sequential steps for translating research into practice, such as the Knowledge-to-Action (KTA) Framework [6] and the Knowledge Model of Knowledge Translation [7]. Determinant frameworks identify multilevel barriers and facilitators that influence implementation outcomes, though they often lack causal explanations [8,9]. Classic theories, drawn from disciplines like psychology and sociology, describe mechanisms of change but are considered “passive” as they do not directly guide implementation efforts [5]. In contrast, implementation theories, such as the Normalization Process Theory [10], offer specific insights into the integration of new practices. Finally, evaluation frameworks, such as RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) provide structured approaches for assessing implementation outcomes [5] and are useful in assessing implementation success and providing outcome categories/criteria for evaluation.”

We have provided additional details on how we will categorize the implementation science MTFs at data extraction on page 11, lines 236-245:

“It is anticipated that categories will include: implementation science MTF used, type of implementation science MTF (based on Nilsen (2015)’s taxonomy) [5, 6], type of pediatric rehabilitation, disability population, and study findings including implementation outcomes, as well as other study characteristics (e.g., author, year of publication, name of journal, country, study design, setting/care context, population, sample size, objective) and additional population characteristics, including PROGRESS-Plus characteristics (Cochrane Methods Equity) [19, 20] (e.g., place of residence, race/ethnicity/language, occupation status, gender/sex, religion, education, socioeconomic status, social capital, personal characteristics associated with discrimination, features of relationships, time dependent relationships).”

2. You state that studies must report “application” of MTFs, but the criteria for determining meaningful use versus superficial citation are not fully specified. clarify how the reviewers will distinguish substantive application from nominal or symbolic reference to frameworks.

Response: Our objective is to understand what the current extent of the literature is with respect to the use of implementation MTFs. As such, we decided to not restrict inclusion based on level of “meaningful” application of the MTF. Studies will be included if they report any use of an implementation MTF, which will allow us to capture the range of reported uses. During data analysis we will be able to report on whether research teams have been “meaningfully” applying implementation MTFs in their study.

3. While deductive content analysis is described, details regarding coding procedures, analyst reflexivity, and consensus-building are limited.

Response: We meant to say that we will conduct content analyses instead of deductive content analyses. As previously mentioned, we will use Nilsen (2015)’s taxonomy to categorize the implementation science MTFs and conduct content analysis to synthesize qualitative data of the included studies.

We have made these changes on page 11-12, lines 251-254:

“Descriptive numerical summaries will be conducted to present characteristics of included studies by frequency and proportion (e.g., number of studies, year of publication, and types of implementation science MTFs used). Content analysis will be used to synthesize qualitative data within the included studies [23].”

4. You exclude formal quality appraisal, consistent with scoping review standards. However, the implications of this decision are not fully discussed. Consider briefly outlining how variation in study rigor will be considered during interpretation.

Response: While formal quality appraisal is not required in scoping reviews, we agree that variation in study rigor should be considered during the data synthesis and interpretation. We have revised the manuscript to clarify that findings will be interpreted in light of study design and methodological characteristics (e.g., study type, sample size, and reporting detail) on page 11, lines 249-251. Our conclusions will emphasize the mapping of evidence and identification of patterns and gaps, rather than making judgments about the strength of evidence. We will also discuss areas where the current evidence base is limited or heterogeneous.

“ Findings will be interpreted with consideration of study design and methodological characteristics, with emphasis on mapping the extent and nature of the evidence.

5. Your proposed timeline is a little ambitious given the scope of databases and analytic plans. While its acceptable, a brief acknowledgment of potential timeline risks and mitigation strategies may enhance credibility.

Response: We acknowledge that the proposed timeline is ambitious given the scope of databases and analytic approach. To mitigate potential delays, we have assembled a large team of experienced reviewers with prior expertise in conducting scoping reviews of similar scope. In addition, we will implement structured workflows, including regular team check-ins, and predefined milestones to closely monitor progress and address any delays early.

We have included this in our manuscript on page 14, lines 302-305

“To mitigate potential delays, we have assembled a large team of experienced reviewers with prior expertise in conducting scoping reviews of similar scope. In addition, we will implement structured workflows, including regular team check-ins, and predefined milestones to closely monitor progress and address any delays early.”

6. Terminology related to “model,” “theory,” and “framework” could be briefly reiterated in the

Response: We have briefly restated the definitions of “model,” “theory,” and “framework” in our discussion section on page 13, lines 277-284:

“This scoping review will provide a comprehensive overview of the extent, nature, and specific contexts of the literature on the use of implementation science MTFs in pediatric rehabilitation. By mapping the current evidence, this review will identify which MTFs are most commonly applied, how they are operationalized, and where gaps exist in their application, adaptation, or development. For consistency, we will follow the definitions of MTFs outlined by Nielson (2015), where a theory is an explanatory set of principles with specified relationships and predicted outcomes; a model is a descriptive representation of a phenomenon; and a framework as a structured overview that categorizes concepts without specifying causal mechanisms [5,6].”

7. The description of equity analysis could be slightly expanded to clarify anticipated outputs.

Response: Thank you for this suggestion. We have expanded the description of the equity analysis to clarify anticipated outputs. Specifically, we now describe how equity-related variables will be summarized descriptively using the PROGRESS-Plus framework and its implications within paediatric rehabilitation on page 12, lines 258-263:

“Equity-related variables will also be analyzed descriptively using the PROGRESS-Plus framework where applicable, with outputs including summaries of reported variables and frequencies across studies. This will help identify how social determinants such as place of residence, gender, or socioeconomic factors influence the success of the implementation of the paediatric rehabilitation interventions.”

Reviewers' comments:

Reviewer #1: Great protocol and very well written.

My recommendations are:

Adding the rationale for why a certain MTF was chosen in a paper and the fidelity of implementation of the MTF as a category for the data to be abstracted

Response: Thank you for this comment! We will be sure to look at congruence and/or discordance between the objective of the study and the selected implementation scien

Attachment

Submitted filename: 25032026_ResponsetoReviewerComments.docx

pone.0348682.s004.docx (47.3KB, docx)

Decision Letter 1

Udoka Okpalauwaekwe

20 Apr 2026

Use of Implementation Science Models, Theories, and Frameworks in Pediatric Rehabilitation: Protocol for a Scoping Review

PONE-D-25-39248R1

Dear Dr. Munce,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Udoka Okpalauwaekwe, MD, MPH, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

I believe most of the reviewer comments have been addressed at this point hence wold move it forward for publication.

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.-->

Reviewer #2: Yes

**********

-->2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.-->

Reviewer #2: Yes

**********

-->3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.-->

Reviewer #2: Yes

**********

-->4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #2: Yes

**********

-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #2: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #2: Thanks for you attention to reiwer comments. I have no further comments at this time and look forward to reading from you in the future.

**********

-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #2:  Yes: Udoka Okpalauwaekwe

**********

Acceptance letter

Udoka Okpalauwaekwe

PONE-D-25-39248R1

PLOS One

Dear Dr. Munce,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

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Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

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Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Udoka Okpalauwaekwe

Academic Editor

PLOS One

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File. Appendix A: Ovid Search Strategy.

    Search strategy for OVID-MEDLINE Database.

    (DOCX)

    pone.0348682.s001.docx (36.4KB, docx)
    S2 File. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist.

    PRISMA-P checklist completed for scoping review protocol.

    (DOCX)

    pone.0348682.s002.docx (34.1KB, docx)
    Attachment

    Submitted filename: 25032026_ResponsetoReviewerComments.docx

    pone.0348682.s004.docx (47.3KB, docx)

    Data Availability Statement

    No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

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