Human interactions remain at the heart of rehabilitation with advanced technology: a practice-embedded longitudinal qualitative study with allied health clinicians.

Background: Technology is gaining momentum in rehabilitation. While evidence is emerging, a growing number of rehabilitation facilities are implementing devices, though with variable success. A public-private rehabilitation provider in Australia recently opened a technology therapy centre with robotic and virtual reality devices. This study was embedded in the setting, which saw substantial clinician uptake of devices and presented a unique opportunity to explore clinician experiences, perceptions and factors influencing uptake, implementation and sustainment of advanced technology in practice.

Methods: A longitudinal qualitative study was conducted, involving interviews with clinicians at three timepoints across the first 16 months of the centre opening. Allied health clinicians in the organisation (n = 119) were invited to participate in interviews, which were audio-recorded, transcribed, coded and analysed using an inductive thematic approach.

Results: In total, 63 interviews were conducted with 25 allied health clinicians across inpatient, outpatient and community rehabilitation services. An overarching finding that human interactions remain at the heart of rehabilitation with advanced technology, comprised three major themes with 12 subthemes. (1) Technology integration involves cognitive and emotional labour for clinicians, stemming from determining the value-add of advanced technology, juggling learning demands and negotiating patients' high expectations of technology. (2) Contextual factors shape clinician uptake and ongoing use of technology, including organisational culture, professional discipline, rehabilitation setting, patient characteristics and device features. (3) Shared understanding and priorities promote technology implementation and sustainment, including understanding advanced technology in relation to conventional therapy, creating a well-designed training model, equipping clinicians to manage patient expectations and maintaining a commitment to evidence-based practice.

Conclusions: While further high-quality evidence regarding the effectiveness of technology in rehabilitation is required, clinicians in this study perceived advanced technology as an adjunct to conventional therapy, with benefits for enhancing therapy dosage, patient engagement, manual handling and providing objective feedback. Important practice-derived considerations for integrating advanced technologies in rehabilitation include: developing clinician technical, clinical reasoning and interpersonal skills, reducing contextual barriers and fostering a positive organisational culture with strong leadership and targeted initiatives to support clinicians. Successful implementation of advanced rehabilitation technologies relies on clinician buy-in to champion change within an enabling person-centered context.