Mapping of the Interests and Influences Perceived in the Actors That Make Up the National System of Innovation in Rehabilitation in Colombia

Abstract

In the last 20 years, there has been an increase in the research and development of technologies that contribute to the physical, occupational, and language rehabilitation processes of people with disabilities. This has led to the management of technology in rehabilitation acquiring relevance. This study identifies the actors involved in innovation activities in rehabilitation and determines their interest and influence on the dynamics of the system, taking Colombia as a case study, including its 32 departments and its capital. Methodologically, the research has a quantitative approach of a descriptive correlational type. The design is non-experimental and cross-sectional. A heat map is used to represent the changes and magnitudes of the data, and the Key Actor Mapping methodology is used to compare the results of the variables studied. The results show the participation of actors that are currently not politically recognized as agents of the system. On the other hand, the interest and influence of the actors in the innovative performance of the system are changing. The main implication of this study is that the innovation system in rehabilitation in developing countries has not been studied and documented completely. This study is the first contribution to this global analysis. Nevertheless, the argumentation in the Latin American context is limited due to the absence of available data required for a sufficient comparison. It is necessary to determine the patterns of linkage between the actors to define strategies for the dynamization of the system that results in innovations that contribute to the welfare and social inclusion of the population with disabilities.

1. Introduction

Disability consists of the presence of a limiting condition in the daily life performance of a human being. It includes restrictions in personal or workspaces and sensibly affects the quality of life and the development of possibilities in different aspects. According to the World Health Organization (WHO) statistics, more than one billion people live with disability worldwide. Those persons have restrictions in today’s society in civic, social, and domestic life situations [1,2,3]. There is a strong correlation between disability and poverty. People with disability are more likely to become poor and people who are living in poverty are more likely to become disabled.

Taking into account the social character of the human being, alternatives have been practiced to help people with disabilities. Some of them were techniques used in antiquity to improve the pain with movements known as Cong Fu [1]; others included the development of machines through the systematic movement of joints, such as Gymnasticon for gout and other diseases in the eighteenth century [2]. Today, advances in technological capabilities have also increased, as well as the development of diagnostic and rehabilitation processes, devices, and strategies. The purpose of this is to facilitate the integration of people affected by disability [3].

In 2017, the World Health Organization (WHO) launched the “Rehabilitation 2030” initiative to conduct concerted and coordinated actions to develop rehabilitation processes in the world on a larger scale. The relationship between disability and poverty is part of the agenda defined in the “Rehabilitation 2030” initiative, which emphasizes that rehabilitation is an investment in human capital that contributes to the economic, social, and health development of people [4].

This is the reason why the promotion of the rights of persons with disabilities, including access to rehabilitation services, becomes a direct contribution to the fulfillment of the objectives of sustainable development. Specifically, the reduction of inequalities is an integral part of the achievement of the United Nations’ Sustainable Development Goal #1—no poverty, United Nations’ Sustainable Development Goal #3—good health and well-being, United Nations’ Sustainable Development Goal #4—quality education, and United Nations’ Sustainable Development Goal #8—decent work and economic growth, which are achieved through social inclusion, universal accessibility, social protection, citizen participation, and the strengthening of the social fabric, among others [5,6].

Nonetheless, putting into clinical practice the devices, methods, and techniques resulting from the research and technological development and innovation in the rehabilitation field is complex. It requires the convergence of clear procedures and processes in normativity, intellectual property, methods of cost-effectivity analysis, financing viability, investment in validation processes, production, maintenance, support, and use by the healthcare system and its users, among others. It also requires the adequate participation of different actors.

The last 20 years have seen an increase in R&D activities related to rehabilitation technology and the processes of technology transfer (hereinafter TT) and innovation. At the same time, barriers to innovation in the sector have been identified as being related to the development and usability of technology [6,7,8] and to the high cost and low rate of return that limit the commercialization, adoption, and use of state-of-the-art technology in the sector [7,8,9].

