165 Engagement with splints and orthotics in stroke survivors - the development of a project protocol

Abstract

Purpose: The service received funding from Stroke Quality Improvement in Rehabilitation (SQuIRe) in 2023 to set up a neurological splinting and orthotics service for stroke patients. The aim of the service evaluation is to understand the factors that influence engagement with splints and orthotics in stroke survivors. Despite recommendations in clinical guidelines (National Clinical Guidelines for Stroke, 2023 and Royal College of Physician Spasticity Guidelines, 2018), clinical experience indicates that continued use of splints and orthotics is variable amongst patients. The objective is to explore the experiences of service users when using their splints and orthotics and identify barriers and facilitators to engagement.

It is anticipated that the findings from the project could help reduce long term complications such as the development of contractures, pain, and pressure ulcers and to maintain independence with walking, transfers, and activities of daily living. Thereby assisting stroke survivors to maintain their independence, reduce carer strain and reduce financial burden to the individual and wider health and social sectors.

Methods: A literature search, Patient and Public Involvement (PPI) group and a Health Inequalities Assessment Toolkit (HIAT) were employed to design the project protocol. The literature search identified previous research studies that investigated the barriers and facilitators of general self-management after stroke and examined current knowledge on the influences upon splint and orthotic use in stroke. This was used to identify the gaps in current research base and develop aims and objectives. A PPI group assisted in the co-production of the protocol by advising on areas such as study design, interview questions and easy read materials. The HIAT integrated an equity lens into the design of the project, including participant recruitment, sampling, and choice of research methods. It explored the health inequalities which could affect participants.

Results: Service users with a diagnosis of stroke who have been wearing a splint and/or orthotic for at least 2 months will be included in the service evaluation. Potential participants who meet the criteria will be approached by their treating clinician and provided with information about the project. After completing the consent process and contextual information survey participants will be interviewed in their own homes or online.

The service evaluation will undertake an interpretative qualitative approach. Semi structured interviews based on the constructs of Bandura’s Social Cognitive Theory will be used to develop a deeper understanding of the barriers and facilitators to splint and orthotic engagement in stroke survivors. A survey will collect protected characteristics to assist in understanding the social determinants of health and health inequalities affecting the participants. This will also support purposeful sampling and ensure that all characteristics are represented within the project.

Ethical approval has been achieved from University of Central Lancashire.

Conclusion(s): Following ethical approval recruitment of participants has commenced and participant interviews are currently being arranged. The aim is to recruit between 10-12 participants for interview, and complete framework analysis of the findings within 6 months.

Impact: It is anticipated that the results will help provide insight into engagement with splints and orthotics and facilitate service design locally.