Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China.

BACKGROUND: Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients. METHODS: The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project. RESULTS: Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased. CONCLUSION: The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.

The mitochondrial genome of the deep-sea pyramid urchin Echinocrepis rostrata (Echinoidea: Holasteroida: Pourtalesiidae).

We present the mitochondrial genome of the deep-sea, epibenthic, irregular echinoid Echinocrepis rostrata, representing the first sequenced mitogenome of the order Holasteroida. The length of the complete E. rostrata mitochondrial genome is 15,716 base pairs, and its GC content is 34.87%. It contains 13 protein-coding genes, two rRNA genes, and 22 tRNA genes, whose order is identical to that of all other available echinoid mitogenomes. Phylogenetic analysis of available mitochondrial genomes, based on all coding loci, places E. rostrata as the sister group to spatangoids (heart urchins).

The measurement of fatigue in clinicians within hospital settings: A systematic review of measurement properties.

Medical staff fatigue leads to accidents and mistakes and puts patient safety at risk. A measure of fatigue in the workplace may help to quantify, predict, and manage fatigue. This review aimed to evaluate instruments used to measure fatigue in medical staff within hospitals. A systematic review following the JBI methodology was undertaken. A search for articles was conducted in 2021. Included articles (all validation studies) were assessed for methodological quality using the COSMIN checklist. Measurement property data was evaluated for Quality of Evidence using GRADE methodology. Ten studies representing five instruments were reviewed: Occupational Fatigue Exertion and Recovery scale (now superseded); Occupational Fatigue Exertion and Recovery scale (15-item); Multidimensional Fatigue Inventory; Need for Recovery Scale; and the Swedish Occupational Fatigue Inventory. Four instruments show promise for measuring fatigue in hospital medical staff, however, there is limited certainty in the measure property estimates. The Quality of Evidence for measurement properties for all instruments is insufficient. Further validation studies following the COSMIN standards are needed before recommendations for use can be made.

Data Note: The Digital Ludeme Project Database.

This document outlines the types of data collected for the Digital Ludeme Project, an ERC-funded research project that aims to improve our understanding of the development of games throughout human history through computational analysis of the available (partial) historical data of games. This document outlines how this data is collected, formatted and stored, and how it can be accessed. It is the aim of the Digital Ludeme Project to provide a data resource of unprecedented depth and scope for the benefit of historical games researchers worldwide. Special attention is paid to the FAIR Guiding Principles for scientific data management and stewardship.

JBI series paper 2: tailored evidence synthesis approaches are required to answer diverse questions: a pragmatic evidence synthesis toolkit from JBI.

Evidence synthesis is critical in evidence-based healthcare and is a core program of JBI. JBI evidence synthesis is characterised by a pluralistic view of what constitutes evidence and is underpinned by a pragmatic ethos to facilitate the use of evidence to inform practice and policy. This second paper in this series provides a descriptive overview of the JBI evidence synthesis toolkit with reference to resources for 11 different types of reviews. Unique methodologies such as qualitative syntheses, mixed methods reviews, and scoping reviews are highlighted. Key features include standardised and collaborative processes for development of methodologies and a broad range of tailored resources to facilitate the conduct of a JBI evidence synthesis, including appraisal and data extraction tools, software to support the conduct of a systematic review and an intensive systematic review training program. JBI is one of the leading international protagonists for evidence synthesis, providing those who want to answer health-related questions with a toolkit of resources to synthesize the evidence.

An Assessment of Officer-Involved Shooting Data Transparency in the United States.

Although researchers and the public intuitively know that the lack of available data on the topic of officer-involved shootings (OIS) is a problem, the scope of the problem has not been identified. A lack of transparency regarding OIS data contributes to the legitimacy crisis facing policing in the United States. Valid and reliable OIS data would create the ability to craft and assess informed public policy. In addition, police organizations' roles could then be evaluated allowing for accountability and additional training based on OIS incidents. Employing content analysis of websites for police agencies, their municipal/county governments, and sheriffs' offices servicing populations of 100,000 or more according to the 2010 U.S. Census, the availability of OIS data is identified and classified. It was found that 155 (of 277) police agencies and 96 (of 548) sheriffs' offices made some form of data available related to OIS incidents across five categories (annual reports, OIS summary reports, individualized shooting reports, press releases, and spreadsheet reports). The current assessment is the first in the literature to systematically evaluate the transparency of law enforcement organizations servicing large jurisdictions regarding OIS incidents. Those reports and data available are described and placed within the context of the recommended national database proposed by Klinger and colleagues to begin to assess the extent of OIS data transparency issues facing policing. In addition, agencies providing data were compared utilizing one-way analysis of variance on a number of structural variables drawn from the 2008 Census of State and Local Law Enforcement Agencies to evaluate any patterns demonstrated by those organizations providing data. Findings suggest great variation in the type, classification, and quality of data presented by law enforcement organizations, which limits its utility for the purposes of research as well as policy creation and evaluation.

