A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

• Published in: Journal of neuroengineering and rehabilitation 2021-07, Vol.18 (1), p.1-121, Article 121
• Main Authors: Celian, Courtney, Swanson, Veronica, Shah, Maahi, Newman, Caitlin, Fowler-King, Bridget, Gallik, Sarah, Reilly, Kaitlin, Reinkensmeyer, David J, Patton, James, Rafferty, Miriam R
• Format: Article
• Language: English
• Subjects: Analysis; Beliefs, opinions and attitudes; Care and treatment; Clinical decision making; Codes; Cognitive ability; Complexity; Content analysis; Decision making; Engineering; Head injuries; Implementation; Inpatient rehabilitation; Interdisciplinary aspects; Multiple sclerosis; Nervous system diseases; Neurologic rehabilitation; Neurology; New technology; Occupational therapists; Occupational therapy; Patients; Physical therapists; Practice; Qualitative analysis; Qualitative research; Rehabilitation; Rehabilitation technology; Spinal cord injuries; Technology application; Therapists; Training; Traumatic brain injury
• ISSN: 1743-0003; 1743-0003
• DOI: 10.1186/s12984-021-00911-6

Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists' real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians' comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects. Keywords: Rehabilitation technology, Occupational therapists, Physical therapists, Inpatient rehabilitation, Neurologic rehabilitation, Implementation