Centre for Allied Health, St George's University, London, UK
Helix Centre, Imperial College London and the Royal College of Art, London, UK.
BMJ Open. 2023 Aug 18;13(8):e062119. doi: 10.1136/bmjopen-2022-062119.
National guidelines emphasise the need to enhance arm and hand recovery poststroke. OnTrack is a 12-week package aiming to address this need. Feasibility was evaluated in a single-arm feasibility study (reported separately). This paper presents findings from a nested process evaluation. The objectives were to explore users' experiences of OnTrack and fidelity of delivery, in order to inform a definitive trial of effectiveness and future delivery.
Participants were interviewed in a range of settings in hospital, home or via telephone, at the end of their intervention cycle. Session observations for a selection of coaching sessions were carried out in person at home or remotely, post-COVID-19.
Eleven participants who completed the intervention following a stroke were interviewed. Seven coaching sessions were observed.
This process evaluation was part of a larger feasibility study of OnTrack, which involves setting movement targets and monitoring activity using a tracker on the wrist, motivational messaging via a Smartphone and self-management coaching. Preliminary analysis of data collected was conducted with a public and patient involvement group formed of stroke survivors. This informed changes in intervention delivery.
Participants reported finding the OnTrack programme beneficial, with the coaching role seen as particularly important. Participants found activity tracking motivating, but some noted discrepancies between tracked movement and what they considered useful activity. Motivational messages were sometimes irritating. Most felt ready to sustain their own activity practice at the end of the programme.
This process evaluation supported initial theoretical assumptions that OnTrack would enable activity practice through the use of remote monitoring. There was a strong emphasis on the coaching role as a mechanism of impact supporting the technological intervention. These findings will inform the next stages of delivery in a definitive trial.
NCT03944486.
国家指南强调需要提高中风后的手臂和手部康复。OnTrack 是一个为期 12 周的方案，旨在满足这一需求。其可行性已在一项单臂可行性研究中进行了评估（另行报告）。本文介绍了嵌套过程评估的结果。目的是探讨用户对 OnTrack 的体验和实施的保真度，以便为有效性和未来实施的确定试验提供信息。
参与者在干预周期结束时，在医院、家中或通过电话的各种环境中接受访谈。选择的教练课程的会话观察在 COVID-19 之后在家庭或远程进行。
11 名参与者在中风后完成了干预，接受了采访。观察了 7 次教练课程。
该过程评估是 OnTrack 更大可行性研究的一部分，该研究涉及使用手腕上的追踪器设定运动目标和监测活动、通过智能手机发送激励信息以及自我管理指导。初步分析了由中风幸存者组成的公众和患者参与小组收集的数据。这为干预实施的改变提供了信息。
参与者报告说发现 OnTrack 计划有益，教练角色被认为尤为重要。参与者发现活动追踪具有激励性，但有些人注意到追踪运动与他们认为有用的活动之间存在差异。激励信息有时会令人烦恼。大多数人在计划结束时感到准备好维持自己的活动实践。
该过程评估支持了最初的理论假设，即 OnTrack 将通过远程监测使活动实践成为可能。教练角色作为影响支持技术干预的机制受到了强烈重视。这些发现将为确定试验的下一阶段实施提供信息。
NCT03944486。
