title: Staff's views on delivering patient-led therapy during inpatient stroke rehabilitation: a focus group study with lessons for trial fidelity.
abstract: BACKGROUND
  Fidelity to the treatment protocol is key to successful trials but often problematic. This article reports the staff's views on delivering a complex rehabilitation intervention: patient-led therapy during inpatient stroke care.
  
  
  METHODS
  An exploratory qualitative study using focus groups with staff involved in a multicenter (n = 12) feasibility trial of patient-led therapy (the MAESTRO trial) was undertaken as part of the evaluation process. Purposive sampling ensured that participants represented all recruiting sites, relevant professions and levels of seniority. Data analysis used a Framework Approach.
  
  
  RESULTS
  Five focus groups were held involving 30 participants. Five main themes emerged: the effect of the interventions, practical problems, patient-related factors, professional dilemmas, and skills. Staff felt the main effect of the therapies was on patients' autonomy and occupation; the main practical problems were the patients' difficulties in achieving the correct position and a lack of space. Staff clearly identified characteristics that made patient-led therapy unsuitable for some patients. Most staff experienced dilemmas over how to prioritize the trial interventions compared to their usual therapy and other clinical demands. Staff also lacked confidence about how to deliver the interventions, particularly when adapting the interventions to individual needs. For each barrier to implementation, possible solutions were identified. Of these, involving other people and establishing a routine were the most common.
  
  
  CONCLUSIONS
  Delivering rehabilitation interventions within a trial is complex. Staff require time and support to develop the skills, strategies and confidence to identify suitable patients, deliver new treatments, adapt the new treatments to individuals' needs and balance the demands of delivering the trial intervention according to the treatment protocol with other clinical and professional priorities.
  
  
  BACKGROUND
  
  ISRCTN29533052 . October 2011.
authors: School of Health, University of Bradford, Horton A Building, Richmond Rd, Bradford, BD7 1DP, England. M.horne@bradford.ac.uk.
authors: Maria
authors: M
authors: Horne
authors: Stroke Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, England. Nessa.thomas@manchester.ac.uk.|School of Nursing, Midwifery & Social Work, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, England. Nessa.thomas@manchester.ac.uk.
authors: Nessa
authors: N
authors: Thomas
authors: Stroke Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, England. Andy.vail@manchester.ac.uk.|Salford Royal NHS Foundation Trust, Stott Lane, Eccles, Salford, M6 8HD, England. Andy.vail@manchester.ac.uk.
authors: Andy
authors: A
authors: Vail
authors: Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Postbus 2040, 3000, CA, Rotterdam, the Netherlands. r.selles@erasmusmc.nl.|Department of Rehabilitation Medicine & Physical Therapy, Erasmus MC, Postbus 2040, 3000, CA, Rotterdam, the Netherlands. r.selles@erasmusmc.nl.
authors: Rudd
authors: R
authors: Selles
authors: Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Upper Borough Walls, Bath, BA1 1RL, England. Candy.mccabe@uwe.ac.uk.|University of the West England, Glenside Campus, Blackberry Hill, Stapleton, Bristol, BS16 1DD, England. Candy.mccabe@uwe.ac.uk.
authors: Candy
authors: C
authors: McCabe
authors: Stroke Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, England. Sarah.tyson@manchester.ac.uk.|School of Nursing, Midwifery & Social Work, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, England. Sarah.tyson@manchester.ac.uk.
authors: Sarah
authors: S
authors: Tyson
mesh_terms: D001291:Attitude of Health Personnel; D005240:Feasibility Studies; D017144:Focus Groups; D006801:Humans; D036301:Qualitative Research; D012648:Self Care; D000071939:Stroke Rehabilitation