Identifying key elements to assess patient’s acceptability of neurorehabilitation in stroke survivors – a Delphi method

Abstract

Purpose

Assessing patient acceptability of treatment is a clinical concern. No guidance exists to determine the best way to measure acceptability in stroke neurorehabilitation. This study identifies key elements to measure patient’s acceptance of stroke neurorehabilitation by establishing expert consensus.

Materials and methods

A four-phase Delphi method with a three-round electronic-based survey was conducted. Experts were considered as stroke survivors or their caregivers and professionals in stroke neurorehabilitation. A twenty-five-item list was sourced from a literature review and discussion with a consumer panel (n = 22). In Round-1 (n = 118) and Round-2 (n = 80), experts ranked the items on a five-point scale. Consensus levels were validated by a Validation group in Round-3 (n = 50). Validity of the results was considered if consensus reached ≥70%, a non-bimodal pattern of response central tendency, SD in Round-2 was lower than that in Round-1, and the agreement scores of responses were similar between all rounds.

Results

In Round-1&2 and Round-3, 77.5% (n = 62) and 74.0% (n = 37) respectively, of the respondents were professionals, 20.0% (n = 16, n = 10 respectively) were either stroke survivors or caregivers, and 2.57% (n = 2) and 6.0% (n = 3) respectively were professionals who themselves were stroke survivors or caregivers. The key elements which met all priori criteria are: Goal setting, Measurable progress, Functional improvement, Challenging, Motivation, Interactive, Communications with health professionals, Knowledge of treatment, and No risks.

Conclusions

Patient’s acceptance is crucial to developing the appropriate neurorehabilitation interventions. Future clinical trials should consider these items when measuring patient’s acceptance of stroke neurorehabilitation interventions during the development and evaluation phases.

Implications for rehabilitation

• Assessing patient acceptability of treatment is a clinical concern in stroke neurorehabilitation.

• This study has identified nine key elements to assess patient acceptability of stroke neurorehabilitation. These key elements are: Goal setting, Measurable progress, Functional improvement, Challenging, Motivation, Interactive, Communications with health professionals, Knowledge of treatment, and No risks.

• Professionals should consider these elements when measuring patient’s acceptance of an intervention during the development, piloting, evaluation, and implementation phases.

• These findings provide a framework in designing neurorehabilitation programs and clinical trials on acceptance of and adherence to treatment in stroke survivors.

Keywords:

• Stroke
• neurorehabilitation
• patient acceptability
• Delphi
• consensus

Acknowledgements

We extend our gratitude to the consumer panel members for their valuable time and constructive feedback throughout this project. We acknowledge Professor Christine Duffield, School of Nursing and Midwifery, ECU, for her guidance in conducting the Delphi method, Professor Dylan Edwards, School of Medical and Health Sciences, ECU for sharing his expert knowledge in neurorehabilitation treatments. We would like to thank the ECU Survey Research Centre for collecting the survey data. We are especially grateful to all participants for taking part in this study. We thank the reviewers for their constructive feedback to improve this manuscript.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded via ECU Early Career Researcher Grant obtained by Dr. Manonita Ghosh.