An investigation into the implementation of robot-assisted upper limb therapy within an Australian rehabilitative setting

Background: Robot-assisted upper limb therapy (RT-UL) is an emerging intervention for stroke survivors with upper limb (UL) impairments. Research into RT-UL has concentrated on investigating the clinical efficacy but implementation and use of RT-UL in routine practice has not yet been adequately explored. This is a notable gap in the field when considering that non-adoption and abandonment is common for health technologies in the clinical setting. The aim of this doctoral research program was to investigate the implementation and use of the InMotion, RT-UL device, for the first time in an Australian clinical setting.

Methods: A multiple methods approach was used in this program of research involving four studies, two qualitative and two quantitative. Study 1 explored therapists’ perceptions of RT-UL prior to the implementation through discipline specific focus groups. Study 2 was an observational study that investigated the amount of UL practice performed by subacute stroke survivors pre and post RT-UL implementation. Study 3 involved audits of RT-UL computer data to investigate the sustainability of RT-UL as part of routine practice over a two-year period. Study 4 explored therapist perceptions of the RT-UL post implementation through discipline specific focus groups.

Results: Study 1 identified therapists were positive towards the implementation of RT-UL perceiving the device would provide opportunity for increased UL practice for strokes survivors in their clinical setting. The availability of a single RT-UL device may however create unique logistical challenges. Study 2 observed a significant increase in UL practice for stroke survivors including those with severe UL impairment following the implementation of RT-UL as part of routine practice. Study 3 discovered that RT-UL was in continued and regular use with stroke survivors two years after implementation. Study 4 found both disciplines continued to be accepting of RT-UL post implementation but it was physiotherapists who predominantly prescribed RT-UL. Implementation of RT-UL had been largely successful due to an increased level of UL practice for patients, the ease of using the device as part of routine practice and positive reception from patients. The implementation process was also clinician initiated and led.

Conclusion: This research program was the first to evaluate the implementation of RT-UL into the routine practices of an Australian rehabilitation setting. New knowledge was acquired about RT-UL use with stroke survivors including occupational therapists and physiotherapists perceptions, impact on the amount of UL practice able to be delivered, sustainability of RT-UL within the inpatient rehabilitation setting and barriers and facilitator to RT-UL implementation.