Development of prehospital care quality indicators for the Australian setting: a modified RAND/UCLA appropriateness method.

BACKGROUND: Globally, the measurement of quality is an important process that supports the provision of high-quality and safe healthcare services. The requirement for valid quality measurement to gauge improvements and monitor performance is echoed in the Australian prehospital care setting. The aim of this study was to use an evidence-informed expert consensus process to identify valid quality indicators (QIs) for Australian prehospital care provided by ambulance services. METHODS: A modified RAND/UCLA appropriateness method was conducted with a panel of Australian prehospital care experts from February to May 2019. The proposed QIs stemmed from a scoping review and were systematically prepared within a clinical and non-clinical classification system, and a structure/process/outcome and access/safety/effectiveness taxonomy. Rapid reviews were performed for each QI to produce evidence summaries for consideration by the panellists. QIs were deemed valid if the median score by the panel was 7-9 without disagreement. RESULTS: Of 117 QIs, the expert panel rated 84 (72%) as valid. This included 26 organisational/system QIs across 7 subdomains and 58 clinical QIs within 10 subdomains.Most QIs were process indicators (n=62; 74%) while QIs describing structural elements and desired outcomes were less common (n=13; 15% and n=9; 11%, respectively). Non-exclusively, 18 (21%) QIs addressed access to healthcare, 21 (25%) described safety aspects and 64 (76%) specified elements contributing to effective services and care. QIs on general time intervals, such as response time, were not considered valid by the panel. CONCLUSION: This study demonstrates that with consideration of best available evidence a substantial proportion of QIs scoped and synthesised from the international literature are valid for use in the Australian prehospital care context.

Interval estimation for concentration in the ELISA setting.

Enzyme-linked immunosorbent assays (ELISAs) are often used to quantify the concentration of biological substances. In a typical analysis only a point estimate of the concentration will be presented as interval estimation continues to present challenges for non-linear dose-response models. In this setting, interval estimates calculated using a Wald approach can suffer from poor coverage and have limits that fall outside parameter boundaries. Here we compare profile likelihood interval estimation procedures to Wald type intervals for the interval estimation of a concentration in the ELISA setting. Through a comprehensive simulation study, it is shown that profile likelihood methods result in interval estimates with superior coverage and that are more robust to differences in assay design when compared to Wald based approaches.

Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs).

BACKGROUND: Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice. AIM: To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies. METHODS: A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy. RESULTS: A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers. LINKING EVIDENCE TO ACTION: Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation.

Improving symptom-related communication skills among cancer patients in an oncology ward: a best practice implementation project.

INTRODUCTION AND AIMS: As a symptom is a subjective perception of patients, good symptom management requires the patients to actively talk to clinicians about their symptom experience and to effectively express concerns about treatment. It has been found that the patients displayed poor communication behaviors and lacked communication knowledge and skills in the oncology ward of a tertiary hospital in PR China, indicating the need for improvement. This project aimed to promote the cancer patients' symptom-related communication with clinicians in this hospital setting. METHOD: A baseline audit against six evidence-based audit criteria derived from best practice recommendations was conducted, utilizing the JBI Practical Application of Clinical Evidence System tool. Identification of facilitators and barriers to best practice was then carried out and strategies were implemented to overcome identified barriers. A postimplementation audit was undertaken to assess any improvement in practice. RESULTS: The baseline audit showed that the nurses' compliance with best practice recommendations was unsatisfactory, with five out of six criteria recording 0% compliance. Strategies including nurse education, patient symptom assessment, patient education and use of communication tools were implemented. The postimplementation audit showed significantly improved compliance in the nurses' practice with all best practice recommendations, with all audit criteria achieving at least 69% compliance. CONCLUSION: The project achieved improved practice in patient communication promotion across all six audit criteria. However, further effort is needed to strengthen and maintain best practice. Patient symptom-related communication behavior should be measured in the future.

Measurement of fatigue in clinicians within hospital settings: a systematic review protocol of measurement properties.

