Table 1.

Putting frameworks into action: a summary of how implementation science frameworks are combined across the lifespan of an implementation project

Framework/concept	Description of framework and how it informs sustainment	Use in proactive physical therapy (PAPT)
Knowledge-to-action cycle (Graham 2006) [5]	Implementation process model. Sustainment phase to provide feedback for future cycles.	Implemented in Y1. Cycled through again in Y2–4.
Dynamic Sustainability Framework (Chambers, 2013) [9]	Emphasizes the importance of using dynamic strategies by describing the key tenets of sustainability within a changing delivery system. ∙ Ongoing intervention optimization ∙ Continuous intervention improvements for stakeholder learning ∙ Ongoing feedback on progress ∙ Organizational fit ∙ Voltage drop is not inevitable ∙ Organizational learning should be a core value ∙ Ongoing stakeholder involvement	∙ Ongoing intervention improvements supported through monthly meetings with bidirectional feedback, sharing new knowledge, organizational data and continuously updating resources. ∙ Organizational fit is managed through leadership engagement and institutionalization of practices. ∙ Organization leadership and facilitator support ongoing training and stakeholder engagement. ∙ Clinic culture promotes communication, engagement, and demand for increasing reach.
RE-AIM (Glasgow et al., 2019) [7] (www.re-aim.org)	An evaluative framework which promotes capture of outcomes from the five important dimensions: that consider internal and external validity in translational research. These dimension include: reach of the program, effectiveness of the implementation, adoption by the clinical team, implementation fidelity, and maintenance of the program. Maintenance specifically refers to when a program becomes “part of routine practices”.	∙ RE-AIM organized results based on the first iteration (Rafferty et al., [4]) and provided a useful comparison for sustainment outcomes of PAPT. ∙ In the first iteration, maintenance was considered broadly including both program and individual maintenance. ∙ In the second iterations, we added measureable sustainability goals and use of sustainability assessment tools.
Clinical Sustainability Assessment Tool (CSAT) (Luke et al, 2018; www.sustaintool.org) [13]	A tool to evaluate clinical program capacity for sustainment that assesses the following domains: engaged staff, engaged stakeholders, monitoring and evaluation, planning and implementation, outcomes and effectiveness, workflow integration, and organizational context by surveying clinical staff and stakeholders. Psychometrics are not available currently.	∙ Key stakeholders (n = 10) provided their insights into 7 key areas for sustainment in a survey at the end of the data collection period. ∙ Results of these assessments were shared back at the monthly meetings in order to address areas with lower ratings.
NHS Sustainability Model	This “diagnostic tool” was created to give insights to an implementation team on specific strengths and weaknesses of a current program and to help predict the likelihood of sustainment. The tool assesses processes, organization, and staff. Psychometrics are not available currently.	∙ Site champions and facilitator (n = 4) provided insights into sustainment of process, staff, and at the organizational level. ∙ Results of these assessments were shared back at the monthly meetings in order to address areas with lower ratings.