Posts Tagged qualitative
[Abstract] A qualitative exploration of the effect of visual field loss on daily life in home-dwelling stroke survivors
To explore the effect of visual field loss on the daily life of community-dwelling stroke survivors.
Semi-structured interviews were conducted with a non-purposive sample of 12 stroke survivors in their own homes. These were recorded, transcribed verbatim and analyzed with the framework method, using an inductive approach.
Two key analytical themes emerged. ‘Perception, experience and knowledge’ describes participant’s conflicted experience of having knowledge of their impaired vision but lacking perception of that visual field loss and operating under the assumption that they were viewing an intact visual scene when engaged in activities. Inability to recognize and deal with visual difficulties, and experiencing the consequences, contributed to their fear and loss of self-confidence. ‘Avoidance and adaptation’ were two typologies of participant response to visual field loss. Initially, all participants consciously avoided activities. Some later adapted to vision loss using self-directed head and eye scanning techniques.
via A qualitative exploration of the effect of visual field loss on daily life in home-dwelling stroke survivors – Christine Hazelton, Alex Pollock, Anne Taylor, Bridget Davis, Glyn Walsh, Marian C Brady, 2019
There is growing interest in occupation-based practice (OBP) as it applies to hand therapy. While leaders in occupational therapy strongly advocate for the primary use of OBP in all practice areas of occupational therapy, some question the broad application of OBP into the hand therapy specialty practice. This study sought to describe the perception and application of OBP among occupational therapy practitioners in hand therapy.
This descriptive qualitative study conducted semi-structured interviews with occupational therapy practitioners (n=10) who practice in hand therapy. Interviews were transcribed, coded by meaning units. Codes were categorized into themes. Peer review and triangulation with analytic memos were used to increase trustworthiness.
Participants ranged in years of experience (3-28 years) and half hold the CHT designation. Four themes emerged from qualitative analysis: how OBP is defined, how OBP is practiced, facilitators, and barriers to OBP. Participants defined OBP as the use of meaningful activities identified by the client and promoting a return to daily activities. Participants practiced OBP processes in the development and execution of treatment plans through activity analysis, compensatory strategies, and simulated environments. Facilitators to practice include the use of functional outcome measures, payor guidelines, therapists’ creativity, and the practitioner’s relationship with the physician and the client. Barriers to practice include insurance limitations, time and space constraints, resource limitations to implement OBP and the nature of orthopedics. Participants also experienced issues with professional identity in the context of contemporary occupational therapy practice.
The study describes the utilization and facilitators of OBP in the hand therapy context. The barriers to OBP, identified in the study, are not unique to hand therapy. However, issues surrounding professional identity requires further exploration. This study has important implications on practice, education, and research regarding OBP.
Occupation- based, Hand therapy, Qualitative.
[ARTICLE] Participant perceptions of use of CyWee Z as adjunct to rehabilitation of upper-limb function following stroke – Full Text PDF
This article reports on the perceptions of 14 adults with chronic stroke who participated in a pilot study to determine the utility, acceptability, and potential efficacy of using an adapted CyWee Z handheld game controller to play a variety of computer games aimed at improving upper-limb function. Four qualitative in-depth interviews and two focus groups explored participant perceptions. Data were thematically analyzed with the general inductive approach. Participants enjoyed playing the computer games with the technology. The perceived benefits included improved upper-limb function, concentration, and balance; however, six participants reported shoulder and/or arm pain or discomfort, which presented while they were engaged in play but appeared to ease during rest. Participants suggested changes to the games and provided opinions on the use of computer games in rehabilitation. Using an adapted CyWee Z controller and computer games in upper-limb rehabilitation for people with chronic stroke is an acceptable and potentially beneficial adjunct to rehabilitation. The development of shoulder pain was a negative side effect for some participants and requires further investigation.
Stroke is the third leading cause of death in New Zealand and a major cause of adult disability for those who experience it . Approximately 85 percent of patients with stroke do not regain upper-limb function and remain dependent on caregivers [2–3], with motor impairments accounting for most poststroke disability . Loss of upper-limb function is a major cause of poor perception of well-being following stroke .
Most recovery of upper-limb function occurs in the first 3 months following a stroke; however, significant gains in dexterity, strength, and function with rehabilitation 6 months poststroke have been reported [6–7]. This subacute recovery in motor function can be explained in part by neural reorganization caused by rehabilitation training [8–12]. It is suggested that key factors to upperlimb stroke rehabilitation training are attention, repetition, intensity of practice, reward, progression of complexity, and skill acquisition and that this training should be task-oriented.
