Development of clinical guidelines for service provision of functional electrical stimulation to support walking: mixed method exploration of stakeholder views

Abstract

Background Over the past 20 years Functional Electrical Stimulation (FES) has grown in clinical use to support walking in people with lower limb weakness or paralysis due to upper motor neuron lesions. Despite growing consensus regarding its benefits, provision across the UK and internationally is variable. This study aimed to explore stakeholder views relating to the value of a clinical guideline focusing on service provision of FES to support walking, how people might use it and what should be included. Methods A mixed methods exploration sought the views of key stakeholders. A pragmatic online survey (n = 223) focusing on the study aim was developed and distributed to the email distribution list of the UK Association for Chartered Physiotherapists Interested in Neurology (ACPIN). In parallel, a qualitative service evaluation and patient public involvement consultation was conducted. Two group, and seven individual interviews were conducted with: FES-users (n = 6), their family and carers (n = 3), physiotherapists (n = 4), service providers/developers (n = 2), researchers (n = 1) and distributors of FES (n = 1). Descriptive analysis of quantitative data and framework analysis of qualitative data were conducted. Results Support for clinical guideline development was clear in the qualitative interviews and the survey results. Survey respondents most strongly endorsed possible uses of the clinical guideline as ensuring best practice and supporting people seeking access to a FES service. Data analysis and synthesis provided clear areas for inclusion in the clinical guidelines, including current research evidence and consensus relating to who is most likely to benefit and optimal service provision as well as pathways to access this. Specific areas for further investigation were summarised for inclusion in the first stage of a Delphi consensus study. Conclusions Key stakeholders believe in the value of a clinical guideline that focuses on the different stages of service provision for FES to support walking. A Delphi consensus study is being planned based on the findings.

Implementing functional electrical stimulation clinical practice guidelines to support mobility: A stakeholder consultation

“…A discussion plan for the consultation was developed by the authors of the recent Clinical Practice Guideline (TJ, LB) ( 4 ) and by a CPG in development (TS, CB, AA, SJ, JB) ( 15 ). The expert author panel included academics, researchers and clinicians with experience using FES.…”

Delphi consensus study and clinical practice guideline development for functional electrical stimulation to support upright mobility in people with an upper motor neuron lesion

“…2 Use of FES can facilitate long-term self-management, increasing physical activity and improving mental and physical wellbeing. 3 The growing evidence base has led to FES being recommended by UK clinical guidelines for supporting walking in people with drop foot after stroke 4 and more generally for people with "drop foot of central neurological origin" (p. 2). 5 Despite evidence for its impacts, FES is not provided equally across the UK and internationally.…”

“…5 Despite evidence for its impacts, FES is not provided equally across the UK and internationally. 3 It is important that people have the choice to explore the use of FES to support their mobility, with its potential to increase their activity and participation in life.…”

“…The lack of detailed evidence exploring the different aspects of FES provision and service delivery made it difficult to create guideline statements that addressed the needs expressed by stakeholders. 3 Additionally, the need to hear voices with different lived experiences was prioritized from the start of the guideline development journey. The process and results of this Delphi study, and use of the results to develop the CPG document, are the focus of this article.…”

Clinician perception of clinical guidelines and confidence in using electrical stimulation technologies

“…Functional electrical stimulation (FES) technologies are increasingly being used to manage and improve motor control and other functions affected by upper motor neuron conditions. With a growing demand for the technology 1 and an increasing number of clinicians delivering it, clinical practice guidelines (CPGs) have been identified as a requirement to ensure best practice and inform healthcare decision‐makers 1 . CPGs have recently been developed to support walking for people with lower limb weakness or paralysis from stroke 2 and other upper motor neuron conditions 3 .…”