Service development: the establishment of a new Lothian Functional Electrical Stimulation Clinic - an evaluation and exploration.

Abstract

It is estimated that 20% of stroke patients will present with dropped foot. Functional electrical stimulation (FES) is a recognised viable clinical option for management of dropped foot, though currently, not widely available in Scotland. A multi disciplinary FES tertiary outpatient service was designed for the Lothian stroke population. The effectiveness of this clinic was evaluated using pre and post intervention analysis. Gait velocity and cadence were the primary quantitative outcome measures. A further qualitative research exploration using semi-structured interviews was undertaken to capture the views of service users. The current conventional management of dropped foot is the application of orthoses. Despite significant benefits with such devices, patient compliance is poor. In contrast, FES has high compliance and additionally, those who have previously used an orthosis demonstrate siginificant functional gains. Quantitative data was routinely collected on 40 consecutive clinic patients. Highly statistically significant improvements (p< 0.001) were demonstrated, with a 34% improvement in gait velocity and 17% increase in cadence. Following thematic analysis of the qualitative data relating to 13 patient and 10 carer interviews, both groups highlighted positive impacts on participation, stamina, confidence, independance and mood. A dedicated FES service positively impacts on functional ability and quality of life after stroke. Following this service review, a Lothian based clinic assessing twenty four patients per annum, has now been established.