Adapting Dance to Complex Clinical Contexts: A Methodology Model.

BACKGROUND: While the content of health-related dance interventions is still relatively undocumented in the literature, the processes of adapting dance to specific situations are even less so, and rarely seem to be based on theoretical or practical guidelines. Yet the description of these processes could guide the adaptation of other interventions. PURPOSE: This study aimed to document the process of adapting a dance intervention in a complex clinical setting, in order to propose a methodology that could inspire the development of other interventions in specific clinical contexts. METHODS: The adaptation methodology described in this article is part of an embedded single-case study, where the case unit was the adaptation process of a dance group intervention and the subunits of analysis were the intervention's clinical and theoretical premises, content, and pedagogy. Participants were rehabilitation therapists (n=21), patients (n=6), relatives (n=4), and rehabilitation assistants (n=4). Data were collected through various techniques (focus groups, situational observation, pilot dance sessions, interviews, critical incidents, research journals, template for intervention description and replication/TIDieR checklist, and video recordings) to allow an iterative adaptation process. Data were analyzed using inductive qualitative analysis. RESULTS: Adaptations were made prior to and throughout the intervention, taking into account relevant scientific and disciplinary knowledge, as well as the different actors' implicit and explicit experiences. The intervention pedagogy focused on adapting the dance content to meet the participants' needs while inviting them to self-adapt this content. The resulting methodology model includes four stages: preliminary design, validation with rehabilitation therapists, specific tailoring, and ongoing tailoring. Conclusion: Optimizing the adaptation of dance and ensuring its complementarity within a complex clinical context requires collaboration with the different disciplinary clinicians in order to offer synergistic coherence and ensure dance's contribution to therapeutic objectives.

Rehabilitation Supported by Technology: Protocol for an International Cocreation and User Experience Study.

BACKGROUND: Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. OBJECTIVE: With this joint research activity, this study primarily aims to gain insight into each living lab's infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. METHODS: This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. RESULTS: Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. CONCLUSIONS: The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/34537.

Use of Adapted Dance to Intensify Subacute Rehabilitation Post-Stroke: A Qualitative Study on the Participation Experience and Active Participation Time.

Background: Strategies are still needed to intensify stroke rehabilitation. As an alternative therapy, dance warrants examination since its multimodal nature appears to offer an enjoyable means of engaging in a rehabilitation activity. Objectives: (1) To describe the participation experience in an adapted-dance group intervention, and (2) to study the patients' active participation time. Methods: In this embedded single-case study, the experience of participating patients, relatives and rehabilitation assistants was examined through semi-structured interviews. The verbatim transcripts underwent thematic analysis (qualitative method), while the patients' active participation time was examined through audiovisual recordings analyzed by type and length of engagement time (quasi-qualitative method). Setting: The study was conducted in the neurology department of a rehabilitation hospital. Participants: The study included patients doing intensive functional rehabilitation post-stroke (≤25 days) (n = 6), relatives (n=4) and rehabilitation assistants (n = 4). Patients were recruited irrespective of their neurologic impairments. Their mean age was 71.0 years ± 9.9 years (range 59 to 86 years). Intervention: An adapted-dance group intervention ranging from moderate to somewhat hard/hard intensity was added to their rehabilitation program in the form of biweekly sessions of 55 minutes each, for up to 10 weeks. Carried out mainly on chairs, the intervention borrowed from dance approaches, rehabilitation practices, and movement-based educational approaches. Results: Observed adherence reached 82%. The participation experience involved 3 types of participation incentives (what motivated, fostered and facilitated their participation) and 4 types of perceived effort (unconscious, self-regulated, feasible and appropriate) conducive to participation. Mean motor engagement time of 50 minutes 4 seconds/session ± 2.53 minutes was observed in patients. Conclusion: The use of an adapted-dance group intervention can contribute to the intensification of stroke rehabilitation and have a positive impact on motivation and perceived effort.

Adapted dance used in subacute rehabilitation post-stroke: impacts perceived by patients, relatives and rehabilitation therapists.

Purpose: To examine the perceived impacts of an adapted-dance group intervention when added to intensive functional rehabilitation post-stroke.Method: In this exploratory qualitative case study, semi-structured interviews were analyzed using a deliberative inductive logic and referring to the International Classification of Functioning, Disability and Health. Participants were patients in rehabilitation post-stroke (≤25 days) (n = 6), relatives (n = 4) and rehabilitation therapists (n = 12). Selection was on a voluntary basis. The intervention added to the patients' rehabilitation program consisted of 55-minute bi-weekly sessions for 10 weeks.Results: Three categories of perceived positive impacts emerged from the data: (1) mobility, (2) mental functions and personal factors (emotional functions, motivation and self-efficacy) and (3) interpersonal interactions and social life. A fourth category of perceived impacts involving exercise tolerance was both positive, in terms of general physical endurance, and negative, in terms of a feeling of increased fatigue.Conclusion: Such an adapted-dance intervention holds promise in subacute rehabilitation post-stroke. Its main strength lies in its perceived positive impact on mental functions, personal factors, and interpersonal and social interactions.Implications for rehabilitationAn adapted-dance group intervention could offer an innovative means of contributing to intensive functional rehabilitation post-stroke by potentially generating positive perceived impacts on emotional functions, motivation and self-efficacy, as well as on interpersonal and social interactions.Adapted dance could be added to inpatients' rehabilitation with only minor impacts on fatigue.