Exploring the reasons behind the low focus on upper limb rehabilitation in the early stages after a stroke: A qualitative study.

Abstract

Background: One aspect that is often impaired in people living with stroke is the motor function of the upper limb.

Purpose: To explore the reasons behind the low focus on upper limb rehabilitation after stroke and to understand the views of rehabilitation professionals (RPs) on the use of upper limb rehabilitation technologies for self-management of stroke.

Study design: A qualitative descriptive design that employs a one-on-one semistructured interview method.

Methods: A total of nine RPs (physiotherapist n = 6 and occupational therapist n = 3) participated. Interviews were held in person or via teleconferencing, recorded, and transcribed verbatim. All transcribed data were analyzed using thematic analysis, with an inductive approach.

Results: The average length of practice years of the RPs in this study was 24.7 ± 9.8, with 16.44 ± 9.19 experience in neurological rehabilitation. The views gathered from all nine (9/9) RPs point to a low focus on upper limb rehabilitation for people living with stroke. In an inpatient setting, this was attributed to the rehabilitation goals/ priorities (of people living with stroke, RPs, and/or hospital's rehabilitation/stroke units), inadequate resources, and the inability of the RPs to deal with the high incidence of stroke. After discharge, it was attributed to the cost of securing private rehabilitation and poor knowledge of technologies that can support self-rehabilitation. The cost, design, and inadequacy of evidence on the effectiveness of some available upper limb rehabilitation technologies were noted as reasons that could make it difficult for RPs to promote the use of rehabilitation technologies.

Conclusions: There is a low focus on upper limb rehabilitation after a stroke, particularly during the early stages, owing to the pursuit of early discharge which appears to attach higher priority to the lower limb in addition to inadequate resources and lack of capacity to deal with the high incidence of stroke.