[RESEARCH PAPER] Expanding stroke telerehabilitation services to rural veterans: a qualitative study on patient experiences using the robotic stroke therapy delivery and monitoring system program
Purpose: The present study reports on a robotic stroke therapy delivery and monitoring system intervention. The aims of this pilot implementation project were to determine participants’ general impressions about the benefits and barriers of using robotic therapy devices for in-home rehabilitation.
Methods: We used a qualitative study design employing ethnographic-based anthropological methods including direct observation of the in-home environment and in-depth semi-structured interviews with 10 users of the hand or foot robotic devices. Thematic analysis was conducted using an inductive approach.
Results: Participants reported positive experiences with the robotic stroke therapy delivery and monitoring system. Benefits included convenience, self-reported increased mobility, improved mood and an outlet for physical and mental tension and anxiety. Barriers to use were few and included difficulties with placing the device on the body, bulkiness of the monitor and modem connection problems.
Conclusions: Telerehabilitation robotic devices can be used as a tool to extend effective, evidence-based and specialized rehabilitation services for upper and lower limb rehabilitation to rural Veterans with poor access to care.
Implications for Rehabilitation
- Participants whose formal therapy services had ended either because they had exhausted their benefits or because traveling to outpatient therapy was too cumbersome due to distance were able to perform therapeutic activities in the home daily (or at least multiple times per week).
- Participants who were still receiving formal therapy services either in-home or in the clinic were able to perform therapeutic activities in the home on the days they were not attending/receiving formal therapy.
- Based on the feedback from these veterans and their caregivers, the manufacturing company is working on modifying the devices to be less cumbersome and more user-friendly (lighter-weight, more mobile, changing software, etc.), as well as more adaptable to participants’ homes. Removing these specific barriers will potentially allow participants to utilize the device more easily and more frequently.
- Since participants expressed that they wished they could have the device in their homes longer than the 3-month usage period required for this pilot project, the project team is working on a proposal to extend this project to a wider area and the new paradigm would extend the usage period until the patient reaches a plateau in progress or no longer wants to use the device.
via Expanding stroke telerehabilitation services to rural veterans: a qualitative study on patient experiences using the robotic stroke therapy delivery and monitoring system program, Disability and Rehabilitation: Assistive Technology, Informa Healthcare.
[ARTICLE] What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services
Introduction: Multi-disciplinary team members predict each patient’s rehabilitation potential to maximise best use of resources. A lack of underpinning theory about rehabilitation potential makes it difficult to apply this concept in clinical practice. This study theorises about rehabilitation potential drawing on everyday decision-making by Health Care Professionals (HCPs) working in stroke rehabilitation services.
Methods: A clinical scenario, checked for face validity, was used in two focus groups to explore meaning and practice around rehabilitation potential. Participants were 12 HCPs working across the stroke pathway. Groups were co-facilitated, audio-recorded and fully transcribed. Analysis paid attention to data grounded in first-hand experience, convergence within and across groups and constructed a conceptual overview of HCPs’ judgements about rehabilitation potential.
Results: Rehabilitation potential is predicted by observations of “carry-over” and functional gain and managed differently across recovery trajectories. HCPs’ responses to rehabilitation potential judgements include prioritising workload, working around the system and balancing optimism and realism. Impacts for patients are streaming of rehabilitation intensity, rationing access to rehabilitation and a shifting emphasis between management and active rehabilitation. For staff, the emotional burden of judging rehabilitation potential is significant. Current service organisation restricts opportunities for feedback on the accuracy of previous judgements.
Conclusion: Patients should have the opportunity to demonstrate rehabilitation potential by participation in therapy. As therapy resources are limited and responses to therapy may be context-dependent, early decisions about a lack of potential should not limit longer-term opportunities for rehabilitation. Services should develop strategies to enhance the quality of judgements through feedback to HCPs of longer-term patient outcomes.
Implications for Rehabilitation
- Rehabilitation potential is judged at the level of individual patients (rather than population-based predictive models of rehabilitation outcome), draws on different sources of often experiential knowledge, and may be less than reliable.
- Decisions about rehabilitation potential may have far reaching consequences for individual patients, including the withdrawal of active rehabilitation in hospital or in the community and eventual care placement.
- A better understanding of what people mean by rehabilitation potential by all team members, and by patients and carers, may improve the quality of joint decision making and communication.
via What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services, Disability and Rehabilitation, Informa Healthcare.
…A holistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children…