Implementing functional electrical stimulation clinical practice guidelines to support mobility: A stakeholder consultation

Abstract

Functional Electrical Stimulation (FES) has been used to support mobility for people with upper motor neuron conditions such as stroke and multiple sclerosis for over 25 years. Recent development and publication of clinical practice guidelines (CPGs) provide evidence to guide clinical decision making for application of FES to improve mobility. Understanding key barriers to the implementation of these CPGs is a critical initial step necessary to create tailored knowledge translation strategies. A public involvement and engagement consultation was conducted with international stakeholders including researchers, clinicians and engineers working with FES to inform implementation strategies for CPG use internationally. Reflexive thematic analysis of the consultation transcripts revealed themes including inconsistent use of CPGs, barriers to implementation such as limited access to FES and low clinician confidence, and the need for a tiered education approach with ongoing support. Insights derived from this consultation will inform the development of knowledge translation strategies to support the next steps to implementing FES use for mobility.

Clinician perception of clinical guidelines and confidence in using electrical stimulation technologies

“…Consultation on the implementation of FES CPGs with clinicians revealed a number of potential barriers. 4 Experienced clinicians, working in specialist FES clinical settings, were concerned that CPGs would be too prescriptive and restrict their current practice, not allowing enough opportunity for clinical judgment and recognition of individual patients' needs and goals. This perspective was influenced by previous experience with CPG recommendations that were limited in scope and appeared inconsistent with the clinician's experience of individual patient cases.…”

“…10 Our consultation also found clinician confidence in using the technology was an important factor for future implementation of the intervention. 4 Less experienced clinicians from nonspecialist FES centers were more likely to express issues with clinician confidence due to a wide range of factors including working independently in the community without support structures available from an experienced team. 4 Clinician confidence also appeared to be influenced by a lack of ongoing support following an initial educational course in FES.…”

“…4 Less experienced clinicians from nonspecialist FES centers were more likely to express issues with clinician confidence due to a wide range of factors including working independently in the community without support structures available from an experienced team. 4 Clinician confidence also appeared to be influenced by a lack of ongoing support following an initial educational course in FES. Clinicians expressed difficulty with keeping up to date with the increasing number of FES devices available and updates in the technology due to limitations of funding and time resources.…”

“…Some barriers are of particular relevance to the successful implementation of FES. 4 Clinician perception of CPGs and clinician confidence in using FES technologies are two potential barriers to successful implementation. Understanding and overcoming these barriers with the development of educational initiatives, may lead to greater uptake of evidence-based technologies, that have the potential to significantly improve the quality of life for patients.…”

“…There are a wide variety of barriers to the successful implementation of CPGs into clinical practice in general healthcare. Some barriers are of particular relevance to the successful implementation of FES 4 . Clinician perception of CPGs and clinician confidence in using FES technologies are two potential barriers to successful implementation.…”