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Archived Comments for: Assistive technologies after stroke: self-management or fending for yourself? A focus group study

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  1. Summary of article

    Ralisa Shape, Independent

    30 October 2014

    Summary & Critique of Article:

    Not so many people needing rehabilitation use assistive technologies, defined in the study of Demain, et al. (2013) as mechanical or electrical devices for assisting the recovery of upper limb movement in affected individuals. This comes despite its potential usefulness amidst the increasing trend towards greater reliance of community-based stroke services on self-management approaches and the fact that some systematic reviews and clinical trials point to the efficacy of assistive technologies in decreasing impairments and at times even improving functions of stroke patients undergoing upper limb rehabilitation.

    Demain, et al. (2013) conducted a focus group study in the aim of identifying current knowledge and service provision, as well as the opportunities and barriers to the evidence-based use on stroke upper-limb rehabilitation, of assistive technologies. The authors targeted survivors of stroke, heath care professionals, and caregivers in family setting as study subjects Demain, et al. (2013) Part of the larger research undertaking, the ATRAS project aimed at being able to inform clinical trials in the assessment of how cost-effective are combinations of assistive technology products, the research envisioned to contribute to evidence-based research by exploring the level of current knowledge and use of upper limb stroke assistive technologies given that such technologies are usually used in clinical practice even with no established evidence based on research (Demain, et al., 2013).

    In undertaking its focus group study, Demain, et al. (2013) employed a qualitative design consisting of an interactive product exhibition and a series of four groups focused on patients, caregivers, and health professionals. In the interactive exhibition part, the study involved inviting delegates to explore each of the technologies by testing them and asking questions. For the focus groups, the authors used purposive sampling of exhibition delegates who signified interest in the study. A researcher each facilitated the focus groups (Demain, et al., 2013).

    The use of focus groups is suitable in the exploration of complex and not-so-well-understood issues because it facilitates the asking of questions, discussions, deep probing, reflecting on others' views, and personal view reconsiderations and such should work for assistive technologies. Four separate topic guides slightly modified according to the participants' needs, covered discussions of different assistive technology categories, namely virtual reality, biofeedback, robots, dynamic splints, electrical stimulation, and constraint induced movement therapy. Researchers transcribed all the groups’ audio-recordings (but with confidentiality maintained through the use of pseudonyms) and then read, re-read and coded using SD and AMH to generate themes. The research design instruments used and methodology in general are reliable and valid because coding were made while being cognizant of the study questions and the codes and emerging themes were discussed throughout with the larger research team to emphasize alternative interpretation and reach consensus. (Demain, et al., 2013).

    Results of the study by Demain, et al. (2013) showed more female caregivers and more male stroke patients, with all stroke survivor delegates having suffered post-stroke impairment of the upper limbs but three of whom having recovered limb's functional use. Qualitative thematic analysis showed the core concept of assistive technologies as potentially providing self-management support in stroke rehabilitation. The study also reports considerable impediments to assistive technology use relating to the themes of device design, information access, and provision access. Demain, et al. concluded that all stakeholders generally view assistive technologies as potentially facilitating rehabilitation self-management and improving upper limb stroke recovery but that adopting and routinely implementing them are impeded by problems or inadequacy with the device; evidence-based research; relationship between the patient and healthcare professional; and the health system. They recommended that assistive technologies should be co-designed by every stakeholder and the devices ought to be tested in practical clinical trial settings Demain, et al. (2013)

     

    Critique and Evaluation

     

    Demain, et al., (2013) provided what appears to be one of the first evidence-based studies on knowledge about and use of assistive technologies in upper limb rehabilitation, therefore presenting an important contribution to the literature on the subject. The interactive product exhibition complimented, and is in fact necessary to, the focus group part of the study amidst the research aim of identifying knowledge/perception and use of assistive technology products.

    The researchers used convenience sampling, i.e., being limited to those who attended an exhibition, thereby limiting the validity of the study but should be good enough, given that it is one of the early researches to explore the matter. Demain, et al., (2013) failed to clearly stipulate the guiding theoretical assumption or principle, which seems to be a whole systems approach as touched on in the final sentences of the study report. Nonetheless, the inclusion of all possible participants in the production and use of assistive technologies, i.e., the rehabilitation patients, caregivers, health care professional, and the product themselves (representing the manufacturers/engineers) already reflected the whole systems approach of the study. Demain, et al. (2013)

    <a href="https://medium.com/@everythingessays" style="text-decoration:none;" >Ralisa Shape</a>

    Competing interests

    None

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