Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation.

AIM: To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. SETTING: The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. METHODS, PARTICIPANTS AND ANALYSIS: A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. RESULTS: Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. CONCLUSION: Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.

By using process evaluation, the user acceptability of newly developed and complex interventions can be evaluated.ICT and app-based solutions can support cross-sectoral person-centred and empowering stroke rehabilitation.Therapists play an important role in implementing and supporting stroke survivors using app-based solutions to support person-centred and empowering stroke rehabilitation.

Using experience-based co-design to develop mobile/tablet applications to support a person-centred and empowering stroke rehabilitation.

AIM: To investigate and describe the process of using experience-based co-design (EBCD) to develop mobile/tablet applications to support a person-centred and empowering stroke rehabilitation. SETTING: Two cross-sectoral stroke rehabilitation settings in Denmark comprising six rehabilitation units. PARTICIPANTS: Stroke survivors (n = 23), significant others (n = 18), occupational therapists (n = 12), physiotherapists (n = 9), representative of a patient organization (n = 1), application developers (n = 3) and researchers (n = 2). METHOD: A structured, facilitated EBCD approach comprising six stages was used to co-design a service that aimed to address the priorities and needs of all relevant end-users. Data were collected by interviews, participant observations, notes on "flip sheets" and written feedback on the content in the apps and on the instruction pages. Data were analyzed descriptively and with a constructivist grounded theory analysis. RESULTS: The content in the application solutions "Mit Sygehus" and "Genoptræn.dk" were co-designed to support the needs identified by all end-users. Relevant evidence-based knowledge, person-centred exercises and guidelines using video recordings were the most important among the developed content in the applications to support person-centred and empowering stroke rehabilitation. Furthermore, easy, and seamless communication were considered important. CONCLUSIONS: EBCD facilitated the development of content in the applications to support a person-centred and empowering stroke rehabilitation. Participants experienced that their contribution was considered important and valued.

Many app-based solutions exist to support stroke rehabilitation; however, stroke survivors and significant others are seldom involved in the design of these solutions, which often reduces the uptake in clinical setting.By involving stroke survivors, significant others, therapists from diverse rehabilitation settings, patient organizations, app-designers, and researchers, we co-designed the content in two app-solutions to support a person-centred and empowering stroke rehabilitation, based on the needs and wishes of all stakeholders. Stroke survivors and significant others experienced that their voices were heard throughout the co-design process, and that their contribution was considered important and valued.

Occupational and Physiotherapy modalities used to support interdisciplinary rehabilitation after concussion: A Scoping Review.

OBJECTIVE: To identify and describe occupational and physiotherapy rehabilitation modalities used to support an interdisciplinary rehabilitation in adults (aged 16 + years) with concussion. METHODS: A scoping review methodology was used. Included studies were categorized according to Wade's elements of rehabilitation and the Danish White Paper definition of rehabilitation. RESULTS: Ten studies were included in this review, addressing: "assessment" (n = 9), "goal-setting" (n = 4), "training" (n = 10), and "social participation and discharge support" (n = 4). Interventions were delivered mainly by physiotherapists or an interdisciplinary team. In two studies occupational therapists were part of the interdisciplinary team. Randomized controlled trials more often addressed several of the rehabilitation elements using interdisciplinary intervention delivery. No studies specifically aimed their intervention at patients with acute or subacute concussion. CONCLUSION: The therapeutic modalities identified were: (i) manual and sensory motor interventions; (ii) physical exercises; and (iii) management of, or coping with, symptoms. More research is needed on how to better support social participation and discharge or return to work in the rehabilitation process. In addition, interventions delivered in the acute phases of concussion need further exploration.

Use of Mobile/Tablet and Web-Based Applications to Support Rehabilitation After Stroke: A Scoping Review.