OBJECTIVE: The objective of this review is to evaluate measurement properties of instruments used to measure fatigue in clinicians within hospital settings. INTRODUCTION: Research has shown that clinician fatigue leads to accidents and mistakes, and puts patient safety at risk. The problem of managing fatigue in clinicians may need a more complex approach than only restricting work hours. It may be helpful to include a measure of fatigue in the workplace so that fatigue may be quantified, predicted, and correlated to performance. INCLUSION CRITERIA: Articles will include clinicians working in hospitals, and will evaluate and present measurement properties of the instruments used to measure fatigue. The studies of interest include validation studies, quantitative research, and instrument development reports. METHODS: Databases to be searched include PubMed, Scopus, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, EThOS (Electronic Thesis Online Service), ProQuest Dissertations and Theses: Global, and will be limited to publications in English. There will be no date limits. Articles will be screened and those meeting the inclusion criteria will be retained and assessed for methodological quality by two independent appraisers. Data will be presented using a narrative synthesis and tables presenting the measurement properties of each instrument and ancillary data. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020186226.

Characteristic heterotopic ossification of the proximal humerus after total shoulder arthroplasty.

OBJECTIVE: A bony spur in a characteristic location involving the proximal humerus is identified on post-operative radiographs in some patients with history of total shoulder arthroplasty. The spur is theorized to represent heterotopic ossification near the attachment site of the pectoralis major tendon on the proximal humerus which is partially detached and then reattached during total shoulder arthroplasty. In this study, we determine the morphology, incidence, demographic associations, and clinical impact of this finding. MATERIALS AND METHODS: This is a single-center, retrospective study of 500 patients who underwent total shoulder arthroplasty (250 standard and 250 reverse technique) between 2012 and 2017. Pre- and post-operative shoulder radiographs were reviewed to identify and measure the characteristic spur; inter-observer agreement was evaluated between the two reviewers. Incidence, demographic associations, and clinical significance were then determined. RESULTS: The study group included 268 men and 234 women with a mean age of 70 (42-89) years, and clinical follow-up of 25 (1-84) months. Characteristic heterotopic ossification was seen in 88 patients (17.6%) and was first noted radiographically at a mean (interquartile range) of 12.1 (11.5-12.8) months after surgery. Male sex (adjusted odds ratio (95% confidence interval), 3.00 (0.68-5.34), p < 0.001) was independently associated with heterotopic ossification. No significant relationships between heterotopic ossification and adverse clinical outcomes were observed. CONCLUSION: Characteristic heterotopic ossification of the proximal humerus in patients status post total shoulder arthroplasty is a common imaging finding that is not associated with adverse clinical outcomes.

Methodological quality of case series studies: an introduction to the JBI critical appraisal tool.

INTRODUCTION: Systematic reviews provide a rigorous synthesis of the best available evidence regarding a certain question. Where high-quality evidence is lacking, systematic reviewers may choose to rely on case series studies to provide information in relation to their question. However, to date there has been limited guidance on how to incorporate case series studies within systematic reviews assessing the effectiveness of an intervention, particularly with reference to assessing the methodological quality or risk of bias of these studies. METHODS: An international working group was formed to review the methodological literature regarding case series as a form of evidence for inclusion in systematic reviews. The group then developed a critical appraisal tool based on the epidemiological literature relating to bias within these studies. This was then piloted, reviewed, and approved by JBI's international Scientific Committee. RESULTS: The JBI critical appraisal tool for case series studies includes 10 questions addressing the internal validity and risk of bias of case series designs, particularly confounding, selection, and information bias, in addition to the importance of clear reporting. CONCLUSION: In certain situations, case series designs may represent the best available evidence to inform clinical practice. The JBI critical appraisal tool for case series offers systematic reviewers an approved method to assess the methodological quality of these studies.

Extending the hierarchical decision matrix to incorporate a dominance ranking score for economic systematic reviews.

As the base of clinical evidence grows, it is increasingly common to conduct economic evaluations in addition to clinical evaluations of effectiveness in order to inform health policies. For economic systematic reviews there is currently no agreed-upon quantitative method to obtain a pooled economic effect size. With no suitable quantitative method available, the hierarchical decision matrix stands out as a tool that enables a visual summary of different types of economic studies, but there are limitations with the hierarchical decision matrix. We extended the hierarchical decision matrix with a weighted scoring system (termed dominance ranking score) to allow for useful information of a study design to be incorporated. •The scoring system of the dominance ranking score incorporates weighting factors that are based on sample size and effect size of a study.•The dominance ranking score enables a more differentiating analysis of dominance levels.•For systematic reviews that include partial economic studies, both the hierarchical decision matrix and the dominance ranking score assist to indicate the level of economic potential for a particular intervention, which facilitates the conduct of subsequent full economic studies.

