Acceptability of a Telerehabilitation Biofeedback System Among Stroke Survivors: A Qualitative Analysis

Abstract

Electromyography (EMG) biofeedback delivered via telerehabilitation can increase access to occupational therapy services for stroke survivors with severe impairment, but there is limited research on its acceptability. This study identified factors influencing the acceptability of a complex, muscle biofeedback system (Tele-REINVENT) for upper extremity sensorimotor stroke telerehabilitation among stroke survivors. We conducted interviews with stroke survivors ( n = 4) who used Tele-REINVENT at home for 6 weeks and analyzed the data with reflexive thematic analysis. Biofeedback, customization, gamification, and predictability affected the acceptability of Tele-REINVENT among stroke survivors. Across themes, features and experiences that gave participants agency and control were more acceptable. Our findings contribute to the design and development of at-home EMG biofeedback interventions, which can improve access to advanced occupational therapy treatment options for those who need it most.

Pre-Implementation Analysis of the Usability and Acceptability of a Poststroke Complex Telehealth Biofeedback Intervention

“…Blinko users emphasized that they were motivated by using their affected arm, not by their score. Our previous preliminary work examining the acceptability of Tele-REINVENT ( Donnelly et al., 2023 ) and the current study suggest the following considerations for future game development: (1) Preserve achievements between sessions (i.e., all-time high scores), (2) use scoring schemes that directly reflect performance, (3) gamify multiple rehabilitation goals, and (4) develop options to compete (e.g., leaderboard) and communicate with other users.…”

“… Develop implementation strategies to address common barriers. Technical issues are ubiquitous in rehabilitation technology, whether an intervention is elegant or bootstrapped; however, in isolation they do not have a detrimental effect on acceptability ( Caughlin et al., 2020 ; Donnelly et al., 2023 ; Neibling et al., 2021 ). In fact, implementation strategies that address inevitable barriers can enhance usability and acceptability.…”

“…Interviews were conducted in a private room by a member of the research team (Miranda Rennie Donnelly, Octavio Marin-Pardo, or Coralie Phanord) and typically lasted between 20 and 40 min. Questions were intentionally broad and experiential to evoke stories and honest appraisals rather than specifically about usability and acceptability (see Donnelly et al., 2023 , for the interview guide). The interviewer did not view the participant’s questionnaire responses before conducting the interview.…”

“…In this study, we evaluated the usability and acceptability of an electromyography (EMG) biofeedback telehealth intervention for poststroke upper extremity motor recovery (Tele-REINVENT; Marin-Pardo et al., 2022 ). This study builds on previous pilot work examining the acceptability of Tele-REINVENT through thematic analysis of interviews with stroke survivors ( N = 4; Donnelly et al., 2023 ) by using a mixed- methods approach, including validated measures of usability and acceptability, with a larger sample of users. The purpose of this pre-implementation work is to support (1) identification of the fit between EMG biofeedback and telerehabilitation for stroke survivors, (2) optimization of EMG biofeedback interventions, and, more broadly, (3) other efforts to develop complex telerehabilitation interventions for routine clinical practice.…”

Improvements in motor control are associated with improved quality of life following an at-home muscle biofeedback program for chronic stroke

“…Additionally, participants qualitatively described modest improvement in their overall quality of life, including increased awareness, sensation, flexibility, relaxation, and use of their impaired arm. Previously, we reported qualitative findings about the acceptability of Tele-REINVENT, showing that participants perceived increased awareness of their residual arm movement and felt motivated to use it for everyday activities outside of the training paradigm, which contrasted with longstanding habits of compensating with the unaffected arm ( Donnelly et al, 2023 ). Similarly, Wright and colleagues reported subjective improvements in hand function during activities of daily living after using EMG-biofeedback despite non-significant reduction in sensorimotor impairment ( Wright et al, 2014 ).…”