To investigate the experiences of chronic stroke patients and non-professional coaches with home-based constraint-induced movement therapy (homeCIMT).
Qualitative study embedded within a cluster randomized controlled trial investigating the efficacy of homeCIMT to improve the use of the affected arm in daily activities.
Patients’ home environment.
13 stroke patients and 9 non-professional coaches’ alias family members who had completed the four-week homeCIMT programme in the context of the HOMECIMT trial.
Semi-structured interviews; qualitative data were analysed using the methodology of the hermeneutic phenomenological data analysis.
We identified six themes in the qualitative analysis describing the experiences of patients and non-professional coaches with homeCIMT: (1) homeCIMT can be integrated into everyday life with varying degrees of success; (2) training together may produce positive experiences as well as strain; (3) self-perceived improvements during and following homeCIMT; (4) using the affected arm in everyday life is challenging; (5) subjective evaluation of and experiences with homeCIMT-specific exercises; and (6) impact of professional therapists’ guidance and motivation during homeCIMT. Statements regarding theme five and six were only provided by patients, whereas the other themes contain both, the experiences of stroke patients and non-professional coaches.
Patients’ and non-professional coaches’ narratives offer a detailed insight into the manifold experiences with the practical implementation of homeCIMT that may help improve implementing the homeCIMT programme and similar approaches involving increased training duration and intensity and/or involvement of family members.
In stroke rehabilitation, repetitive, task-specific training is one of the key principles.1,2 For stroke patients with upper limb dysfunction, constraint-induced movement therapy and its modifications are one of the most promising techniques taking this principle into account.1–4 To induce the use of the affected arm in everyday life,5 constraint-induced movement therapy comprises an intensive motor training, the use of adherence-enhancing behavioural methods and the immobilization of the non-affected hand.5,6 A four-week home-based training in conjunction with the support of a non-professional coach (e.g. family member) and reduced professional assistance to meet ambulatory care conditions (home-based constraint-induced movement therapy (homeCIMT)) is one way to deliver constraint-induced movement therapy to patients in long-term care.7 The HOMECIMT trial showed homeCIMT to be superior to conventional therapies with regard to the self-perceived use of the stroke-affected arm in daily activities.8
HomeCIMT and other forms of constraint-induced movement therapy have been shown to be particularly effective in improving upper limb function post stroke.1,3 However, these interventions will only work if patients adhere to them. Constraint-induced movement therapy requires numerous hours of repetitive exercises, which are likely to present a challenge for patients.9,10 Regarding homeCIMT, the involvement of a non-professional coach might be an additional challenging aspect for both, patients and non-professional coaches. Thus, it is vital to better understand the users’ experiences with different forms of constraint-induced movement therapies in order to adapt the way how we deliver these interventions and maximize adherence to them. However, there are only few investigations with the users’ perspectives on constraint-induced movement therapies. We are only aware of three minor qualitative studies investigating the experiences of two or three patients with modified constraint-induced movement therapies.11–13 A qualitative research approach, in particular, provides information about the users’ experiences with the practical application of a therapy.14,15
In addition to the cluster randomized controlled HOMECIMT trial, we conducted a comprehensive qualitative study to explore the users’ perspectives on homeCIMT following the driving question: What are the experiences of chronic stroke patients and non-professional coaches with homeCIMT?[…]
Continue —> Stroke patients’ and non-professional coaches’ experiences with home-based constraint-induced movement therapy: a qualitative study – Anne Stark, Christine Färber, Britta Tetzlaff, Martin Scherer, Anne Barzel, 2019
Figure 1. Themes regarding the experiences of patients and non-professional coaches with homeCIMT.
Introduction: This study aimed at exploring the perceived benefits and drawbacks of practicing tai chi, an alternative therapy that can be implemented in the community, as part of upper-limb rehabilitation following stroke.
Methodology: Semistructured interviews were carried out with participants with chronic stroke (>6 months). The participants took part in 16 tai chi sessions over 8 weeks. Interviews were conducted in person using an interview guide based on the theory of planned behavior (TPB), and a thematic analysis was conducted.
Results: Eight interviews were carried out with participants at various stages of motor recovery. Participants perceived a number of physical, functional, and psychological benefits. They found tai chi to be a global exercise, including both physical and mental aspects, and suggested that it can be included as part of rehabilitation for stroke patients. Many participants expressed a desire to continue practicing tai chi after completion of the study because it exceeded their expectations, among other reasons.
This study can serve to guide future tai chi interventions and research on tai chi for rehabilitation in terms of the characteristics of the intervention and the various areas to assess in order to measure the overall benefits.
IMPLICATIONS FOR REHABILITATION
Tai chi was perceived as a good way of integrating various skills learned during rehabilitation.
Despite having different functional abilities, all the participants noted various physical, functional, and psychological benefits from participating in the tai chi sessions.
Tai chi seems to be a form of exercise that stroke patients would perform more long-term since all the participants in this study expressed the desire to continue practicing tai chi.
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Source: Tai chi for upper limb rehabilitation in stroke patients: the patient’s perspective – Disability and Rehabilitation –