In “Rehabilitation 2030”, several priorities were identified, including the creation and strengthening of networks and partnerships in the field of rehabilitation, especially among low-, middle-, and high-income countries [4].

Under this scenario, the management of innovation in rehabilitation has acquired relevance; however, it is necessary to take into account that innovation patterns vary according to the productive sector due to different factors such as the percentage of R&D expenditure associated with the development of products and processes in each sector, technological change, and innovation activities. These are not homogeneously distributed among the different industrial sectors, therefore the knowledge acquired about innovation is different in each sector [10,11,12,13].

Innovation in a sector is considered to be affected by three main factors: knowledge and technologies, actors and networks, and institutions. All knowledge, actors, and institutions in the sector exert an important influence on innovation. A sector means a set of activities unified by groups of associated products for a given or emerging demand and characterized by a common knowledge base [13,14].

Specifically, in the field of rehabilitation, the main purpose of technological innovation and change is to optimize functionality and reduce disability in individuals with specific health conditions that limit their interaction with the environment.

Although there are reports of experiences in the use of various models for TT in the sector, it is still a challenge for developing countries to achieve systematic processes of knowledge management. The TT studies in health started in the 1970s; one decade later, researchers revealed that 96% of medical equipment imported to developing countries did not work after 5 years of its acquisition. Moreover, 39% never worked due to the absence of manuals, accessories, and assistance personnel capacitation [15]. Twenty years later, WHO updated these numbers, indicating that 70% of this equipment is not functional in developing countries [16,17].

This article analyzes this context for the Colombian case, identifying the actors, their interests, and their influence on innovation activities in rehabilitation in developing countries such as Colombia, considering that the actors have the potential to accelerate learning processes, provide opportunities for problem-solving, and promote the dissemination of innovation [18]. Moreover, this identification contributes to a broadening of the possibilities for competing for national and international resources. Finally, it strengthens alliances among the actors in the system to mitigate barriers to the supply of high-tech rehabilitation services in Latin America.

The paper is divided as follows: Section 2 presents a literature review, including topics such as innovation in rehabilitation, technology transfer, actors of national innovation systems, and health innovation systems. Section 3 presents the materials and methods used to acquire and process the information. Section 4 presents results, including identified actors of the National System of Innovation in Rehabilitation in Colombia, and a heat map of interest and influence of those actors. Finally, Section 5 presents the discussion of the relevance of these findings.

2. Literature Review

2.1. Innovation in Rehabilitation

According to the Pan American Health Organization, rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in their interaction with their environment and is one of the essential services defined in universal health coverage [19,20].

Recognizing the broad concept of rehabilitation, in the last twenty years, research oriented to the development and production of instruments, systems, and devices, as well as the impact of these elements in the rehabilitation processes of human body movement, speech, language, and occupation of people with disabilities, has increased in the world [6].

Since the second half of the 20th century, there is evidence of a growing pace in the development of methods, tools, and devices designed to support processes for diagnosis and rehabilitation. This has led to the formulation and consolidation of different R&D lines such as Biotechnology, Bioengineering, Biomedical Engineering, and Rehabilitation Engineering.

In particular, from the first decade of the 2000s, there has been an interest in Rehabilitation Engineering that has materialized in the growing development of more complex technologies, based on robotic systems and virtual reality as therapeutic support tools. These technologies allow for the imitation of many of the functions and environmental characteristics that are required for rehabilitation, in addition to contributing to therapeutic adherence, treatment, and the active participation of people in the rehabilitation process [21,22,23,24].

Barriers to innovation have simultaneously been identified in the area related to technology development and usability [7,22,23] and to the high cost and low rate of return that limit the commercialization, adoption, and use of state-of-the-art technology in the industry [10,11,12].

