Translation of evidence-based Assistive Technologies into stroke rehabilitation: users’ perceptions of the barriers and opportunities

BMC Health Services Research

Ian Swain⁴  Ruth Turk²  Lisa Tedesco-Triccas²  Claire Meagher²  Caroline Ellis-Hill³  Sara Holtum Demain²  Jane Helena Burridge²  Ann-Marie Hughes¹ 

[1] Electronics and Computer Sciences, Faculty of Physical & Applied Sciences, University of Southampton, Southampton, UK;Faculty of Health Sciences, University of Southampton, Southampton, UK;School of Health and Social Care, Bournemouth University, Bournemouth, UK;Clinical Science and Engineering, Salisbury NHS Foundation Trust, Salisbury, UK

关键词: Perceptions;    Translation into practice;    Stroke rehabilitation;    Upper limb;    Assistive technology;   

Others  :  1133272
DOI  :  10.1186/1472-6963-14-124

 received in 2012-11-01, accepted in 2014-02-23,  发布年份 2014

【 摘 要 】

Background

Assistive Technologies (ATs), defined as “electrical or mechanical devices designed to help people recover movement”, demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients’, carers’ (P&Cs) and healthcare professionals’ (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems.

Methods

Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development.

Results

292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly.

Conclusion

Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation.

