An example of the adaptation of the Nominal Group Technique (NGT) to a virtual format (vNGT) within healthcare research.

The Nominal Group Technique (NGT) has been used to establish clinical priorities and generate guidelines within healthcare since its creation over fifty years ago. It is characterised by its five distinct stages; introduction, silent idea generation, 'round robin', clarifications and rating or ranking. A key element traditionally has been the inclusion of face-to-face discussion, however in the context of COVID-19 innovations were required. This article provides a case study illustrating an adaptation of the NGT to a virtual format (vNGT) and outlines the processes involved in a virtual NGT (vNGT), using an illustrative study exploring the rehabilitation of stroke survivors. The vNGT offers opportunities for global collaborations without the constraints of geography or incurred costs. Future studies should evaluate it's acceptability for stroke survivors to enable their participation within research.Summary statement1. This study provides a guide for the use of virtual nominal group technique (vNGT), using a freely available video-conferencing platform2. vNGT increases opportunities for global collaborations whilst incurring minimal costs.3. It remains unclear how feasible this procedure is with patient populations who have potentially less digital confidence and access.This work was supported by NIHR ARC-East Midlands, Grant number NIHR200171.

Barriers and facilitators in providing home-based rehabilitation for stroke survivors with severe disability in the UK: an online focus group study with multidisciplinary rehabilitation teams.

OBJECTIVES: In the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our previous research has focused on establishing consensus regarding the core components of home-based rehabilitation for this under investigated group. This study explores the barriers of providing rehabilitation and identifies strategies to overcome them. DESIGN: Three focus group interviews were conducted with n=20. The context coding framework was employed to organise the transcribed data and to facilitate inductive and deductive analysis and synthesis. SETTING: Online, MSTeams, UK. PARTICIPANTS: A purposive sample of 20 National Health Service clinical staff participants, from 3 multidisciplinary teams providing home-based stroke rehabilitation for this population (n=7, 6 and 7). RESULTS: High levels of need were reported across multiple domains for survivors including continence, communication and physical function. Interventions often required multiagency collaboration in order to optimise the available resources and specialist skills. There was lack of clarity regarding who was ultimately responsible for providing components of rehabilitation for stroke survivors with severe disability. Teams provide rehabilitation for this population but are insufficiently commissioned or resourced to fully meet their needs. In-complete and disjointed pathways with resultant healthcare inequalities were commonly reported. Teams used a variety of strategies to overcome these barriers and optimise rehabilitation opportunities. These included upskilling a diverse range of partners to capitalise on the skills and resources across health, social care and voluntary sector boundaries employing multiagency collaboration. Teams established and engaged networks of stakeholders in order to advocate on behalf of stroke survivors. CONCLUSIONS: Collaboration and partnership working is important in the delivery of rehabilitation for stroke survivors with severe disability. Commissioners need to be aware that cross-agency multidisciplinary expertise is required, if rehabilitation opportunities are to be realised and existing health inequalities addressed.

Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability.

In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge. OBJECTIVES: To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus. SETTING: Virtual nominal group technique (vNGT) across the UK. PARTICIPANTS: Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience. METHODS: Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique's five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements. RESULTS: A combined total of 421 statements achieved positive consensus (>75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required. CONCLUSION: The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.