OBJECTIVE: To describe and review evidence of mobile/tablet and web-based applications to support the rehabilitation process after stroke. The secondary aim was to describe participants' stroke severity, and use of applications in relation to, respectively, the setting and phase of the rehabilitation process. METHODS: A scoping review methodology was used to identify studies, through databases such as Pub-Med, CINAHL, Embase and AMED. In addition, grey literature was searched. The studies were categorized according to Wade's model of rehabilitation. RESULTS: The literature search resulted in 12,065 records. Forty-six studies were included, in which applications were used to support: assessment (n = 16); training (n = 25); discharge from hospital (n = 2); and 2 studies were targeted at supporting discharge/education/information and training. One study targeted assessment, discharge support and goal-setting. No studies were related to the element "participation" using Wade's model of rehabilitation. Of the 46 studies, 33 studies included participants with mild to moderate stroke, and 4 studies included participants with severe stroke. In 9 studies the stroke severity was not reported. Twenty three studies included participants with chronic stroke, 16 acute and/or subacute stroke, and 5 included participants with acute and/or subacute and/or chronic stroke. In 2 studies, stroke onset was not reported. Applications were used in a rehabilitation setting (n = 21), home setting (n = 17), and both settings (n = 3). In 5 studies the setting was not reported. CONCLUSION: Most studies of applications developed to support the rehabilitation process after stroke have been explorative. They primarily include participants with mild or moderate stroke and focus on a limited aspect of the rehabilitation process, e.g. assessment or training. Future applications to support stroke rehabilitation should accommodate stroke survivors' and significant others' need for solutions, irrespective of stroke severity and throughout the entire rehabilitation process.

Physiotherapists' and occupational therapists' perspectives on information and communication technology in stroke rehabilitation.

AIM: The aim of this study was to explore the current and potential use of information and communication technology (ICT) to enhance coherent person-centred rehabilitation after stroke, from the perspectives of physiotherapists and occupational therapists. METHOD: Five occupational therapists and four physiotherapists from different phases of the Danish stroke rehabilitation process were included and two focus group interviews were carried out. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. RESULTS: Three subcategories were identified from the analysis of interviews with participants: 1) ICT and apps as meaningful and supportive in the rehabilitation process, 2) ICT as a tool in communication and documentation and 3) Barriers to the integration of ICT and apps in the rehabilitation process. From these categories one core category emerged: The potential of a personalized app solution to facilitate coherent person-centred rehabilitation. CONCLUSION: ICT was perceived as important to integrate in stroke rehabilitation both for assessment, training and to compensate for remaining deficits. The development of a personalized app solution could accommodate stroke survivors' and significant others' need for insight into and overview over the rehabilitation process as well as access to relevant information, which would thereby empower them. Furthermore, a personalized app solution could also facilitate follow-up after discharge and was perceived to ease the communication and documentation within and between sectors, as well as communication with both stroke survivors and significant others.

Significant others' perspectives on person-centred information and communication technology in stroke rehabilitation - a grounded theory study.

Aim: The aim of this study was to explore significant others' perspectives on how information and communication technology can support the rehabilitation process after stroke and facilitate participation in everyday life.Method: Thirteen significant others were included in the study, and to capture their perspectives, two focus groups, and five individual interviews were carried out in Denmark and Sweden 6-12 months after the stroke incident. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis.Results: Five subcategories were identified from the analysis of the interviews: (1) Information and communication technology providing a sense of security, (2) Information and communication technology as a social mediator, (3) Information and communication technology as a compensator for deficits, (4) Information and communication technology as a way to reach information, and (5) Information and communication technology as a possibility to supplement the rehabilitation process. From these categories, one core category emerged: The potential of information and communication technology to facilitate participation in everyday life and thereby reduce the strains that significant others experience after stroke.Conclusion: Information and communication technology has the potential to facilitate participation in everyday life after stroke. It is important, therefore, to start using information and communication technology in the rehabilitation process after stroke, to bring meaning to everyday life and to support both the stroke survivors and their significant others.IMPLICATIONS FOR REHABILITATIONIntegration of information and communication technology in the rehabilitation process after stroke can accommodate several of the significant others´ needs.Educating stroke survivors to use information and communication technology as part of the rehabilitation process offloads their significant others.Integration of information and communication technology in the rehabilitation process after stroke can bring new meaning in everyday life and can facilitate both independence and participation in everyday life.