Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
BMC Neurol. 2023 Jul 13;23(1):266. doi: 10.1186/s12883-023-03312-5.
Most individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance.
Two individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants' experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers.
Four themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one's balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual's unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously.
End-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.
大多数患有脊髓损伤/疾病（SCI/D）或中风的患者每年至少会经历一次跌倒；因此，需要开发针对平衡控制的干预措施和技术。本研究的目的是从终端用户的角度确定和探讨以平衡为重点的干预措施和技术的优先级，以帮助设计一种将功能性电刺激（FES）与站立平衡视觉反馈训练相结合的干预措施。
招募了 2 名 SCI/D 患者、1 名中风患者、2 名物理治疗师（PT）和 1 名医院管理人员。参与者参加了三次遵循参与式共同设计方法的焦点小组会议。使用从 FAME（可行性、适宜性、有意义、有效性、经济证据）框架中开发的半结构化访谈指南来引导讨论，询问参与者对平衡缺陷和干预措施以及 FES 的体验。会议进行了录音，并逐字记录了下来。三位研究人员对记录进行了迭代和反思性的归纳主题分析。
确定了四个主题：（1）平衡对日常生活和康复很重要。参与者承认各种因素会影响平衡控制，以及平衡缺陷如何干扰活动参与。终端用户强调在离开医院康复后继续关注自己的平衡的重要性。（2）平衡干预措施的理想特征。参与者解释说，平衡干预措施应根据个人的独特需求和目标量身定制，与他们的生活相关，平衡安全和风险，并具有吸引力。（3）为未来治疗用途提供 FES 的经验。中风或 SCI/D 患者描述了他们对 FES 的最初担忧，但体验到了许多好处，促使他们继续使用 FES。提到了 FES 的挑战，包括电线、成本和设置时间。（4）FES 在平衡干预中的潜在作用。参与者认为 FES 将补充平衡干预措施；然而，他们之前没有体验过这种联合疗法。
终端用户描述了他们的平衡缺陷、康复和 FES 经验如何影响他们对平衡干预措施的优先级。研究结果为设计和实施针对 SCI/D 或中风患者的未来平衡干预措施提供了信息，包括涉及 FES 和视觉反馈训练的干预措施。