A systematic review of the effects of probiotic administration in inflammatory arthritis.

OBJECTIVE: To systematically identify and appraise evidence of the formulation specific effects and population specific responses of probiotics in inflammatory arthritis. METHODS: MEDLINE (PubMed), CINAHL, EMBASE, and SCOPUS databases were searched for studies utilising probiotics in populations with inflammatory arthritis. The Joanna Briggs Institute (JBI) method was used to conduct the systematic review. A single reviewer undertook screening and data extraction. Two independent reviewers assessed the quality of evidence using JBI tools. RESULTS: The search identified 5876 unique articles, with 154 potentially relevant full text articles retrieved. Twelve studies met the inclusion criteria and were included in the review, of which ten (83%) were randomised control trials (RCT) and two (17%) were quasi-experimental studies. Four studies included a variety of spondyloarthopathies (SpAs) and eight studies focused on rheumatoid arthritis (RA). Probiotics were supplied for a median of 60 days and mode of 56 days across all included studies (range 7-365 days). Overall, 17 different probiotics were supplied in colony forming units (CFU) per 24 hrs ranging from 1 × 108 to 2.25 × 1011. The order of probiotics supplied to the most participants and across the most studies was Lactobacillales. There was no statistical difference in the relative risk (RR) of minor adverse events between probiotic and control groups (RR 1.02, 95% CI 0.69 to 1.51) when including nil event studies. Meta-analysis identified a statistically significant benefit of probiotics on quality of life with a standard mean difference (SMD) of -0.37 (95% CI -0.59,-0.15) with subgroup analysis favouring Lactobacillales-only formulations. Small but statistically significant reductions in pain were identified, with a mean difference (MD) of -8.97 (95% CI-15.38, -2.56) on a 100mm visual analogue scale, independent of formulation. Meta-analysis confirmed the known statistically significant benefit of probiotics on the inflammatory marker C-reactive protein (CRP) concentration MD (mg/L) -2.33 (95% CI -4.26, -0.41), with subgroup analysis demonstrating a greater effect in RA and from combined Bifidobacteriales and Lactobacillales formulations. CONCLUSION: This review indicates there may be differential benefits to combined formulations of Bifidobacteriales and Lactobacillales compared to purely Lactobacillales formulations, with respect to reducing pain, lowering CRP and improving quality of life. It also suggests variable benefits associated with the type of inflammatory arthritis. Relatively less benefit for lowering CRP was attributed to individuals with SpA compared to individuals with RA. Generalisability of results to clinical practice is limited by the dominant demographic of older individuals with established disease beyond the 'therapeutic window of intervention'. Small but statistically significant benefits require confirmation in clinical studies with greater consideration to potentially confounding factors of age, gender, diet and individual microbial signature.

Development and testing of Australian prehospital care quality indicators: study protocol.

INTRODUCTION: Historically, ambulance services were established to provide rapid transport of patients to hospital. Contemporary prehospital care involves provision of sophisticated 'mobile healthcare' to patients across the lifespan presenting with a range of injuries or illnesses of varying acuity. Because of its young age, the paramedicine profession has until recently experienced a lack of research capacity which has led to paucity of a discipline-specific, scientific evidence-base. Therefore, the performance and quality of ambulance services has traditionally been measured using simple, evidence-poor indicators forming a deficient reflection of the true quality of care and providing little direction for quality improvement efforts. This paper reports the study protocol for the development and testing of quality indicators (QIs) for the Australian prehospital care setting. METHODS AND ANALYSIS: This project has three phases. In the first phase, preliminary work in the form of a scoping review was conducted which provided an initial list of QIs. In the subsequent phase, these QIs will be developed by aggregating them and by performing related rapid reviews. The summarised evidence will be used to support an expert consensus process aimed at optimising the clarity and evaluating the validity of proposed QIs. Finally, in the third phase those QIs deemed valid will be tested for acceptability, feasibility and reliability using mixed research methods. Evidence-based indicators can facilitate meaningful measurement of the quality of care provided. This forms the first step to identify unwarranted variation and direction for improvement work. This project will develop and test quality indicators for the Australian prehospital care setting. ETHICS AND DISSEMINATION: This project has been approved by the University of Adelaide Human Research Ethics Committee. Findings will be disseminated by publications in peer-reviewed journals, presentations at appropriate scientific conferences, as well as posts on social media and on the project's website.

Pelvic circumferential compression devices for prehospital management of suspected pelvic fractures: a rapid review and evidence summary for quality indicator evaluation.

