Understanding implementation of a complex intervention in a stroke rehabilitation research trial: A qualitative...

Area of Science:

• Neurorehabilitation
• Motor Learning
• Stroke Recovery

Background:

• Pilot cluster randomised controlled trial investigating implicit learning strategies in acute stroke rehabilitation.
• Intervention delivered by clinical teams in UK Stroke Units, focusing on therapist instructions and feedback.
• Focus on understanding the implementation processes of a complex intervention in stroke care.

Purpose of the Study:

• To understand therapist and patient perspectives on the implicit learning intervention.
• To identify factors influencing the implementation of new motor learning strategies.
• To derive broader learning for complex intervention research in stroke rehabilitation.

Main Methods:

• Qualitative evaluation using focus groups with 20 clinical staff and 19 semi-structured interviews with stroke patients.
• Mixed inductive and theory-driven analysis, guided by Normalisation Process Theory.
• Data collection from 8 participating Stroke Units in the UK.

Main Results:

• Therapist sense-making and experience critically impacted intervention implementation.
• Team-based shared understanding and flexible interpretation of the intervention facilitated better implementation.
• Patient experiences did not reflect therapist concerns about potential negative impacts on relationships or learning.

Conclusions:

• Implementation of complex interventions in stroke rehabilitation is influenced by team dynamics and cultural flexibility.
• Flexible team cultures may be more conducive to the successful adoption of novel interventions.
• Researchers should consider team context and flexibility when designing and implementing stroke rehabilitation interventions.