Under this scenario, the management of innovation in rehabilitation has acquired relevance, because, although there are reports of experiences in the use of various models for TT in the sector, it is still a challenge for developing countries to achieve systematic processes of knowledge management in which the appropriation of technology is materialized in the innovation of products, services, and processes that simultaneously meet the social health needs of the population more efficiently.

This challenge is articulated with the development objective “Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation”, whose purpose is, among others, to support the development of technologies, research, and national innovation in developing countries [9].

The scientific literature reports different classifications for rehabilitation technology based on variables such as purpose, complexity, and form of production, among others [24,25]. In particular, technologies that support therapeutic intervention processes could also be reclassified based on the complexity in development and function. Under this classification, high-tech equipment is identified as devices that are based on virtual reality systems, artificial intelligence, nanotechnology, and robotic systems, which are characterized by generating controlled environments during the care process [20] and associated with the specialized software of a recreational nature, and which maintain high patient motivation, collect systematic information on the clinical evolution of the user, and increase the effectiveness of the rehabilitation processes, thus improving the overall rehabilitation process.

The rehabilitation technology market is made up of different global players in which companies from countries such as the United States, India, and China dominate the world market in a context in which development and TT are mainly driven by the profit motive [25].

This panorama is far from the reality of Third World countries such as Colombia, since the accumulation of R&D capabilities in the sector is permeated by legal frameworks that discourage industrialization, thus limiting the opportunities for organizations to accumulate capabilities to obtain profits from innovation activities in the sector and respond to the social needs in the health of the population through TT processes.

Another barrier identified to the dynamization of the national innovation system in rehabilitation is the low capacity for TT [26,27,28,29], which is permeated by the limitations in the technology development process, in which usability criteria that could enable the use of technology in a specific context are ignored. This panorama is especially relevant because it highlights the importance of recognizing the role played by the actors and their interests in the transformation of the economic and social landscape that nurtures the creation and the transfer of knowledge, both tacit and codified.

In this context, innovation is a critical factor in the development and survival of organizations within the health system, particularly in rehabilitation. This makes it essential to develop a regulatory framework that guides the processes of the evaluation of technology in rehabilitation to mitigate the risks in the processes of development and transfer of technology in the sector and to guarantee the safety and well-being of the residents’ end users (professionals, patients, etc).

2.2. Technology Transfer

Technology management, as a discipline, provides strategic tools to optimize the productivity of organizations based on the system’s capacity to develop the activities and processes involved in TT, which, understood from a holistic perspective, includes the movement of technology from the place of origin to the place of use. Adopting this definition implies the understanding that technology is successfully transferred only when it has been accepted and used by the end-user [15,30].

Specifically, in rehabilitation, during the last decades, there has been an evolution in the capacities for the development of state-of-the-art technology; however, it is still necessary to strengthen TT processes that provide social and economic value in all areas of knowledge, especially technology based on virtual reality, robotics, artificial intelligence, and computer vision systems. Developing countries face greater challenges for technological management and appropriation [31], because, despite the progress in available technological capabilities, the supply of high-tech services in rehabilitation is still limited.

Research on technology transfer in rehabilitation has focused mainly on the study of the achievements and challenges in the technology development process, the barriers to technology transfer, the usability of technology by end users, and the technical evaluation and experiences in the use of technology transfer models in the sector.

Through the state of the art, it is possible to identify reports of experiences in the use of models for the transfer of state-of-the-art technology in rehabilitation. Each of these models is characterized by being generic, that is, their design has arisen from the innovation characteristics of sectors other than rehabilitation, which could affect the results of transfer and the appropriation of the technology; therefore, it is clear that the patterns of innovation vary according to the productive sectors, and therefore that the technology transfer process could have relevant variables and even processes different from those found in other sectors that could be unnoticed by these models.

Innovation activities include all development, financial, and commercial activities undertaken by an organization [15]. By understanding the importance of each of these activities for the use and commercialization of support technologies for rehabilitation processes, the stages of TT in rehabilitation can be categorized according to the main or core activity performed by the actors in the processes of technology transfer and absorption; however, it is worth noting that this categorization does not imply that the transfer processes are linear or that the actors do not participate in more than one activity in a complementary manner.

