Experiences and perceptions related to post-stroke walking function and gait rehabilitation: A mixed methods analysis Open Access
Leone, Taylor (Spring 2024)
Abstract
Introduction
Stroke is a leading cause of death and adult disability worldwide. The experiences and perceptions of individuals undergoing rehabilitation and therapy are under-studied and need to be further researched to improve global secondary care and design more tailored and efficacious interventions. This case series, conducted as part of an ongoing gait rehabilitation clinical trial evaluated the experiences and perceptions of individuals undergoing fast treadmill walking paired with functional electrical stimulation to improve gait function post-stroke.
Methods
A mixed methods approach was used to evaluate four participants’ (N=4) perceptions, outcomes, and experiences of the gait study. Qualitative in-depth interviews were conducted with each participant after completing the study. The Timed Up and Go (TUG) and 10-meter-walk (10MWT) tests at the fast and self-selected speeds were conducted at several time points of the gait training study to assess changes in walking function.
Results
Three of 4 participants improved their self-selected 10MWT walking speed between pre-training and follow-up. All four participants increased speed in the fast 10MWT between pre-training and follow-up. Two of 4 participants increased their TUG scores between pre-training and follow-up. Interview data revealed themes important for the uptake and acceptability of the intervention: communication style of providers, motivators, positive mentality, staff participation, outside physical activity, and perception of walking capability and control during and after the gait training study.
Discussion
This study provides important guidance on how to make post-stroke gait recovery programs more acceptable and motivating for participants. Promotion of positive perceptions of gait recovery post-stroke may have lasting impacts on reducing the risk of injury from falls and other negative health outcomes. Future research on this topic should be conducted with a larger sample size. There is potential for adaptability of the results of this thesis globally to low- and middle-income country (LMIC) rehabilitation settings that should be explored in the future. These have the potential to contribute to alleviating the global burden of injury from falls and functional disability post-stroke due to gait impairments.
Table of Contents
INTRODUCTION 1
BACKGROUND 3
METHODS 7
Biomechanical and Neural Mechanisms of Post-stroke Gait Training: Participants and Methods 7
Quantitative Outcomes Assessments 8
Qualitative In-depth Interviews 9
Data Analysis 10
RESULTS 11
Participant Demographics 11
Clinical Outcomes 11
Self-selected 10-meter walk test11
Fast 10-meter-walk test 12
TUG Test 13
Qualitative In-Depth Interviews Analytical Themes 16
Communication and information are powerful tools 16
Maintaining positivity 16
Positive perception of previous therapy/study experiences post-stroke 17
Active participation of staff valued 17
Internal drives are powerful motivators 18
Training was not a challenge 19
Drive for high levels of physical activity during the study outside of training sessions 19
Conscientiousness of walking fundamentals 20
Perceived improvement 21
DISCUSSION 25
Communication and participation of staff 25
Increased physical activity during the study period and conscientiousness of step fundamentals 26
Clinical measures of improvement 27
Perceived measures of improvement 30
Clinical and Public Health Recommendations 30
Communication and interactions 30
Perceived versus clinical improvement 31
Future Research 32
Strengths and Limitations 33
Conclusions 33
References 35
Appendix A. In-Depth Interview Guide. 41
About this Master's Thesis
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