Patients’ and therapists’ experience and perception of exoskeleton-based physiotherapy during subacute stroke rehabilitation: a qualitative analysis

Abstract

Purpose

To explore the experience and acceptability of an exoskeleton-based physiotherapy program for non-ambulatory patients during subacute stroke rehabilitation from the perspective of patients and therapists.

Materials and methods

This was a qualitative descriptive study using semi-structured interviews and thematic analysis. Fourteen patients with stroke who participated in the experimental arm of a randomized controlled trial investigating the efficacy of exoskeleton-based physiotherapy were recruited. Six physiotherapists who provided the intervention were also recruited.

Results

Three themes were identified relating to the experience and acceptability of an exoskeleton-based physiotherapy program: (1) A matter of getting into the swing of things depicted the initial and ongoing learning process of using an exoskeleton; (2) More of a positive experience than anything else described the participants’ mostly favorable attitude toward exoskeleton-based gait training; and (3) The best step forward captured participant-identified recommendations and considerations for the future integration of exoskeleton training into stroke rehabilitation.

Conclusions

Patients with stroke were even more optimistic than therapists toward the experience and benefits of exoskeleton-based gait training during subacute stroke rehabilitation. Future clinical practice should consider the balance between actual and perceived benefits, as well as the potential barriers to integrating an exoskeleton into stroke rehabilitation.

IMPLICATIONS FOR REHABILITATION

• Powered robotic exoskeletons can be used to provide higher duration and more repetitious walking practice for non-ambulatory patients with stroke.

• Patients with stroke view exoskeleton-based physiotherapy highly favorably, attributing greater opportunity and benefit to using the device during subacute rehabilitation.

• Physiotherapists should consider learning challenges, patient characteristics, and implementation barriers when integrating exoskeleton-based training within a treatment program.

Keywords:

• Physical therapy modalities
• stroke
• walking
• lower limb
• exoskeleton device
• qualitative research

Ethical approval

This study was approved by the relevant university research ethics board: University of British Columbia Clinical Research Ethics Board (H15-01339); University of Alberta Health Research Ethics Board (Pro00071806); Western University Health Sciences Research Ethics Board (108618).

Clinical trial registration

The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial (some of whose participants took part in this qualitative study) was registered at ClinicalTrials.gov (NCT02995265).

Acknowledgements

We would like to thank Alyssa Chen, Chelsea Chua, Bryce Jay, Johnson Liu, and Lara Radovic for transcribing the interviews. We would also like to thank all of the patients with stroke and therapists who took part in this research.

Disclosure statement

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

Additional information

Funding

This study was supported by the Heart and Stroke Foundation of Canada Grant in Aid [G-15-0009030] and Canadian Institutes of Health Research Foundation Grant [FDN 143340]. Additional funding supporting the independent work of the authors is as follows: DRL is supported by the Heart and Stroke Canadian Partnership for Stroke Recovery Trainee Award and Vanier Canada Graduate Scholarship Program; WBM is supported by a New Investigator Award from the Canadian Institutes of Health Research. JJE is supported by the Canada Research Chair Program.