Under this perspective, the first stage for the transfer of technology categorized in this study is the R&D technological research and development activities, whose main function is the generation of knowledge, technological development, and training of human talent.

The second stage for technology transfer is the activities related to the registration and protection of intellectual property for the inclusion of the technology in the market and compliance with good practices in the commercialization chain associated with the technologies undergoing rehabilitation.

The third stage for technology transfer is the activities related to technology commercialization and the management of financial resources for entrepreneurs. Finally, the fourth stage refers to the activities developed to guarantee the supply of rehabilitation services and the use of technology in the market.

From the categorization of the main innovation activities, the scientific literature reports experiences in the use of models for TT in rehabilitation such as the diffusion of innovations model [10,32], the conceptual model of technology transfer in the field of care [26], the decomposed theory of planned behavior (DTPB) model [25], the technology adoption model (TAM), the concern-based adoption model (CBAM) [33], the dynamic transfer model [11,34], the technological activity model [3], the appropriation model [11], the useful knowledge model, and the appropriability model, among others. Each of these models is characterized by being generic, i.e., the design and implementation of the models have arisen from the innovation characteristics of sectors other than rehabilitation, which could affect the results of technology appropriation in the sector, since the transfer process could have variables and actors different from those found in other sectors.

Under this scenario, identifying the dynamics of the actors in each of the moments of TT in rehabilitation is relevant in determining the eagerness in which a country transfers technology and the opportunities of the system to increase its innovative performance to propose successful models that are coherent with the technological, social, and political context of the country in which the innovation system emerges.

2.3. Actors of National Innovation Systems (NIS) and Health Innovation Systems (HIS)

National innovation systems, from a systemic perspective, are composed of a network of diverse actors or institutions whose interactions promote the production and diffusion of new technologies [35]. Specifically, in the framework of social innovation, non-government organizations (NGOs) and public organizations are recognized as the main actors in innovation, followed by private companies, social enterprises, and research institutes [36,37]. It is worth noting that social innovations, particularly those that emerge at the grassroots of civil society, which is a key role for this actor, which ceases to act as a beneficiary of technology and becomes its promoter.

Regarding the actors in Health Innovation Systems, the number and nature of the actors involved are greater than in other sectors, and the regulatory framework has a substantial impact on the introduction of new knowledge-based applications [38]. The literature recognizes patients or users of the system, health service provider organizations (public or private), and governmental entities [39] as key actors. Accordingly, it is clear that, in the health sector, interdisciplinarity and interaction among the different actors is an essential element for the accumulation of capabilities for innovation [40].

In Latin America, the State is one of the central actors for innovation, since, through the issuance of regulations, it facilitates coordination between private entities and makes up for market failures that hinder financing to mitigate the deficit in terms of the incorporation of knowledge and technology in the region’s productive processes [41].

Particularly in Colombia, in 2016, the Administrative Department of Science, Technology, and Innovation—Colciencias (Minciencias), as a governmental entity in the country, extended recognition to other actors of the National System of Science, Technology, and Innovation (SNCTeI) that previously could not compete for national resources: these actors are research groups; technological development and innovation organizations; researchers; research centers and institutes; research results transfer offices; highly innovative companies; R&D&I business units; incubators of technology-based companies; innovation and productivity centers; science; technology or innovation parks; science centers and organizations that promote the use and appropriation of science, technology and innovation [42].

3. Materials and Methods

This research focused on the identification of actors, their interests, and perceived influences on the innovative performance of the rehabilitation system in developing countries, taking Colombia as a case study, including its 32 departments and its capital Bogotá. The data analysis was performed under a quantitative descriptive correlational approach. For the processing and treatment of data, Matlab software was used.

The research design is non-experimental and cross-sectional since no variables were manipulated and the data were collected at a single time and moment.

