JMIR Publications

ABSTRACT

Background:

Continuous innovation of technology-based interventions in stroke neurorehabilitation supports the development of best practices and promotes optimal outcomes for stroke survivors. One such intervention is neurofeedback delivered via functional near-infrared spectroscopy (fNIRS) for motor function rehabilitation in the upper limbs. Most research has focused on whether individuals can control the neurofeedback signal, yet little is known regarding the acceptability of this intervention from the perspective of stroke rehabilitation clinicians.

Objective:

This study aims to uncover the perceived acceptability of the fNIRS intervention from the perspective of stroke rehabilitation clinicians whose scope of practice includes motor function, such as physiotherapists, occupational therapists, and recreational therapists.

Methods:

Using an interpretive description approach, this qualitative study was guided by both the Technology Acceptance Model (TAM) and the Theoretical Framework of Acceptability (TFA). Semi-structured interviews with physiotherapists, occupational therapists, and recreational therapists were conducted following a single 5-minute intervention experience or virtual demonstration. Thematic analysis guided by principles of interpretive description was used to develop codes and build themes.

Results:

Participants (n=11) shared key insights leading to the development of four themes: (1) “From Protocol to Practice” highlights the core differences between research and clinical environments that impact the acceptability of the intervention, including subthemes related to the clients and the clinical setting; (2) “The Cost of Implementation” discusses the various costs associated with the intervention, including non-financial costs such as equipment management, agency resources, and ethical implications; (3) “The Human Element: Navigating Fit” explores subthemes related to both the client experience of the intervention and personal characteristics of clients and clinicians which may impact the acceptability of the intervention; and (4) “For the Hope of It All” demonstrates how, despite the various challenges and barriers, clinicians are hopeful for the developments in stroke neurorehabilitation and the hope that this type of intervention can spark among clients.

Conclusions:

Alignment of the themes with the study’s theoretical framework suggests a nuanced interconnectedness between the clinicians’ perceived acceptability as it relates to the TAM and TFA, including complexities related to personal characteristics and ethical costs. Ultimately, the clinical reality of stroke neurorehabilitation does not align with the current prototype of the intervention. Design considerations for successful implementation are provided based on the study’s findings. By addressing clinician-identified real-world constraints to intervention implementation, research into these technology-based interventions can continue to move towards becoming sustainable, equitable, and transformative in the lives of stroke survivors.