title: A mixed methods service evaluation of a pilot functional electrical stimulation clinic for the correction of dropped foot in patients with chronic stroke.
abstract: OBJECTIVE
  To undertake a service evaluation of the pilot Lothian functional electrical stimulation (FES) clinic using both quantitative and qualitative methods and clinical practice reflection.
  
  
  BACKGROUND
  Clinical guidelines recommend that FES, for the management of dropped foot after stroke, is delivered by a specialist team. However, little detail is provided about the structure and composition of the specialist team or model of service delivery. A pilot Lothian FES clinic was developed to explore the clinical value of providing such a service to stroke patients with dropped foot and identify any service modifications.
  
  
  METHODS
  Mixed methods were used to evaluate the service and included quantitative, qualitative and reflective components. Phase 1: Before and after service evaluation of patients attending the FES clinic between 2003 and 2007. Outcomes of gait velocity and cadence were recorded at initial clinic appointment and 6 months after application of FES. Phase 2: Qualitative research exploring patients with stroke and carers' experiences of the FES clinic. Data were collected via semi-structured interviews. Phase 3: A reflection on the service delivery model.
  
  
  METHODS
  Phase 1: 40 consecutive out-patients with stroke; Phase 2: 13 out-patients with stroke and 9 carers; Phase 3: Three specialist physiotherapists engaged in running the FES clinic.
  
  
  RESULTS
  Statistically significant improvements (p < 0.001) were demonstrated in gait velocity and cadence. Qualitatively, one super-ordinate theme 'The FES clinic met my needs' emerged. Within this were four sub-themes, namely 1. 'Getting to grips with FES wasn't difficult'; 2. 'It's great to know they're there'; 3. 'Meeting up with others really helps' and 4. 'The service is great but could be better'. On reflection, minor modifications were made to the service delivery model but overall the service met user needs. This dedicated FES clinic produced positive physical outcomes and met the needs of this chronic stroke population.
authors.affiliation: Specialist Physiotherapist, Physiotherapy Department, Astley Ainslie Hospital, Edinburgh, Scotland, UK. Jane.Shiels@nhslothian.scot.nhs.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Shiels
authors.forename: Katie
authors.initials: K
authors.lastname: Wilkie
authors.forename: Cathy
authors.initials: C
authors.lastname: Bulley
authors.forename: Stephen
authors.initials: S
authors.lastname: Smith
authors.forename: Lisa
authors.initials: L
authors.lastname: Salisbury
mesh_terms: D000554:Ambulatory Care Facilities; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000295:instrumentation; D010865:Pilot Projects; D036301:Qualitative Research; D013223:Statistics as Topic; D020521:Stroke / Q000628:therapy; D000071939:Stroke Rehabilitation; D006113:United Kingdom