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Open Access Research article

Translation of evidence-based Assistive Technologies into stroke rehabilitation: users’ perceptions of the barriers and opportunities

Ann-Marie Hughes12*, Jane Helena Burridge1, Sara Holtum Demain1, Caroline Ellis-Hill3, Claire Meagher1, Lisa Tedesco-Triccas1, Ruth Turk1 and Ian Swain45

Author Affiliations

1 Faculty of Health Sciences, University of Southampton, Southampton, UK

2 Electronics and Computer Sciences, Faculty of Physical & Applied Sciences, University of Southampton, Southampton, UK

3 School of Health and Social Care, Bournemouth University, Bournemouth, UK

4 School of Design, Engineering and Computing, Bournemouth University, Bournemouth, UK

5 Clinical Science and Engineering, Salisbury NHS Foundation Trust, Salisbury, UK

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BMC Health Services Research 2014, 14:124  doi:10.1186/1472-6963-14-124

Published: 12 March 2014

Abstract

Background

Assistive Technologies (ATs), defined as “electrical or mechanical devices designed to help people recover movement”, demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients’, carers’ (P&Cs) and healthcare professionals’ (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems.

Methods

Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development.

Results

292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly.

Conclusion

Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation.

Keywords:
Assistive technology; Upper limb; Stroke rehabilitation; Translation into practice; Perceptions