BACKGROUND: Pelvic fractures, especially when unstable, may cause significant haemorrhage. The early application of a pelvic circumferential compression device (PCCD) in patients with suspected pelvic fracture has established itself as best practice. Ambulance services conduct corresponding performance measurement. Quality indicators (QIs) are ideally based on high-quality evidence clearly demonstrating that the desirable effects outweigh the undesirable effects. In the absence of high-quality evidence, best available evidence should be combined with expert consensus. OBJECTIVES: The aim of the present study was to identify, appraise and summarize the best available evidence regarding PCCDs for the purpose of informing an expert panel tasked to evaluate the validity of the following QI: A patient with suspected pelvic fracture has a PCCD applied. METHODS: A rapid review of four databases was conducted to identify relevant literature published up until 9 June 2020. Systematic reviews, experimental, quasi-experimental and observational analytic studies written in English were included. One author was responsible for study selection and quality appraisal. Data extraction using a priori extraction templates was verified by a second reviewer. Study details and key findings were summarized in tables. RESULTS: A total of 13 studies were assessed to be eligible for inclusion in this rapid review. Of these, three were systematic reviews, one was a randomized clinical trial (crossover design), two were before-after studies, and seven were retrospective cohort studies. The systematic reviews included mostly observational studies and could therefore not be considered as high-level evidence. Overall, the identified evidence is of low quality and suggests that PCCD may provide temporary pelvic ring stabilization and haemorrhage control, although a potential for adverse effects exists. CONCLUSION: Given the low quality of the best available evidence, this evidence would need to be combined with expert consensus to evaluate the validity of a related quality indicator before its implementation.

Pre-treatment assessment for patients with breast cancer undergoing chemotherapy: a best practice implementation project.

OBJECTIVES: This project aimed to conduct an audit of pre-treatment assessment for patients with breast cancer undergoing chemotherapy and to assess the impact of these changes in improving the compliance with evidence-based best practice criteria in a large tertiary hospital. INTRODUCTION: Pre-treatment assessment before cancer chemotherapy is paramount in order for patients to receive effective and safe treatment. Numerous guidelines and consensus-based standards for safe chemotherapy administration have been developed, which state that nurses should conduct and document comprehensive health assessments for patients prior to administration of chemotherapy. METHODS: The project was conducted in the Breast Surgery Department of a nearly 3000-bed tertiary hospital in China. Evidence-based audit criteria were developed based on a JBI evidence summary. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tool were used to promote changes in practice. Sample sizes of 13 clinical nurses and 30 breast cancer patients undergoing chemotherapy were included in baseline and follow-up audits. RESULTS: The baseline audit indicated significant deficits in pre-treatment assessment nursing practice in the unit, with eight of the 12 criteria recording 0% compliance and one criterion recording only 3% compliance. Barriers to compliance were identified by the project team, and a series of strategies were adopted to address the barriers. There was improvement in compliance with all the best practice criteria in the follow-up audit compared with the baseline audit, with each one achieving a minimum of 90% compliance. CONCLUSIONS: The project showed that regular and focused education and ongoing audits on pre-treatment assessment can help to optimize safe and effective chemotherapy treatment. Further strategies are planned to sustain the implementation of evidence.

Adoption of robotic stroke rehabilitation into clinical settings: a qualitative descriptive analysis.

AIM: Through this qualitative research of clinicians' perspectives and experiences, we seek to inform rehabilitation clinicians about the various aspects of adopting and integrating robotic stroke therapy into clinical settings. METHODS: Semistructured interviews were conducted with individual clinical therapists to seek their perspectives on robotic stroke rehabilitation. From the data collected, qualitative descriptive analysis was used to inductively identify codes, categories and central themes. RESULTS: The study examined various clinical, human behavioural and organizational factors of adopting robotic rehabilitation into clinical settings, and found that a preimplementation plan addressing various aspects (staff capacity, patient flow and transport, funding mechanism, location and physical space of the robotic devices) needed to be in place to ensure the successful adoption of robotic rehabilitation in a multidiscipline hospital. We also identified how to conduct robotic rehabilitation in terms of the patient inclusion criteria, therapy duration, and patient setup and supervision. We examined the attitudes and views of therapists and patients towards robotic rehabilitation, and presented the benefits that robotic training brought to these two user groups. CONCLUSION: Both therapist attitude and device benefit work together to shape the motivation of therapists to adopt robotics, and it would be worthwhile to have an adoption plan that actively generated positive attitudes and expounded the benefits of robotic training. Overall, an adoption plan needs to be well thought through and be all-encompassing, and we hope that the findings of this study can assist to inform this plan.