Embedding Telerehabilitation in Practice: Adapting NeuroRehabilitation OnLine (NROL) for a New Context Through Co-Production and Implementation Science Knowledge.

BackgroundDelivering recommended intensity of neurorehabilitation remains a challenge, with telerehabilitation offering one solution. NeuroRehabilitation OnLine (NROL) is a multidisciplinary, group-based telerehabilitation model embedded within one region in England, showing promise and alignment with healthcare strategic priorities. The importance of scaling successful evidence-informed practices is recognised, however careful adaptation is required to ensure contextual fit and sustainability. This study describes the adaptation of NROL for implementation in a new context. MethodsThe four-step ADAPT guidance was applied with previously identified implementation strategies to guide the adaptation of NROL from Region 1 to Region 2. Adaptation activities were co-produced. Contextual factors were detailed using the Consolidated Framework for Implementation Research and Intervention Sustainability Assessment Tool. The adapted innovation was described using the TIDieR-Rehab checklist. ResultsNROL was successfully adapted for Region 2. Step 1 confirmed strategic fit but identified barriers including workforce, infrastructure and resource. Led by an adaptation team and supported by a learning collaborative, Step 2 responded to barriers, retaining core components while tailoring role configuration and materials. Step 3 demonstrated feasibility and acceptability through piloting and phased integration, and improved fit within service pathways. Step 4 focused on sustainment, supported by training, stakeholder engagement, and reporting. DiscussionThis study offers a transferable approach for scale-up, providing an example of context-sensitive adaptation to a new region, demonstrating how frameworks and co-production can support the adaptation of telerehabilitation models. This example has potential wider use for researchers and implementers tasked with delivering impact, though highlights the effort and resource needed. PLAIN LANGUAGE SUMMARYStroke and neurological rehabilitation services often struggle to provide enough therapy due to staffing and system challenges. Digital delivery of rehabilitation offers one solution. NeuroRehabilitation OnLine (NROL) is a programme that offers live, group therapy and peer-support remotely for people recovering neurological conditions. It has been delivered within one region of England, showing promise and alignment with healthcare priorities. The importance of spreading successful, evidenced practices is recognised, but requires careful consideration to ensure they fit well and can be continued in the new location. This study explains how NROL was adapted for use in a second region. The four-step process called the ADAPT guidance was used with previously identified practical strategies to guide changes to NROL for Region 2. Relevant staff from both regions worked together to ensure the programme met local needs. Evidenced tools were used to understand what made the new region different and to describe the adapted programme clearly. NROL was successfully adapted for Region 2. Step 1 confirmed NROL alignment with healthcare priorities but highlighted challenges including limited staffing and resource. Led by a small team, Step 2 responded to challenges. The core parts of NROL were kept the same, like live group therapy and technology support, but changes were made to the staffing structures and materials. Step 3 tested the changes with small pilot groups and used feedback to improve the programme before wider roll-out and refinement. Step 4 focused on maintaining and reporting the adapted programme. This work offers a transferable approach for spreading evidenced health innovations, providing an example of local needs driving relevant change, and demonstrating how tools and teamwork can support the adaptation process of digital health programmes. This example has potential wider use for researchers and clinical staff tasked with delivering change, though highlights the effort and resource needed.