在卒中随机对照可行性试验的背景下实施动态Lycra®矫形器进行手臂康复:一项使用归一化过程理论的定性研究。

IF 2.3 Q1 REHABILITATION Rehabilitation Process and Outcome Pub Date : 2020-08-31 DOI:10.1177/1179572720950210
Joke Delvaux, Alexandra John, Lucy Wedderburn, Jacqui Morris
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引用次数: 3

摘要

目的:作为一项可行性随机对照试验的一部分,探讨非研究资助的康复从业者如何在康复实践中使用动态Lycra®矫形器进行中风后手臂恢复。设计:定性访谈研究。设置:两个中风住院病房和相关的康复病房。受试者:作为可行性随机对照试验的一部分,有目的地选择了15名参与提供动态Lycra®矫形器的中风康复从业者。方法:在试验结束时进行半结构化访谈。访谈调查了他们使用矫形器的经验。规范化过程理论构建了访谈指南和知情数据分析。NVivo软件支持数据分析。结果:尽管矫形器的有效性(认知参与)存在不确定性,但从业者在面对其确切作用机制的不确定性时直观地理解了干预(规范化过程理论结构:连贯性),并支持对研究的承诺。然而,他们确实根据感知的治疗需求、自己的技能和中风幸存者的偏好(集体行动)调整了干预措施。他们不确定收益(反射性监控)。在4个理论结构中,人们发现了对干预的矛盾心理。结论:歧义干扰了实施,但只是在一定程度上只要实施不破坏从业者和中风幸存者之间的关系,足够好的连贯性、认知参与、集体行动和反射性监测就足以启动正常化。歧义源于从业者对干预理论和行动机制的不确定性。使干预行动机制对从业者更加明确可能会影响他们如何实施和调整研究干预,并可能决定这些过程是否会破坏或增强结果。
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Implementation of Dynamic Lycra® Orthoses for Arm Rehabilitation in the Context of a Randomised Controlled Feasibility Trial in Stroke: A Qualitative study Using Normalisation Process Theory.

Objective: To explore how non-research funded rehabilitation practitioners implemented dynamic Lycra® orthoses for arm recovery after stroke into rehabilitation practice, as part of a feasibility randomised controlled trial.

Design: Qualitative interview study.

Setting: Two in-patient stroke units and associated rehabilitation units.

Subjects: Fifteen purposefully selected stroke rehabilitation practitioners involved in delivery of dynamic Lycra® orthoses as part of a feasibility randomised controlled trial.

Methods: Semi-structured interviews conducted at the end of the trial. Interviews examined their experiences of orthosis implementation. Normalisation Process Theory structured the interview guide and informed data analysis. NVivo software supported data analysis.

Results: Practitioners intuitively made sense of the intervention in the face of uncertainty about its precise mechanisms of action (Normalisation Process Theory construct: coherence) and espoused commitment to the research, despite uncertainty about orthosis effectiveness (cognitive participation). They did however adapt the intervention based on perceived therapeutic need, their own skillsets and stroke survivor preference (collective action). They were uncertain about benefits (reflexive monitoring). Across the 4 theoretical constructs, ambivalence about the intervention was detected.

Conclusions: Ambivalence interfered with implementation - but only to an extent. 'Good-enough' coherence, cognitive participation, collective action and reflexive monitoring were sufficient to initiate normalisation - as long as implementation did not undermine the relationship between practitioner and stroke survivor. Ambivalence stemmed from practitioners' uncertainty about the intervention theory and mechanisms of action. Making intervention mechanisms of action more explicit to practitioners may influence how they implement and adapt a research intervention, and may determine whether those processes undermine or enhance outcomes.

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审稿时长
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期刊最新文献
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