Fieldwork lasted seven months, ending in March 2022, and was carried out through virtual and face-to-face meetings with the different actors in the system. The unit of analysis is the actors currently typified by the SNCTeI. Considering the unit of analysis, the size of the population under study for the Colombian case is infinite, therefore the non-probabilistic sampling type—snowball sampling—was used. The sample size was 137 actors.

Regarding the operationalization of the variables, the construct on which the analysis was based is the actors of the National System of Innovation in Rehabilitation in Colombia. The dimensions that guided the analysis of the data were: the interest of the actors in the development of innovation activities in each of the stages of the TT and the perceived influence of the actors in the innovative performance in rehabilitation in the country.

Table 1. Focus and Dimensions Analyzed.

Construct	Dimension
Actors and relationships within the framework of the National System of Innovation in Rehabilitation	Interest in research and development activities in rehabilitation technology
	Influence on the country’s capacity to develop rehabilitation technology
	Interest in rehabilitation technology protection and patenting activities
	Influence on the country’s ability to protect and patent rehabilitation technology
	Interest in commercializing state-of-the-art technology in rehabilitation
	Influence to commercialize state-of-the-art rehabilitation technology
	Interest in using state-of-the-art technology in rehabilitation care processes
	Influence of the use of state-of-the-art technology in rehabilitation care processes

contains the approach and dimensions analyzed.

Each dimension is composed of a set of variables (items) which were measured using a Likert scale ranging from zero to ten that allowed us to identify the intensity of each variable in each dimension [43], which, due to the nature of the data, the median was used as a statistic. Additionally, the heat map is used as a graphic representation to reflect the behavior of the actors concerning their interest and influence in the development of innovation activities in rehabilitation in the country. Subsequently, the methodological tool known as Key Actor Mapping (KAM) [44] is used to visualize the key actors of a system and to represent the innovation dynamics of the system based on the results of the variables analyzed.

The primary sources of information for the research were the actors that are currently typified and recognized by the SNCTeI, to whom a survey was applied with open and closed questions, the latter on a Likert scale, which made it possible to identify the interest and perceived influence of each of the typologies of actors in the performance of innovation activities in rehabilitation from a systemic perspective with national geopolitical limits.

4. Results

According to the latest version of the Oslo Manual, innovation, as a new or improved product or process that has been made available to potential users, gives relevance to the actor as the axis of innovation [15]. From this perspective, the identification of the typology of actors that comprise innovation systems, with emphasis on their systemic nature and national dimension, is fundamental for the appropriation of technology and the political organization of the local context.

In Latin America, each country has the recognition of the actors for innovation. The recognition of these actors is necessary to dynamize the innovative performance of the system; however, the dynamics of innovation are multidimensional and can be influenced by different actors depending on the sector. In Colombia, the most populated centers are the capital Bogotá and the main cities such as Medellín, Cali, Barranquilla, and Cartagena. The study was national in scope; however, the first finding was to confirm that the innovation activities in this country are concentrated in these departments. It has relation to the population and dynamics of research and innovation (R&D) in these sectors of the country.

The scientific literature recognizes actors of innovation systems organizations such as R&D companies, universities and research groups, technology development laboratories, technology transfer offices, technology protection support entities, technology-based business incubators, technology commercialization companies, and health service provider institutions; however, as this study reveals, it is found that, in the national innovation system, in rehabilitation (case study Colombia), other actors have not been recognized and are relevant for the dynamics of the innovation system in the area, such as the associations and guilds of rehabilitation professionals, public and private sports centers, and public and private organizations for the care of the population with disabilities.

Table 2. Actors of the National System of Innovation in Rehabilitation grouped according to their main activity.