【 授权许可】

   
2014 Hughes et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Hong KS, Saver JL: Quantifying the value of stroke disability outcomes: WHO global burden of disease project disability weights for each level of the modified rankin scale * supplemental mathematical appendix. Stroke 2009, 40(12):3828-3833.
• [2]Saka O, McGuire A, Wolfe C: Cost of stroke in the United Kingdom. Age Ageing 2009, 1(38(1)):27-32.
• [3]Nichols-Larsen DS, Clark PC, Zeringue A, Greenspan A, Blanton S: Factors influencing stroke Survivors’ quality of life during subacute recovery. Stroke 2005, 36(7):1480-1484.
• [4]Truelsena T, Ekmanb M, Boysen G: Cost of stroke in Europe. Eur J Neurol 2005, 12(Suppl 1):78-84.
• [5]Department of Health: National Stroke Strategy. 2007. Report No.: DH_081062
• [6]Forster A, Young J: The Clinical and Cost-Effectiveness of Physiotherapy in the Management of Elderly People Following a Stroke. London: Chartered Society of Physiotherapy; 2002.
• [7]Wade DT, Langton-Hewer R, Wood VA, Skilbeck CE, Ismail HM: The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry 1983, 46(6):521-524.
• [8]Royal College of Physicians National clinical guidelines for stroke: Prepared by the Intercollegiate Stroke Working Party. 4th edition. London: Royal College of Physicians; 2012.
• [9]Stroke Association: Stroke Statistics Fact Sheet. London: Stroke Association; 2010.
• [10]Chartered Society of Physiotherapy: CSP Research Priorities Project. London: CSP London; 2010.
• [11]Boddice G, Brauer S, Gustafsson L, Kenardy J, Hoffmann T, National Stroke Foundation: Clinical Guidelines for Stroke Management 2010. Melbourne, Australia: National Stroke Foundation; 2010. ISSBN0-978-0-9805933-3-4)
• [12]US VA/DOD The Management of stroke rehabilitationWorking Group: Clinical Practice Guidelines for the Management of Stroke Rehabilitation Version 2.0. 2010.
• [13]Kwakkel G, Wagenaar RC, Koelman TW, Lankhorst GJ, Koetsier JC: Effects of intensity of rehabilitation after stroke: a research synthesis. Stroke 1997, 28(8):1550-1556.
• [14]Reinkensmeyer DJ, Bonato P, Boninger ML, Chan L, Cowan RE, Fregly BJ, Rodgers MM: Major trends in mobility technology research and development: overview of the results of the NSF-WTEC European study. J Neuroeng Rehabil 2012, 9:22. http://www.jneuroengrehab.com/content/9/1/22 webcite BioMed Central Full Text
• [15]Cramer SC, Nelles G, Benson RR, Kaplan JD, Parker RA, Kwong KK, Kennedy DN, Finklestein SP, Rosen BR: A functional MRI study of subjects recovered from hemiparetic stroke. Stroke 1997, 28(12):2518-2527.
• [16]Krakauer JW: Arm function after stroke: from physiology to recovery. Semin Neurol 2005, 25(4):384-395.
• [17]Mehrholz J, Platz T, Kugler J, Pohl M: Electromechanical and Robot-Assisted arm Training for Improving arm Function and Activities of Daily Living After Stroke. Art. No.: CD006876 edition. Ltd Chichester, UK: John Wiley & Sons; 2008.
• [18]Langhorne P, Coupar F, Pollock A: Motor recovery after stroke: a systematic review. Lancet Neurol 2009, 8(8):741-754.
• [19]Sirtori V, Corbetta D, Moja L, Gatti R: Constraint-Induced Movement Therapy for Upper Extremities in Stroke Patients. Cochrane Database of Systematic Reviews. 4th edition. 2009. Art. No.: CD004433. DOI: 10.1002/14651858.CD004433.pub2.4
• [20]Saposnik G, Levin M, for the Stroke Outcome Research Canada (SORCan) Working Group: Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians. Stroke 2011, 1(42(5)):1380-1386.
• [21]Kwakkel G, Meskers CGM, van Wegen EE, Lankhorst GJ, Geurts ACH, van Kuijk AA, Lindeman E, Visser-Meily A, de Vlugt E, Arendzen JH: Impact of early applied upper limb stimulation: the EXPLICIT-stroke programme design. BMC Neurol 2008, 8:49. BioMed Central Full Text
• [22]Page SJ, Levine P: Back from the brink: electromyography-triggered stimulation combined with modified constraint-induced movement therapy in chronic stroke. Arch Phys Med Rehabil 2006, 87(1):27-31.
• [23]Sun SF, Hsu CW, Sun HP, Hwang CW, Yang CL, Wang JL: Combined botulinum toxin type a with modified constraint-induced movement therapy for chronic stroke patients with upper extremity spasticity: a randomized controlled study. Neurorehabil Neural Repair 2010, 24(1):34-41.
• [24]Broeren J, Rydmark M, Bj + Ârkdahl A, Sunnerhagen KS: Assessment and training in a 3-dimensional virtual environment with haptics: a report on 5 cases of motor rehabilitation in the chronic stage after stroke. Neurorehabil Neural Repair 2007, 21(2):180-189.
• [25]Hesse S, Werner C, Schonhardt EM, Bardeleben A, Jenrich W, Kirker SG: Combined transcranial direct current stimulation and robot-assisted arm training in subacute stroke patients: a pilot study. Restor Neurol Neurosci 2007, 25:9-15.
• [26]Malcolm MP, Triggs WJ, Light KE, Gonzalez Rothi LJ, Wu S, Reid K, Nadeau SE: Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial. Am J Phys Med Rehabil 2007, 86:707-715.
• [27]Demain SH, Burridge J, Ellis-Hill C, Hughes AM, Yardley L, Swain I: Assistive Technologies after stroke: self-management or fending for yourself? BMC Health Serv Res 2013, 13:334. BioMed Central Full Text
• [28]Pomeroy VM, King L, Pollock A, Baily-Hallam A, Langhorne P: Electrostimulation for Promoting Recovery of Movement or Functional Ability After Stroke. Art. No.: CD003241 edition. 2006.
• [29]Boynton PM, Greenhalgh T: Selecting, designing, and developing your questionnaire. BMJ 2004, 328:1312-1315.
• [30]Boynton PM: Administering, analysing, and reporting your questionnaire. BMJ 2004, 328:1372-1375.
• [31]Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, Kwan I: Increasing response rates to postal questionnaires: systematic review. BMJ 2002, 324:1183.
• [32]Hughes AM: Research into using technologies in stroke rehabilitation – Volunteers Wanted. Differ Strokes Newslett 2010., (44)
• [33]Cheeran B, Cohen L, Dobkin B, Ford G, Greenwood R, Howard D, Husain M, Macleod M, Nudo R, Rothwell J, Rudd A, Teo J, Ward N, Wolf S: The future of restorative neurosciences in stroke: driving the translational research pipeline from basic science to rehabilitation of people after stroke. Neurorehabil Neural Repair 2009, 23(2):97-107.
• [34]Burridge JH, Hughes AM: Potential for new technologies in clinical practice. Curr Opin Neurol 2010, 23:671-677.
• [35]Teasell R, Foley N, Salter K, Bhogal RS, Bayona N, Jutai J, Speechley M: Evidence based review of stroke rehabilitation. 2013. Available at: http://www.ebrsr.com webcite
• [36]Cook AM, Polgar JM, Livingston NJ: Need- and task-based design and evaluation. In Design and Use of Assistive Technologies: Social, Technical, Ethics and Economic Challenges. Edited by Oishi MNK Mitchell IIM, Van der Loos HFM. New York, New York, Dordrecht Heidelberg London: Springer; 2010:41-47.
• [37]Wagner TH, Lo AC, Peduzzi P, Bravata DM, Huang GD, Krebs HI, Ringer RJ, Federman DG, Richards LG, Haselkorn JK, Wittenberg GF, Volpe BT, Bever CT, Duncan PW, Siroka A, Guarino PD: An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke 2011, 42(9):2630-2632.
• [38]Renaud K, van Biljon J: Predicting technology acceptance and adoption by the elderly: a qualitative study. In Proceedings of SAICSIT. Wilderness, South Africa: Wilderness Beach Hotel; 2008.
• [39]Davis FD: Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q 1989, 13(3):319-340.
• [40]Bagozzi RP, Davis FD, Warshaw PR: Development and test of a theory of technological learning and usage. Hum Relat 1992, 45(7):660-686.
• [41]Venkatesh V: Determinants of perceived ease of use: Integrating control, intrinsic motivation, and emotion into the technology acceptance model. Inf Syst Res 2000, 11(4):342-365.
• [42]Venkatesh V, Morris MG, Davis GB, Davis FD: User acceptance of information technology: toward a unified view. MIS Q 2003, 27(3):425-478.
• [43]Venkatesh V, Bala H: Technology acceptance model 3 and a research agenda on interventions. Decis Sci 2008, 39(2):273-315.
• [44]Rogers EM: Diffusion of Innovations. New York: The Free Press; 2003.
• [45]Silverstone R, Haddon L: Design and the domestication of information and communication technologies: technical change and everyday life. In Communication by Design: The Politics of Information and Communication Technologies. Oxford University: Oxford; 1996:44-74.
• [46]May C: A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res 2006, 6:86. BioMed Central Full Text
• [47]Pollock AS, Legg L, Langhorne P, Sellars C: Barriers to achieving evidence-based stroke rehabilitation. Clin Rehabil 2000, 14(6):611-617.