Occupational Therapists’ Perspectives on Home Programs for People With Stroke

PURPOSE: Stroke is a leading cause of long‐term disability in the United States (National Stroke Association, 2018). About half of stroke survivors report hemiparesis in the months after the stroke, making functional use of the arm a focus of occupational therapy intervention (Petrea et al., 2009). Direct services are often limited, leading to use of occupational therapy home programs as a means of extending services, even though adherence to these programs is low (Jurkiewicz et al., 2011). Although patient perspectives on home programs for upper extremity rehabilitation poststroke are present in the literature, limited research has described the perspectives of occupational therapy practitioners related to home programs. This study aimed to build on previous research to deepen the understanding of the process of creating, progressing, incorporating technology into, and monitoring adherence in upper extremity–focused home programs for people with stroke.

METHOD: This study was a follow‐up to a national survey of occupational therapy practitioners that used qualitative description to report perspectives of clinicians in three practice settings. Researchers obtained a purposeful sample through criterion‐based chain and convenience sampling of licensed occupational therapy practitioners in the United States who had experience in upper extremity home program creation for adults with stroke.

A single semistructured interview was conducted with each participant. Interviews were conducted via telephone and lasted 45–60 min. Interviewers were trained and monitored by the primary investigator to ensure consistency in data collection. Interviews were transcribed verbatim and coded using content analysis. The first set of interviews was coded independently by the members of the research team and used to create a consensus codebook that was referenced for subsequent coding. As additional interviews were coded, new codes were added, merged, and removed. Preliminary themes were identified on the basis of patterns noted in participant responses to the interview questions. Data collection in the form of additional interviews is ongoing.

RESULTS: Preliminary themes were noted in the areas of home program experience, application of technology, understanding adherence, key components of a successful home program, and clinician resources and barriers. Most participants had their first exposure to home program creation during fieldwork and limited coverage in their educational curriculum. Participants also reflected growth in home program development, with a reported increase in client centeredness and focus on function with increased experience. The application of technology varied among participants and practice settings. Participants also deepened their understanding of adherence, noting that monitoring adherence beyond client report is challenging. Key components of successful home program across settings included gaining client interest, ensuring understanding, and promoting caregiver support. Finally, participants noted that common barriers to creating home programs were time and accessibility of resources.

CONCLUSION: The themes resulting from this analysis are consistent with previous research, including limited monitoring of home program adherence and the influence of caregivers. This study contributes to future occupational therapy practice by highlighting that home program development is a skill that continues to evolve with clinical experience and identifying areas that could be targeted for future research. Occupational therapy practitioners are key stakeholders in the creation of upper extremity home programs, and their perspective provides a critical component that can be used to increase effectiveness of this commonly used strategy.

References

Jurkiewicz, M. T., Marzolini, S., & Oh, P. (2011). Adherence to a home‐based exercise program for individuals after stroke. Topics in Stroke Rehabilitation, 18, 277–284. https://doi.org/10.1310/tsr1803–277

National Stroke Association. (2018). Stroke facts. Retrieved from http://www.stroke.org/understand‐stroke/what‐stroke/stroke‐facts

Petrea, R. E., Beiser, A. S., Seshadri, S., Kelly‐Hayes, M., Kase, C. S., & Wolf, P. A. (2009). Gender differences in stroke incidence and poststroke disability in the Framingham Heart Study. Stroke, 40, 1032–1037. https://doi.org/10.1161/STROKEAHA.108.542894