Research and Development	Technology Protection	Technology Commercialization	Technology Reception and Use
R&D Companies	Technology Transfer Offices	Technology-based Business Incubators	Health Service Providing Institutions
Universities and Research Groups	Technology Protection Support Entities	Technology Marketing Companies	Public and Private Sports Centers
Technology Development Laboratories			Organizations Providing Services to the Disabled Population
Rehabilitation Professional Associations and Guilds

shows the categorization of these actors based on the main or core activity they perform in the technology transfer and absorption processes in the sector.

After the identification of new actors in the system, the heat map is used as a strategy to represent changes and magnitudes regarding the interest and influence of the actors that are already recognized by the scientific literature for the development of the different innovation activities in rehabilitation. In

Table 3. Heat map of the interest and influence of the actors that are recognized for the development of innovation activities.

Interest
Actor	R&D	Patenting	Commercialization	Use
RRTO	7.5	8.0	8.0	8.0
HSPI	10.0	10.0	9.0	10.0
U&RG	9.0	9.0	7.0	8.0
R&D	7.5	7.5	8.5	6.0
TTC	10.0	10.0	10.0	10.0
PLCO	8.0	8.0	8.0	8.0
EU	8.0	8.0	8.0	8.0
STIL	7.5	8.0	8.0	8.0
Influence
Actor	R&D	Patenting	Commercialization	Use
RRTO	2.3	2.3	2.4	2.0
HSPI	2.4	2.3	2.2	2.3
U&RG	2.3	2.2	2.2	2.0
R&D	2.0	1.8	2.0	1.5
TTC	1.7	1.5	2.0	1.5
PLCO	2.5	2.1	2.3	1.5
EU	2.5	2.5	2.6	3.0
STIL	2.5	2.6	2.0	1.5

RRTO—Research Results Transfer Office; HSPI—Health Service Provider Institution; U&RG—Universities and Research Groups; R&D—R&D Companies; TTC—Technology Trading Companies; PLCO—Patent and Legal Counsel Offices; EU—Entrepreneurship Unit; STIL—Science, Technology, and Innovation Laboratories.

, the green color represents the highest values concerning the interest and influence perceived by the actors for the development of innovation activities in the sector and the red color represents the lowest activity; the intermediate values are reflected in the yellow and orange colors.

Additionally, to compare the results of the two variables studied, the Key Actor Mapping (KAM) methodology is used. As evidenced in Figure 1, for the construction of the KAM, scatter plots were used for each of the dimensions analyzed, using the median as a statistic due to the type of ordinal scale. As shown in Figure 1, the X-axis shows the interest perceived by each of the actors in the development of each of the different innovation activities in rehabilitation. A multi-axis graph is used on the Y-axis, which shows the influence perceived by the actors on the innovative performance of the system based on the main innovation activities, namely, technology development, technology protection, technology commercialization, reception, and use of technology.

From the statistical results, it is evident that the institutions in charge of providing health services and the technology commercialization organizations are characterized as being the promoters of all of the main innovation activities in rehabilitation in the country; however, when assessing the influence of these actors in the innovation dynamics of the system, it is found that health service provider institutions are the only actors that, In addition to being permanent promoters, are influential in the development of all innovation activities in the sector, which differs from the technology commercialization companies, since, despite their high interest in the dynamization of the system, they have almost no influence in the development of the main stages of TT in rehabilitation in the country.

On the other hand, the country’s universities and research groups are promoters of technological research and development activities and the development of actions related to technology management and intellectual property; however, their interest declines when it comes to promoting the commercialization and use of state-of-the-art rehabilitation technology in the country.

This finding is consistent with the results of the perception of its influence on the dynamics of the system, since, although it is an influential actor in the development of all the main innovation activities, the statistical results show that its influence is greater in the research and technological development stage and decreases gradually throughout each stage. For companies whose mission is the development of R&D activities, there is an interest in the development, patenting, and commercialization of the technology; however, this interest is minimized at the stage of reception and use of the technology by the end user.

