Abstract
Background: Embedding study interventions and procedures into usual rehabilitation practice is vital for trial success and eventual implementation. In planning a feasibility randomized controlled trial, we explored how rehabilitation staff implemented Dynamic Lycra Orthoses (DLO) as an adjunct to upper limb (UL) rehabilitation after stroke.
Method: Rehabilitation staff in three inpatient stroke units facilitated DLO wear with 17 stroke survivors over eight weeks, following a preliminary study protocol, after which nine purposively sampled staff participated in semi-structured interviews. Perceptions of the intervention, perceived benefits, fit with practice, and team implementation processes were explored. Interviews were audio-recorded and transcribed. Framework Analysis structured data management and data were interrogated using Normalization Process Theory (NPT).
Results/Findings: Findings are structured around NPT concepts. Coherence: coherence with usual UL rehabilitation goals stemmed from perceived intervention benefits including sensory, motor, and tone control and functional task performance. Cognitive Participation: motivation for study participation was facilitated by training, relationships with study researchers, and perceived importance of this research. Collective Action: Task allocation was negotiated within teams. Ensuring correct DLO washing technique for infection prevention was paramount. Reflexive Monitoring: DLO effects, safety, and perceived fit with rehabilitation goals were closely monitored. Adverse events were of concern, with practitioners precipitating study withdrawal in some cases.
Discussion: NPT provided a useful framework for explaining how study procedures were viewed and implemented into usual practice. Practitioners were committed to success of the study but only when processes and perceived clinical effects were coherent with safety concerns.
Conclusion: The study highlights complexities in implementing an ostensibly simple intervention.
Method: Rehabilitation staff in three inpatient stroke units facilitated DLO wear with 17 stroke survivors over eight weeks, following a preliminary study protocol, after which nine purposively sampled staff participated in semi-structured interviews. Perceptions of the intervention, perceived benefits, fit with practice, and team implementation processes were explored. Interviews were audio-recorded and transcribed. Framework Analysis structured data management and data were interrogated using Normalization Process Theory (NPT).
Results/Findings: Findings are structured around NPT concepts. Coherence: coherence with usual UL rehabilitation goals stemmed from perceived intervention benefits including sensory, motor, and tone control and functional task performance. Cognitive Participation: motivation for study participation was facilitated by training, relationships with study researchers, and perceived importance of this research. Collective Action: Task allocation was negotiated within teams. Ensuring correct DLO washing technique for infection prevention was paramount. Reflexive Monitoring: DLO effects, safety, and perceived fit with rehabilitation goals were closely monitored. Adverse events were of concern, with practitioners precipitating study withdrawal in some cases.
Discussion: NPT provided a useful framework for explaining how study procedures were viewed and implemented into usual practice. Practitioners were committed to success of the study but only when processes and perceived clinical effects were coherent with safety concerns.
Conclusion: The study highlights complexities in implementing an ostensibly simple intervention.
| Original language | English |
|---|---|
| Article number | 327 |
| Pages (from-to) | 1408 |
| Number of pages | 1 |
| Journal | Clinical Rehabilitation |
| Volume | 32 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 6 Jul 2018 |
| Event | Society for Research in Rehabilitation Winter Meeting 2018 - University of the West of England, Bristol, United Kingdom Duration: 6 Feb 2018 → 6 Feb 2018 https://srr.org.uk/srr-events/past-conferences/past-meeting-winter-2018/ |