Harrison Madeleine, Palmer Rebecca, Cooper Cindy
Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, United Kingdom.
Rehabilitation and Assistive Technology Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
Front Neurol. 2020 Nov 23;11:582328. doi: 10.3389/fneur.2020.582328. eCollection 2020.
Aphasia is a communication disorder often acquired after a stroke. Independent use of specialist aphasia software on a home computer is a form of asynchronous tele-rehabilitation that can provide increased opportunity for practice of rehabilitation exercises. This study aimed to explore the factors associated with adherence to self-managed aphasia computer therapy practice. A mixed methods exploration of adherence was conducted alongside the Big CACTUS randomized controlled trial [ISRCTN: 68798818]. The trial evaluated the clinical effectiveness of self-managed aphasia computer therapy. This study reports secondary analysis of data from participants randomized to the computer therapy group to investigate whether any demographic, clinical or intervention variables were associated with adherence to therapy practice. A sub-sample of the same participants took part in qualitative interviews exploring the factors perceived to influence the amount of aphasia computer therapy practice undertaken. Interviews were analyzed thematically. A convergence-coding matrix was used to triangulate the two sets of findings. Data from 85 participants randomized to the computer therapy group were included in the quantitative analyses. At a clinical level, a greater length of time post-stroke was associated with higher adherence to self-managed aphasia therapy practice on a computer. At an intervention level, length of computer therapy access and therapist time supporting the participant were associated with greater adherence to computer therapy practice. Interviews with 11 patients and 12 informal carers identified a multitude of factors perceived to influence engagement with tele-rehabilitation by people with aphasia. The factors grouped around three themes: capability to use the computer therapy, having the opportunity to practice (external influences and technological issues) and motivation (beliefs, goals and intentions vs. personality, emotions, habit and reinforcement). Triangulation demonstrated convergence for the finding that participants' practiced computer-based therapy exercises more when they received increased support from a speech and language therapist. Clinicians delivering asynchronous tele-rehabilitation involving self-management of aphasia therapy practice on a computer should consider the factors found to be associated with engagement when deciding which patients may be suited to this option, as well as how they can be supported to optimize the amount of practice they engage in.
失语症是一种通常在中风后获得的沟通障碍。在家用电脑上独立使用专业失语症软件是一种异步远程康复形式，可为康复练习提供更多的实践机会。本研究旨在探讨与坚持自我管理的失语症计算机治疗实践相关的因素。在“大仙人掌”随机对照试验[ISRCTN: 68798818]的同时，对坚持情况进行了混合方法探索。该试验评估了自我管理的失语症计算机治疗的临床效果。本研究报告了对随机分配到计算机治疗组的参与者的数据进行的二次分析，以调查是否有任何人口统计学、临床或干预变量与坚持治疗实践相关。同一参与者的一个子样本参加了定性访谈，探讨了被认为会影响失语症计算机治疗实践量的因素。访谈采用主题分析法进行分析。使用收敛编码矩阵对两组结果进行三角验证。定量分析纳入了85名随机分配到计算机治疗组的参与者的数据。在临床层面，中风后较长的时间与更高的坚持在家用电脑上进行自我管理的失语症治疗实践相关。在干预层面，计算机治疗访问时长和支持参与者的治疗师时间与更高的坚持计算机治疗实践相关。对11名患者和12名非正式护理人员的访谈确定了许多被认为会影响失语症患者参与远程康复的因素。这些因素围绕三个主题分组：使用计算机治疗的能力、有练习的机会（外部影响和技术问题）以及动机（信念、目标和意图与个性、情绪、习惯和强化）。三角验证表明，当参与者从言语和语言治疗师那里获得更多支持时，他们会更多地进行基于计算机的治疗练习这一发现具有趋同性。提供涉及在家用电脑上自我管理失语症治疗实践的异步远程康复的临床医生，在决定哪些患者可能适合这种选择以及如何支持他们以优化他们参与的练习量时，应考虑与参与相关的因素。