This compartment is similar to the perceived influence, because, although they influence the development and commercialization of rehabilitation technology, their influence is null when it comes to guaranteeing the protection and use of the technology in the market. Concerning the STIL and the patenting and consulting offices, it is evident that these actors, although they maintain an interest in the development of all innovation activities in the sector, have no influence at the moment of reception and use of the technology in the market by the end user, which, in this case, is the health professional.

Finally, the RRTO and entrepreneurship units show interest and influence maintained by these actors in the development of all stages of technology transfer, which corresponds to the mission functions of these types of organizations.

These results show an imbalance between the influence and the perceived interest of some actors concerning others in each of the innovation stages. This finding is relevant because any technological innovation to be used in the health context will require joint work between the actors that guarantees the quality of the devices and the safety of the patient, in addition to complying with current national and international standards.

In this context, technology evaluation studies to optimize their quality and usability are an essential component to guarantee the quality of the devices developed and minimize risks during the process of transferring technology from the laboratory to the clinic, even more so when there is a need regarding the collection of patient-centered data that help guide the care process [26,45,46,47], since it is clear that, if technology does not add value to the intervention process, it will not be possible to innovate.

5. Discussion

Innovation systems are made up of different actors who, based on the particularities of the sector, develop the dynamics of technology transfer and appropriation, which are permeated by the policies that affect technological change and by the same historical and social context in which innovation takes place [5]. Based on this premise and emphasizing that, in Colombia, rehabilitation is recognized as an essential health service that seeks to respond to the needs related to the capabilities and functioning of individuals and groups, knowing the context in which rehabilitation takes place and its different actors is essential for the development of innovation activities in the sector.

Under this premise, and consistent with the conceptual framework provided by WHO through the International Classification of Functioning, Disability, and Health (ICF), which specifies that contextual factors can act as facilitators or barriers to the functioning and inclusion of people with disabilities [34], it is clear that the processes of the rehabilitation of human body movement, speech, language, and occupation transcend the institutions providing health services and impact the contexts in which life takes place. This explains why public and private sports centers are valued as actors of the national innovation system in the sector, since they are responsible for leading actions for the social inclusion of people with disabilities in the sports and recreational field, which is supported by the public policy guidelines for the promotion and development of the inclusion of people with disabilities in physical education, recreation, activity, and sports [35].

The country’s current regulations stipulate that sports venues are a pillar for the rehabilitation and inclusion of people with disabilities. This normative panorama is supported by each of the research and development activities that are being carried out in this field at a national and international level, in which inclusive sport opens the door to a new market with great possibilities for economic and social impacts.

Likewise, public and private organizations that provide services to the population with disabilities are valued as actors of the national innovation system in the sector, since these entities are called to design inclusion strategies to improve the quality of life of the population with disabilities through the development of digital skills in the population and participation in various innovation activities that result in job and business opportunities in the growing digital economy, as developed countries have achieved [48].

Finally, it is foreseeable that, in Colombia, the associations and guilds of rehabilitation professionals will become visible as actors of the national innovation system, since, in general, their mission is to lead the scientific and academic development of the professions in the sector. In fact, the rehabilitation associations in Colombia are responsible for political transformations that have an impact on the occupational performance of professionals and therefore on the social development of the populations and the health of the groups they serve.

Based on the results of this study, it is necessary to extend recognition to other actors by differentiating their profile to compete for resources that will enhance their actions in science, technology, and innovation to introduce competitive advantages in the sector and thus mitigate the barriers to the use of state-of-the-art technology in the healthcare chain.

Regarding the findings of the perceived interest and influence of the actors in the innovative performance of the system in each of the stages of TT, in rehabilitation, in the country is changing. It is striking that the institutions in charge of providing health services are the actors that have a high interest and influence in the development of all innovation activities in the sector, which indicates a dynamic governed by the Market Pull model, in which the market is conceived as a source of ideas for the development of R&D activities [48,49], which suggests a reactive functioning of the system and its actors, making it necessary to delve into future studies on the technological management model that predominates in the sector, the relationships that emerge among the actors, and their impact on the results of the system.

