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Staff’s views on delivering patient-led therapy during inpatient stroke rehabilitation: a focus group study with lessons for trial fidelity

Overview of attention for article published in Trials, April 2015
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Title
Staff’s views on delivering patient-led therapy during inpatient stroke rehabilitation: a focus group study with lessons for trial fidelity
Published in
Trials, April 2015
DOI 10.1186/s13063-015-0646-9
Pubmed ID
Authors

Maria Horne, Nessa Thomas, Andy Vail, Rudd Selles, Candy McCabe, Sarah Tyson

Abstract

Fidelity to the treatment protocol is key to successful trials but often problematic. This article reports the staff's views on delivering a complex rehabilitation intervention: patient-led therapy during inpatient stroke care. An exploratory qualitative study using focus groups with staff involved in a multicenter (n = 12) feasibility trial of patient-led therapy (the MAESTRO trial) was undertaken as part of the evaluation process. Purposive sampling ensured that participants represented all recruiting sites, relevant professions and levels of seniority. Data analysis used a Framework Approach. Five focus groups were held involving 30 participants. Five main themes emerged: the effect of the interventions, practical problems, patient-related factors, professional dilemmas, and skills. Staff felt the main effect of the therapies was on patients' autonomy and occupation; the main practical problems were the patients' difficulties in achieving the correct position and a lack of space. Staff clearly identified characteristics that made patient-led therapy unsuitable for some patients. Most staff experienced dilemmas over how to prioritize the trial interventions compared to their usual therapy and other clinical demands. Staff also lacked confidence about how to deliver the interventions, particularly when adapting the interventions to individual needs. For each barrier to implementation, possible solutions were identified. Of these, involving other people and establishing a routine were the most common. Delivering rehabilitation interventions within a trial is complex. Staff require time and support to develop the skills, strategies and confidence to identify suitable patients, deliver new treatments, adapt the new treatments to individuals' needs and balance the demands of delivering the trial intervention according to the treatment protocol with other clinical and professional priorities. ISRCTN29533052 . October 2011.

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Geographical breakdown

Country Count As %
United States 1 1%
Unknown 67 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 16 24%
Librarian 6 9%
Researcher 6 9%
Student > Ph. D. Student 6 9%
Student > Doctoral Student 5 7%
Other 13 19%
Unknown 16 24%
Readers by discipline Count As %
Nursing and Health Professions 17 25%
Medicine and Dentistry 16 24%
Computer Science 4 6%
Pharmacology, Toxicology and Pharmaceutical Science 2 3%
Neuroscience 2 3%
Other 7 10%
Unknown 20 29%