Table 5 Key characteristics of NROL and exemplar quotes

Complexity

Staff

Effortful to initiate

S04: it was new, we had to develop our group… so that was a lot of work initially.

Technology assistance was key

S12: they had the skills from the physio point of view. I'm not sure they did from the technical point of view. When [tech support] wasn't around it was more difficult

Challenges were surmountable

S01: A lot of it was just trying to problem solve with many different devices trying to access the same platform… all reacting in different ways … in all cases there’s always been work around.

Patients

Technology assistance was key

P01: The only thing that would make it difficult for people is the technology, lack of familiarity with it and physically getting on…. And that’s why you need a person like (technology support role) and, you have to clone him.

Relative advantage

Staff

Advantages in terms of resource, saving:

- Time

- Energy

(physical & mental)

- Travel

S02: For face-to-face groups… you need to find premises, you need to deal with the transport issues, you need to deal with the care issues, the practicalities of toileting and wheelchairs and drinks, …. so actually there's a reluctance sometimes to develop groups face-to-face, because of all the complexities. But this is an easy way of doing it.

S13: in terms of efficiency to some extent, we're not having to travel to five different patients. We can see them all in one go. So it's good from that respect. … you're not claiming on expenses, from an eco friendly point of view, you're cutting down on your carbon emissions as well.

Group format with peer support identified as valuable

S08: I think they’ve actually taken on board the education better because they’re hearing it from each other not just from a therapist who hasn’t experienced having a brain injury.

S03: So if that peer support can give them the feeling of not being the only one… if that can help with their wellbeing…they're gonna feel more motivated to do the therapy…

Patients

Advantages in terms of resource, saving:

- Time,

- Energy

(physical & mental)

- Travel

P06: you’re not tired when you arrive…I used to joke it's a full time job being ill… I use patient transport so it can be half a day to a day …Well, this is short sharp burst. It's easy, it's manageable, and you can do it. It's done and you can integrate it then into your life. If it's a speaking thing or it's a physical thing, you can recuperate faster and you can do some more.

Group format with peer support identified as valuable

P06: I've always extolled the benefits of doing things within a group. You build a bit of camaraderie, you get shared learning and experiences. It's a good model to use. So there's the therapeutic effect… and we had fun learning and there was still a tangibility at the end of it.

P03: it was actually really good to see how I was comparing against the other people… So you don't even get that kind of insight when you are in a 1:1 situation at a hospital.

Adaptability

Staff

Continuous adaptation required

S14: The group should meet the needs of the patients, not the patients meet the needs of the groups. We should constantly review what the groups are offering as to the patients that are referred, so making sure that it kind of tailors to their needs, not ours.

S03: so far the majority of it is being run by, qualified therapists… a lot of them are band sixes and band sevens, which to get things off the ground and to make sure it's running well is, you know I can understand why … Once things are a bit more established, I think we need to play about with the experience levels … and utilize assistants a bit more…

Patients

Modifiable to patient need

P01: …he’d [the physio] see some things I was struggling on… ‘perhaps just do it from sat down’…so they could modify, and I think that's the benefit as well.

P06: We got the feeling, it's bespoke really. And to be fair a lot of this has felt bespoke which is nice and rare.