Burke, J., Palmer, R. orcid.org/0000-0002-2335-7104 and Harrison, M. orcid.org/0000-0001-9874-921X (2021) What are the factors that may influence the implementation of self-managed computer therapy for people with long term aphasia following stroke? A qualitative study of speech and language therapists’ experiences in the Big CACTUS trial. Disability and Rehabilitation, 44 (14). pp. 3577-3589. ISSN 0963-8288
Abstract
Purpose
To explore speech and language therapists’ (SLT) experiences of delivering therapy using a computerised self-management approach within a pragmatic trial, in order to identify and understand key factors that may influence the implementation of computerised approaches to rehabilitation for aphasia in routine practice.
Methods
Qualitative semi-structured telephone interviews were conducted with eleven SLTs delivering computer therapy in the multisite Big CACTUS trial. The interviews were recorded, transcribed verbatim and analysed using thematic analysis in NVivo11.
Results
Five themes with implications for implementation emerged: 1) characteristics of the intervention: complexity and adaptability 2) knowledge and beliefs about the intervention: familiarity with computers and the benefits of training; 3) patient needs and the service resource dilemma: “is there anything I can be doing on my computer at home?”; 4) networks and communications; 5) reflecting and evaluating: adaptations for sustainability.
Conclusions
Personalisation, feedback and volunteer/assistant support were viewed as benefits of this complex intervention. However, the same benefits required resources including therapist time in learning to use software, procuring it, personalising it, working with volunteers/assistants, and building relationships with IT departments which formed barriers to implementation. The discussion highlights the need to consider integration of computer and face-to-face therapy to support implementation and potentially optimise patient outcomes.
IMPLICATIONS FOR REHABILITATION
Benefits of the self-managed computer approach to word finding therapy evaluated in the Big CACTUS trial included the ability to personalise content, to provide feedback, and provide support with volunteers or assistants depending on availability in different clinical contexts to enable repetitive self-managed practice of word finding.
Whilst use of computer therapy approaches can facilitate self-management of practice and increased therapy hours in an efficient manner, services need to consider the resources required to implement and support the approach: costs of software and hardware SLT time required to learn to use the software, tailor and personalise it and manage volunteers/assistants.
Readiness for successful adoption of computer approaches requires building of relationships and mutual understanding of requirements between SLT and IT departments within an organisation.
For time efficiency, it is recommended that SLTs providing self-managed computer therapy approaches pilot the approach with each individual to check patient ability and engagement before fully investing SLT time in personalisation and tailoring of software.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2021 Informa UK Limited, trading as Taylor & Francis Group. This is an author-produced version of a paper subsequently published in Disability and Rehabilitation. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Aphasia; stroke; rehabilitation; computer therapy; self-management; implementation |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 18 Jan 2021 10:59 |
Last Modified: | 06 Jun 2024 11:25 |
Status: | Published |
Publisher: | Informa UK Limited |
Refereed: | Yes |
Identification Number: | 10.1080/09638288.2020.1871519 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:170141 |