Background
Evaluated system and intervention
BCI-FEST system
Intervention
Methods
Study design
Participants
Data collection
Subcomponent | Explanation |
---|---|
Physical capability | Physical capability entails the physical strength, stamina, or skill to perform BCI-FEST clinically |
Psychological capability | Psychological capability entails the mental strength or stamina and knowledge, or psychological skills to engage in the necessary mental processes to perform BCI-FEST clinically |
Physical opportunity | The physical opportunity to perform BCI-FEST clinically is related to the time, resources, locations, cues, and physical affordance provided by the environment |
Social opportunity | Social opportunity is supplied by social cues, interpersonal influences, and cultural norms that influence our thoughts concerning a behaviour |
Automatic motivation | Automatic motivation includes emotional reactions, impulses, inhibitions, drive states, reflex responses, wants and needs |
Reflective motivation | Reflective motivation encompasses planning and evaluation (i.e., beliefs) about executing BCI-FEST in a clinical setting |
Analysis
Results
Participants
Content analysis
COM-B subcomponents | Inductive subthemes | Quote number | Quote | |
---|---|---|---|---|
Capability | Physical | Transfer of physical ability and modality use | 1 | “I didn’t feel like I needed more skills in using the FES unit because it was pretty straight (forward), the FES unit.” (P6) |
2 | “[Would you need to increase your physical strength or endurance?] "Not really I go to the gym.” (P5) | |||
3 | “I wouldn’t say I have to increase my strength or even facilitation. I always get the patient into a more biomechanically advantageous position for me to do these treatments.” (P1) | |||
Psychological | Applying varying depths of evidence-based research to BCI-FEST | 4 | “I did not receive any formal training. But, of course, informal training in the sense of how the BCI works, what potentially are the benefits of using BCI-FES or only using FES.” (P3) | |
5 | “I brag about delivering an evidence-based intervention. So, I really am patient centred. But [patients] ask me: “Is this going to improve? How is my movement? Is this voluntary or a reflex? Is it spasticity or hypertonia?”…Your comments, your information, that you are disseminating to your patient, their family, or your other team members in rounds must be very accurate. Will you rely on science rather than: “Oh I think? Oh, maybe?” [Science] is more accurate. Consistent. So, then we can use an outcome measure.” (P5) | |||
Reliance on the supplementary knowledge of the BCI operator | 6 | “I would feel more comfortable to know that I have resources and other people to talk to if I have trouble using it or if I have a difficult case. Also, with the [BCI operator] understanding the device better in a technical way, that would be great too.” (P4) | ||
7 | “And some patients, they were frustrated because, I think, lots of therapists and engineering…I prefer the therapist to know everything and have one less person in the scene. Less interruption because we want to satisfy the patient and get the most of it.” (P5) | |||
Opportunity | Physical | Set-up time relative to therapy time required for BCI-FEST | 8 | "To be honest, I think lots of patients would benefit from (BCI-FEST) so just the barriers of setup time, having an extra person there, and whether and how effective the therapy is. (This is) what will take me one way or the other in terms of whether I choose to use the unit or not.” (P1) |
9 | “I think when you are doing the therapy, you always wonder whether it was enough time; but I think when you look back on it you realize it’s tiring for the patient. If they’re really focusing, doing a good job, and putting all their mental attention to it, you probably don’t want to do it too long. Probably half an hour is a good amount of time for them to fully concentrate and focus.” (P2) | |||
10 | “Maybe it was the study, the push, you know, rush rush RUSH. We have one hour. The patient, might have a catheter, have to, empty their bladder, then they come back. It was a rush. So, when we have someone, in this one-hour window, it didn’t allow me to treat the way I treat my patients (P5) | |||
Extra resources are needed to increase the efficiency and clinical feasibility of BCI-FEST | 11 | “In a clinical sense, outside of a study, it would be resource intensive because it requires the computer and the head setup and the FES unit, and then two people, both the engineer and the therapist, to be available at the same time, right?” (P6) | ||
Social | BCI-FEST therapist community development | 12 | If there were a group of therapists that all utilize “BCI FEST. If you could converse with them about it…It’s a new device, it’s research and I’m pretty sure at the beginning, not everyone will be using it. It (could be used) to share experiences, the good and the bad.” “I think the idea of having a group is very good and frequent communication with the group for example. So, just reach out to them: Are you using the BCI-FES?” “Do you have any questions? Do you need a call?” Just a reminder because things like that go on a shelf very easily and they stay there.” (P4) | |
Motivation | Automatic | Passion for technology promotes the intuitive use of BCI-FEST | 13 | "Oh yeah. I think that any new technology, I think that you have to get into it and practice so that it will become second nature.” (P3) |
Reflective | Knowledge from scholarly practice and inquiry innately transfers to BCI-FEST | 14 | “In general, I look at the patient and see where they’re at and what their goals are. Then I try to think of different technology, different treatment styles that would help them reach their goals. If BCI-FES is one of them, it’s something that I would bring up to them and see what their thoughts are.” (P1) | |
15 | “So doing (UE training) 1 h, 5 times per week, we are not training the rest of what (the patient) needs to work on. Maybe in the chronic stages when they want to work mostly on the hands and upper extremity function, that will be good. But in acute and subacute rehab, this is absolutely not something that I will do because it won’t do the rest (of the body) and the rest is very important.” (P4) | |||
16 | “I think this system is going to help me to evaluate my interventions, whether they are working or not working.” (P5) |
Capability
Physical capability
Transfer of physical ability and electrotherapeutic modality experience
“I don’t think (I needed to increase physical strength and stamina) because the type of therapy we are doing already is quite hands on and it can be physical.” (Participant 2—P2)
Psychological capability
Applying varying depths of evidence-based research to BCI-FEST
“In the beginning, like part of the learning curve, I had to dedicate a little bit more mental space into delivering BCI-FEST.” (P1).
Reliance on the supplementary knowledge of the BCI operator
“There was (a BCI operator) there that was taking care of the technical aspects of (BCI-FEST), so I felt like I didn’t really need to know too much about that. Just a basic idea of how (the BCI-FES) works.” (P2).
Opportunity
Physical opportunity
Set-up time relative to therapy time required for BCI-FEST
“At least for the patient population that we were treating I don’t think they would be able to tolerate more than what we were delivering at the time.” (P3)
Extra resources are needed to increase the efficiency and clinical feasibility of BCI-FEST
“The system (has) to be more user-friendly, no flaws…It’s just a system, it has technical challenges.” (P5)
Social opportunity
BCI-FEST therapist community development
“I think what helps the most is having a mentor or somebody that you can go to on the spot if you are having issues—having like an expert on staff, maybe another therapist that would be the BCI expert.” (P2).
Motivation
Automatic motivation
Passion for technology promotes the intuitive use of BCI-FEST
“I love technology. My PhD was on technology. I think that is the road we have to go. We clinicians have to accept, embrace and utilize (technology), but still, I feel the resistance among us.” (P5).
Reflective motivation
Knowledge from scholarly practice and inquiry innately transfers to BCI-FEST
“I actually did extra work looking at different treatment techniques for stroke and spinal cord just so I had that background information.” (P2)