Community Stroke Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
School of Health and Related Research, The University of Sheffield, Sheffield, UK.
Disabil Rehabil. 2022 Jul;44(14):3577-3589. doi: 10.1080/09638288.2020.1871519. Epub 2021 Jan 17.
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.
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.
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.
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 REHABILITATIONBenefits 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.
探索言语治疗师在实用临床试验中使用计算机自我管理方法提供治疗的经验，以确定和理解可能影响在常规实践中实施计算机辅助失语症康复方法的关键因素。
对在多地点大型 CACTUS 试验中提供计算机治疗的 11 名言语治疗师进行了定性半结构式电话访谈。访谈进行了录音，逐字记录，并在 NVivo11 中使用主题分析进行了分析。
出现了五个对实施有影响的主题：1）干预措施的特点：复杂性和适应性；2）对干预措施的知识和信念：对计算机的熟悉程度和培训的益处；3）患者的需求和服务资源困境：“我在家可以在电脑上做些什么吗？”；4）网络和沟通；5）反思和评估：可持续性的调整。
个性化、反馈和志愿者/助手支持被认为是这种复杂干预的好处。然而，相同的好处需要资源，包括治疗师学习使用软件、采购软件、个性化软件、与志愿者/助手合作以及与 IT 部门建立关系的时间，这些都构成了实施的障碍。讨论强调需要考虑将计算机和面对面治疗相结合，以支持实施并可能优化患者的结果。
对康复的影响在大型 CACTUS 试验中评估的自我管理计算机选词治疗方法的好处包括能够个性化内容、提供反馈，并根据不同临床环境的可用性提供志愿者或助手的支持，以便重复进行选词自我管理练习。虽然计算机治疗方法的使用可以以高效的方式促进实践的自我管理和增加治疗时间，但服务需要考虑实施和支持方法所需的资源：软件和硬件的成本，治疗师学习使用软件、调整和个性化软件以及管理志愿者/助手所需的时间。
为了成功采用计算机方法，需要在组织内建立 SLT 和 IT 部门之间的关系，并相互了解需求。为了提高时间效率，建议提供自我管理计算机治疗方法的 SLT 在对患者进行充分的个性化和软件调整之前，先与每位患者一起试用该方法，以检查患者的能力和参与度。
