Patient engagement as a core element of translating clinical evidence into practice- application of the COM-B model behaviour change model.

The results of rehabilitation trials are often not fully attained when the intervention is implemented beyond the initial trial. One of the key reasons is that a patients' ability and/or capacity to take part in their own healthcare is not considered in the trial design yet has significant impact on the outcomes during the implementation phase. We propose a shift from a therapist-focus to patient-focus in trial design, through addressing patient engagement as a core consideration in trials. We argue that engaging patients in any rehabilitation program is a process of behavioural change. Exercise prescription is used as an example to illustrate how the Behaviour Change Wheel can be applied to analyse barriers and facilitators associated with patients' capabilities, opportunities and motivations in integrating trial interventions into their daily life. We propose a framework to assist in this shift. A core part of implementing rehabilitation interventions at the primary care level requires patient engagement. Related aspects of interventions should be identified and assessed using the COM-B model at the outset of trial design to ensure that the results are realistic, meaningful and transferable, so as to enable real impact. Rehabilitation programs tested in clinical trials often focus on the therapists’ effort and the program itself.Engaging patients in any rehabilitation program is a process of behaviour change of patients.Our proposed framework based on the COM-B model, including the Behaviour Change Wheel, enriches rehabilitation trial design through considering core aspects of patient engagement to ensure the real impact of any rehabilitation program can be achieved.