Implementing Dynamic Lycra Orthoses as an adjunct to upper limb rehabilitation rehabilitation within the context of a feasibility randomized controlled trial (RCT): a qualitative study

Jacqui Morris, Alexandra John, Lucy Wedderburn

Research output: Contribution to journalMeeting abstract

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.
Original languageEnglish
Pages (from-to)1408
Number of pages1
JournalClinical Rehabilitation
Volume32
Issue number10
Early online date6 Jul 2018
DOIs
Publication statusPublished - 6 Jul 2018
EventSociety for Rehabilitation Research Annual Conference - Bristol
Duration: 6 Feb 20186 Feb 2018

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Splints
Upper Extremity
Rehabilitation
Randomized Controlled Trials
Stroke
Interviews
Safety
Task Performance and Analysis
Motivation
Inpatients
Extremities
Research Personnel
Infection
Research

Cite this

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title = "Implementing Dynamic Lycra Orthoses as an adjunct to upper limb rehabilitation rehabilitation within the context of a feasibility randomized controlled trial (RCT): a qualitative study",
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 toupper 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 importanceof 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 onlywhen processes and perceived clinical effects were coherent with safety concerns.Conclusion: The study highlights complexities in implementing an ostensibly simple intervention.",
author = "Jacqui Morris and Alexandra John and Lucy Wedderburn",
year = "2018",
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doi = "10.1177/0269215518784346",
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AU - John, Alexandra

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N2 - 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 toupper 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 importanceof 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 onlywhen processes and perceived clinical effects were coherent with safety concerns.Conclusion: The study highlights complexities in implementing an ostensibly simple intervention.

AB - 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 toupper 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 importanceof 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 onlywhen processes and perceived clinical effects were coherent with safety concerns.Conclusion: The study highlights complexities in implementing an ostensibly simple intervention.

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