A Realist Evaluation Protocol for Integrated Rehabilitation Care in Canada

Background: Fragmented rehabilitation services remain a major barrier to recovery for people with cardiovascular and neurological conditions. The INtegrated Smart ImplemeNtation of Care (IN-SINC) project aims to understand how integrated rehabilitation care (IRC) can be implemented and sustained to achieve better outcomes. Partnering with three Quebec health authorities, patients, and clinicians, IN-SINC evaluates IRC strategies through the lens of the Health Standards Organisation Principles for Integrated Care. The Quintuple Aim will guide outcome evaluation: improving experience, equity, population health, provider well-being, and cost efficiency.

 

Approach: IN-SINC applies a multiple-case realist evaluation (2025-2030) to explore how IRC strategies such as tele-rehabilitation, early supported discharge, and digital coordination systems work in different contexts. Each health authority represents a distinct context (urban, suburban, or rural). Data sources include document reviews, semi-structured interviews (~59 participants: patients, clinicians, managers, community partners, policymakers), and administrative and patient-reported data. Guided by Normalization Process Theory, we will build Context-Mechanism-Outcome (CMO) configurations to explain what explains if IRC succeeds or fails. An integrated knowledge translation (iKT) approach engages partners in bi-monthly learning sessions to refine findings and guide improvements.

 

Results: / Expected Results :By 2026, preliminary CMO configurations will describe contextual and organizational factors that enable or hinder integrated rehabilitation. Early findings will identify key drivers such as leadership, interprofessional collaboration, and digital tools. Over five years, IN-SINC will assess how IRC influences access, care intensity, patient experience, and cost across health authorities.

 

Implications: IN-SINC offers a framework to evaluate and scale equitable, person-centred rehabilitation within complex health systems. Findings will inform policy and practice across Canada and internationally by identifying what works, for whom, and under what conditions. The project’s advisory group, including Neurological Health Charities Canada (NHCC) and partner health authorities, will work with the research team to extend findings and implementation tools nationally and internationally, supporting learning health systems and sustainable integrated care.

 

Keywords: Integrated rehabilitation; realist evaluation; implementation science; health equity; tele-rehabilitation; digital health