Designing a trial of early electrical stimulation to the stroke-affected arm: Qualitative findings on the barriers and facilitators.

Abstract

Introduction: This study aimed to explore the barriers and facilitators to implementing early therapeutic electrical stimulation (ES) treatment from both the patient and therapist perspectives as part of a feasibility study. Methods: Design: Interviews were conducted with patients and their carers and focus groups with the therapists post-intervention period. Setting: Interviews were in the patient’s homes and for the focus groups in a specialist stroke unit in Nottinghamshire. Subjects: Fifteen patient participants (34% of sample) were interviewed (intervention n = 9; control group n = 3; carers n = 3). Sixteen therapists (9 occupational therapists; 7 physiotherapists) took part in the three focus groups. Intervention: Participants were randomized to receive usual care or usual care and ES to wrist flexors and extensors for 30 min, twice a day, 5 days a week for 3 months. Findings: The barriers to ES treatment cited by the therapists outweighed the barriers mentioned by patients. Therapists’ barriers included lack of confidence and staff knowledge regarding ES and time pressures of delivering the ES. No patients mentioned time as a barrier and considered the treatment regime to be acceptable; however, lack of staff support was mentioned 14 times by them. Conclusion: Although initially the perceived barrier for therapists was time restrictions, after analysing the data, it appears that confidence/knowledge is the real barrier, and time is the manifestation of this underlying self-doubt. Patients were able to confidently self-manage treatment, and although efficacy was not measured, patients volunteered information regarding its perceived benefit, and no adverse effects were reported.