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Parker J.1, Mawson S.1, Mountain G.2, Nasr N.1, Zheng H.3
1University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, United Kingdom, 2University of Bradford, School of Dementia Studies, Bradford, United Kingdom, 3Ulster University, School of Computing & Maths, Newtownabbey, United Kingdom
Background: Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. Exploring the use and potential for these systems necessitates a complex methodological approach as described by the MRC framework by asking what works, for whom and in what circumstances and respects.
Purpose: This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home.
Methods: Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, what works for whom and in what circumstances and respects?
Results: Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms.
Conclusion(s): Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery.
Implications: Exploring complex interventions often require innovative exploratory methodological approaches to understand the intricacies of interventions and answer the questions what works for whom and in what circumstances and respects?
The adoption of realist evaluation can provide a framework at the early stages of the MRC framework to provide a platform for further research and successful trials.
Funding acknowledgements: This was supported by The University of Sheffield, Sheffield Hallam University and the Engineering and Physical Sciences Research Council (EPSRC)
Topic: Research methodology & knowledge translation
Ethics approval: Ethical approval was given by the South Yorkshire Research Ethics Committee Ref: 08/H1310/63
All authors, affiliations and abstracts have been published as submitted.
