Exploring physiotherapists’ and occupational therapists’ perceptions of the upper limb prediction algorithm PREP2 after stroke in a rehabilitation setting: a qualitative study

Abstract

ObjectiveTo explore how physiotherapists (PTs) and occupational therapists (OTs) perceive upper limb (UL) prediction algorithms in a stroke rehabilitation setting and identify potential barriers to and facilitators of their implementation.DesignThis was a qualitative study.SettingThe study took place at a neurorehabilitation centre.ParticipantsThree to six PTs and OTs.MethodsWe conducted four focus group interviews in order to explore therapists’ perceptions of UL prediction algorithms, in particular the Predict Recovery Potential algorithm (PREP2). The Consolidated Framework for advancing Implementation Research was used to develop the interview guide. Data were analysed using a thematic content analysis. Meaning units were identified and subthemes formed. Information gained from all interviews was synthesised, and four main themes emerged.ResultsThe four main themes were current practice, perceived benefits, barriers and preconditions for implementation. The participants knew of UL prediction algorithms. However, only a few had a profound knowledge and few were using the Shoulder Abduction Finger Extension test, a core component of the PREP2 algorithm, in their current practice. PREP2 was considered a potentially helpful tool when planning treatment and setting goals. A main barrier was concern about the accuracy of the algorithm. Furthermore, participants dreaded potential dilemmas arising from having to confront the patients with their prognosis. Preconditions for implementation included tailoring the implementation to a specific unit, sufficient time for acquiring new skills and an organisation supporting implementation.ConclusionIn the present study, experienced neurological therapists were sceptical towards prediction algorithms due to the lack of precision of the algorithms and concerns about ethical dilemmas. However, the PREP2 algorithm was regarded as potentially useful.

External validation and extension of the Early Prediction of Functional Outcome after Stroke (EPOS) prediction model for upper limb outcome 3 months after stroke

“…Thus, caution is needed when applying the EPOS model very early after stroke, especially in those patients who initially have no voluntary upper limb motor function (i.e., the ‘unfavorable’ prognosis group). Since prognostic models for upper limb recovery are implemented increasingly [ 42 , 43 ], this becomes an even more important issue, as the model would misinform therapists and patients in the early false negative prognosis scenario. In the case of an unfavorable prognosis, it recommended to focus on the application of compensational strategies [ 15 ].…”

Predicting later categories of upper limb activity from earlier clinical assessments following stroke: an exploratory analysis

“…This effort to predict an individual’s subsequent UL performance category is informed by the development of the PREP 2 algorithm [ 19 , 20 ], which has demonstrated that prediction of an UL capacity (i.e. activity a person has the capability to do) category provides clinically-useful information to people with stroke and their families [ 21 – 24 ]. Advances in computing have improved upon old and led to new analysis techniques for building prediction models of UL outcomes after stroke.…”