Development of clinical guidelines for service provision of functional electrical stimulation to support walking: Mixed method exploration of stakeholder views
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Bulley, C., Meagher, C., Street, T., Adonis, A., Peace, C., Singleton, C. & Burridge, J. (2021) Development of clinical guidelines for service provision of functional electrical stimulation to support walking: Mixed method exploration of stakeholder views. BMC Neurology, 21:263.
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.