Technology Acceptance of a Novel Closed-loop Functional Electrical Stimulation Intervention from People with Stroke

Research Objectives: Falls are prevalent in people with stroke due to a lack of balance control. A novel balance intervention was created utilizing closed-loop functional electrical stimulation with visual feedback balance training (FES+VFBT); however, the acceptance of this intervention by people with stroke has not been investigated. This study explored how people with chronic stroke perceive the usability and meaningfulness of FES+VFBT.

Design: A qualitative exploratory design was utilized.

Setting: Research lab within a rehabilitation hospital.

Participants: Ten adults with chronic stroke (i.e., >1-year post-stroke) participated in this study.

Interventions: Participants completed 18 sessions of FES+VFBT over six weeks (i.e., three sessions/week). The FES+VFBT intervention targets multiple balance control deficits commonly present in people post-stroke (e.g., functional limits of stability and cognitive deficits).

Main Outcome Measures: A questionnaire and semi-structured interview, both informed by the Technology Acceptance Model (TAM)-2, were conducted post-intervention. Themes were identified through deductive content analysis while codes were identified inductively.

Results: Through the TAM-2 questionnaire, participants reported the FES+VFBT to be enjoyable, relevant, not risky, and comfortable; no barriers to access were identified. The information gained through the interviews was organized into four themes based on the constructs of the TAM-2. 1) Behavioral Intention: described in one code as Initial Impressions and Familiarity, which explored how their previous experiences and first impressions impacted their intention to use the FES+VFBT. 2) Perceived Ease of Use: described in three codes: Negotiating Barriers, Need for Therapists, and Barriers and Restrictions, all discussed various factors that did or could impact their ability to participate. 3) Perceived Usefulness: described in five codes: The Therapeutic Experience, Therapeutic Goals as a Motivator, Safety and Security, Noticeable Benefits, and Engagement. These codes summarized what the participants experienced while using the FES+VFBT. 4) Usage Behavior: described in four codes: Real World Integration, Dosage Preferences, Individualization, and Intervention Improvement Ideas. This theme encapsulates how the participants would like to see the FES+VFBT used and improved within clinical practice.

Conclusions: The FES+VFBT intervention was accepted by the study participants as evidenced by their responses to the questionnaire and interview. Participants liked the FES+VFBT’s enhanced safety protocols and found the FES+VFBT to be engaging. Although responses on the TAM-2 questionnaire suggested participants did not experience access barriers, further probing in the interviews identified several barriers, such as commuting to the sessions, the electrical stimulation sensation, and the time required to participate.

Author(s) Disclosures: Funding provided by the Canadian Institutes of Health Research and Natural Sciences and Engineering Research Council of Canada.