What are the factors that may influence the implementation of self-managed computer therapy for people with long term aphasia following stroke? A qualitative study of speech and language therapists’ experiences in the Big CACTUS trial

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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 REHABILITATION

• Benefits 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.

Keywords:

• Aphasia
• stroke
• rehabilitation
• computer therapy
• self-management
• implementation

Acknowledgements

The authors thank all of the SLTs who took part in the interviews.

Disclosure statement

RP was the chief investigator of the Big CACTUS trial, which was funded by the NIHR (National Institute for Health Research) and the Tavistock Trust for Aphasia. MH was employed on the Big CACTUS trial and received fellowship funding from the Stroke Association.