Regarding the role of technology commercialization companies, the result of the interest in the dynamization of the system with its general mission is concordant; however, the fact that their influence is almost null in the development of the main stages of TT in rehabilitation in the country generates alarm, since this actor is essential in the placement of the products the Market Pull versus [15]. Therefore, its low influence marks a rupture in the TT process in the sector and becomes in itself a barrier for the appropriation of technology, which suggests a need to more thoroughly investigate the facilitators and limiting factors it faces for the development of marketing and commercialization activities of technology in the sector.

Regarding universities and research groups, the results show a limited influence, since, despite their vocation for the search, teaching, dissemination, and application of knowledge [50], there is no sustained interest or influence in the commercialization and use of state-of-the-art technology in the rehabilitation in the country.

This finding reflects a limited dynamic of university/industry research cooperation that hinders knowledge management activities and processes. This finding is consistent with the results presented in 2021 by the DNP’s Directorate of Innovation and Business Development, in which it is evident that, between 2014 and 2020, the University–Business Collaboration sub-index decreased by an average of 1.5% each year [51]. The results suggest the importance of strengthening, among other strategies, the triple helix model in the country at different departmental and territorial levels.

Concerning the entrepreneurship units and the RRTO, it is clear that they are actors that maintain a sustained interest and influence in all innovation activities in rehabilitation, which is consistent with the general mission of these actors, since they are essentially responsible for promoting the entrepreneurial culture, facilitating the processes of technology transfer, and encouraging the creation of sustainable companies that respond to market needs. Their influence is based on the possibility of these actors accompanying the acceleration of high-potential ventures and the obtaining of resources for the development of different innovation activities in the country.

The Patent and Legal Advice Offices and the Science, Technology, and Innovation laboratories have little scope in the activities of use and appropriation of technology in the sector, which corresponds to the scopes defined for these entities in the country, which are to manage the National Industrial Property System and strengthen the country’s scientific ecosystem, respectively. Under this perspective, one of the challenges of the system is, among others, to improve the capacities and conditions to generate and transfer knowledge to the country’s productive sector [44].

Finally, R&D companies present a similar picture to the previous one; however, their low interest and influence in the use of technology is striking because it suggests a disconnection between the actors, therefore it is necessary to delve into studies to identify the barriers that discourage the actors to link and facilitate the processes of the appropriation of technology in the rehabilitation in the country.

One of the advantages of this study is that, to date, there is no complete description in the literature of the innovation system in rehabilitation in developing countries. This study represents the first approach to the case of Colombia, which brings new knowledge to the global analysis. However, the absence of any documented dynamics of national innovation systems in other countries creates a limitation when attempting to contrast the dynamics of systems at the regional or global level.

One of the challenges for future studies derived from this work is to evaluate the relationship between the organizations that make up the national innovation system with regulatory entities, which are essential actors for system dynamics. The analysis with this particular actor requires a separate assessment due to the coexistence of multiple agencies with overlapping regulatory functions, specifically in the health sector, as evaluated in recent studies [52], which creates issues for technology adoption and represents a limitation of this study.

Recognizing the interest and influence of the actors in the dynamics of innovation contributes to strengthening regulatory frameworks that guarantee quality and evaluate the contribution of innovation to the well-being of people with disabilities.

6. Conclusions

The recognition of the actors that participate in the innovation system is essential for the technological and scientific development of the country. Therefore, in the health sector, specifically in the rehabilitation area, it is worthwhile to make public and private organizations that provide care to the population with disabilities, public and private sports centers, and professional associations in the area visible as organizations that, due to their functions in the sector, are key to the dynamics of innovation in the system.

Likewise, it is necessary to determine the characteristics and patterns of linkage and the interaction of the actors in each of the innovation activities from a systemic approach that allows the ability to define strategies that ultimately result in innovations that contribute to the welfare and social inclusion of the population with disabilities.