The aim of the study was to gather information from therapists that would inform the design of an UL FES Rehab Tool for treatment of the hemiplegic upper limb post stroke.
4.2.1 Methods
A combination of secondary and primary data collection was used for three of the four therapist advisory group meetings. The secondary data collection utilised the literature review in chapter 2 (the neuroscience literature that underpins motor re-learning following stroke, a review of FES studies, particularly those that use sensors to trigger stimulation, a review of existing FES systems and their efficacy, technology adoption and usability). This was necessary to inform the focus of the therapist advisory groups (deductive approach). The primary data collection was the data generated from within the four advisory groups (inductive approach). The inductive approach (Boyatzis, 1998) was felt to be essential in order to allow ideas and comments to flow freely from the therapists during the meetings. Constraining these discussions too much could have led to a ‘loss of richness’ of the data. This combination of secondary and primary data was used to inform the overall design requirements of the new system. All meetings followed a participatory design (PD) philosophy. PD has been defined as “a strong commitment to understanding practice, guided by the recognition that designing the technologies people use in their everyday activities shapes, in crucial ways, how those activities might be done” (Robertson & Simonsen, 2012, pg.5). Every participant is viewed as an expert and as a stakeholder whose voice needs to be heard. This type of approach goes some way to ensuring that the final design of the UL FES Rehab Tool is usable in practice. Fundamental to this project, it enabled technical and non-technical participants to take part on equal terms. It provides a forum that is conducive to understanding professional backgrounds and practice, identifying issues and perhaps most importantly, provides an opportunity to enhance user buy-in.
The first therapist advisory group meeting explored current rehabilitation practice for the hemiplegic upper limb and identified patients who might benefit from an advanced FES Rehab Tool. Specific trigger questions were put to the therapists to facilitate discussion. The second meeting identified relevant FES tasks, FES
73 parameters and practice schedules for patients who might use the system. At the third meeting the attendees were invited to comment on a mock-up of the first prototype of the software user interface (GUI). The fourth meeting’s aim was to identify how bio- feedback was used in current practice and what type of feedback might be useful to guide patient performance during the relearning of functional tasks. In addition to this, therapists were asked to identify which data from the system would be useful when it came to analysing patient’s performance during and following treatment sessions. The fifth and final meeting was used to validate the therapists design requirements. They were asked to rank these in order of importance using a 5 point Likert type scale, where 0 = not important, through to 4 = extremely important. It was also used to gain therapists input to the design of the proof of concept clinical trial.
4.2.2 Advisory group participants
In order to gain a range of views from potential users of the software tool, invitations to join the therapist advisory group were sent to a number of clinicians from both community and acute stroke settings across Greater Manchester, using clinical networks from the authors’ department. Although convenience sampling is a non- probability sampling technique (Lund Research Ltd, 2012), the sample was felt to be sufficiently representative of the final FES system users to allow generalisability of the findings. Previous researchers have advocated that user involvement in medical assistive technology design be sufficiently representative of the final users of the device, in this case, occupational therapists and physiotherapists (MATCH, 2010). A decision was made in advance to allow a maximum number of 12 participants, as this was felt to be the maximum manageable size for this type of group, and would allow for drop out in the eventuality that participants were unable to attend. Ultimately only 11 senior clinicians, namely, 6 physiotherapists and 5 occupational therapists (2 males & 9 females) expressed an interest in joining the group. A total of 5 advisory groups were planned for the first stage of the design. Each user group was facilitated by an experienced academic physiotherapist. A combination of semi-structured group discussions, patient case studies and mock up design presentations were used to focus the discussions. Each meeting was video recorded and 2 researchers also took field notes during the meetings. Only the data from meetings 1 to 4 will be reported on in
74 this chapter, as they were most pertinent to the design requirements. Table 4.1 below displays the therapist composition of each meeting and the meeting number attended. Table 4.1: Table displaying the participant ID, designation, novice (N) or expert FES user (E) and meeting number attended
4.2.3 Data analysis
Thematic analysis was used to analyse the data from the first meeting in order to identify key themes that emerged (Daly, Kellehear, & Gliksman, 1997). The process involved the identification of themes through “careful reading and re-reading of the data” (Rice & Ezzy, 1999, pg. 258). Thematic analysis is a form of pattern recognition where the emerging themes become the categories for the analysis (Fereday & Muir-Cochrane, 2006). The stages of data analysis were as follows:
Participant ID Designation Novice (N) or Expert (E) FES user Meeting number attended PT1 Band 8, Physiotherapist E 1,2,3,5 OT1 Band 7, Occupational therapist N 1,3,5 PT2 Band 7, Physiotherapist N 1,2,3,4,5 PT3 Band 6, Physiotherapist N 1,2,3, OT2 Band 6, Occupational therapist N 1,2,3,4 PT4 Band 7, Physiotherapist N 1,2,3 PT5 Band 6, Physiotherapist N 1,2,3,4,5 OT3 Band 5, Occupational therapist N 1, 3 PT6 Independent Physiotherapist E 1,2,3,4,5 OT4 Band 6, Occupational therapist N 1,2,3,4,5 OT5 Band 7, Occupational therapist E 3
75 Table 4.2: Stages of the data analysis process, adapted from Fereday and Muir-Cochrane (2006).
Stage Action Conducted by
Stage 1 Transcribing the raw data Author
Stage 2 Summarising and identifying initial
themes Author
Stage 3 Review of initial themes and coding to form ‘higher order’ themes Author, co-researchers and the design team collectively
Stage 4
Connecting, ordering & re-coding the themes to establish relationships
between themes
Author and design team collectively.
Stage 5 Corroborating and legitimating coded themes
Author with advisory group therapists and by referring back to the literature