A mixed methods service evaluation of a pilot functional electrical stimulation clinic for the correction of dropped foot in patients with chronic stroke

Abstract

Aim: To undertake a service evaluation of the pilot Lothian functional electrical stimulation (FES) clinic using both quantitative and qualitative methods and clinical practice reflection. Background: Clinical guidelines recommend that FES, for the management of dropped foot after stroke, is delivered by a specialist team. However, little detail is provided about the structure and composition of the specialist team or model of service delivery. A pilot Lothian FES clinic was developed to explore the clinical value of providing such a service to stroke patients with dropped foot and identify any service modifications. Methods: Mixed methods were used to evaluate the service and included quantitative, qualitative and reflective components. Phase 1: Before and after service evaluation of patients attending the FES clinic between 2003 and 2007. Outcomes of gait velocity and cadence were recorded at initial clinic appointment and 6 months after application of FES. Phase 2: Qualitative research exploring patients with stroke and carers' experiences of the FES clinic. Data were collected via semi-structured interviews. Phase 3: A reflection on the service delivery model. Participants: Phase 1: 40 consecutive out-patients with stroke; Phase 2: 13 outpatients with stroke and 9 carers; Phase 3: Three specialist physiotherapists engaged in running the FES clinic. Findings: Statistically significant improvements (p , 0.001) were demonstrated in gait velocity and cadence. Qualitatively, one super-ordinate theme 'The FES clinic met my needs' emerged. Within this were four sub-themes, namely 1. 'Getting to grips with FES wasn't difficult'; 2. 'It's great to know they're there'; 3. 'Meeting up with others really helps' and 4. 'The service is great but could be better'. On reflection, minor modifications were made to the service delivery model but overall the service met user needs. This dedicated FES clinic produced positive physical outcomes and met the needs of this chronic stroke population.

Advances in neuroprosthetic management of foot drop: a review

“…FES uses electrical pulse trains on the muscle or peripheral nervous system to trigger a controlled tetanic muscle contraction [9,10,[19][20][21]. The shape of the individual pulses that make up the electric pulse trains has an effect on the muscle response.…”

Functional electrical stimulation for restoration of gait and motor recovery after a stroke. Review of scientific literature

“…Ряд исследований свидетельствует о статистически значимом улучшении скорости ходьбы во время проведения 10-минутного теста ходьбы (10 min walking test) как при отдельном использовании аппарата ФЭС, так и в сочетании с традиционной реабилитацией [30][31][32]. Результаты другого исследования показали статистически значимое повышение скорости ходьбы и улучшение последовательности шага после 6 мес применения ФЭС (p < 0,001) [33].…”

Conception, Development, and Clinical Trial Design of Point-of-care Technologies: A Case of Improved FES Device Development

“…In our independent analysis, after discussions with clinicians at the National Institute of Orthopaedically Handicapped (NIOH) at Kolkata, we found that very limited options (like conventional physiotherapy) are available for the rehabilitation of stroke survivors in India. The recent literature on advances in stroke rehabilitation and the National Health Science (NHS-UK) guidelines on neurological disorders recommend the use of FES in correcting the problem of foot drop 7 . The operating cost is the most important determinant for this rehabilitation technology from the perspective of the population of developing countries.…”