Identifying key elements to assess patient's acceptability of neurorehabilitation in stroke survivors - a Delphi...

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.

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.

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.

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 rehabilitationAssessing 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.