1 Jane Shiels; 2 Lisa Salisbury; 1 Katie Wilkie; 3 Cathy Bulley; 1 Caroline McGuire

1. Stroke patient and carer experiences of Functional Electrical Stimulation (FES) as provided through a Lothian drop foot clinic – a qualitative exploration. 1 Jane Shiels;2 Lisa Salisbury; 1 Katie Wilkie; 3 Cathy Bulley; 1 Caroline McGuire 1 Physiotherapy Department, Astley Ainslie Hospital, Edinburgh; 2 Centre for Integrated Healthcare Research, Edinburgh University, Edinburgh; 3 Physiotherapy Subject Area, Queen Margaret University, Edinburgh. Background FES Carer Quotes FES Patient Quotes Functional electrical stimulation (FES) is the use of electrical stimulation to cause functional movement in muscles paralysed due to central nervous system lesions e.g. lifting the affected foot during walking. A pilot clinic providing FES to stroke patients has been running at the Astley Ainslie Hospital, Edinburgh since 2003. Following service audit and review, a proposal has been submitted to Lothian Health for the provision of a permanently funded clinic. In order to further support and enhance this application a qualitative project was undertaken to explore patients’ and carers’ experiences of FES and the pilot clinic. Functional Ability “She likes to go places before she’d just sit in the wheelchair. Now she can walk a lot of the way….and that makes a big difference” “I go out into the car and he just trots out behind me and he gets into the car on his own……and he can go shopping” Functional Ability “I get to overtake old ladies with sticks rather than be overtaken by them” “The difference between using FES and not using it is something like probably 15 or 20% improvements to the walking. The quality is better the stamina is definitely better” Participation “If she wants to get up and walk around the room she just does it now and I don’t worry so much” “Well he now cleans windows for me and does different things” Participation “Now I’m travelling all over the place and I have changed my role with the company as well……but the only reason I’m back to what I am doing or allowing myself is this” (FES) Methodology Semi-structured interviews were undertaken by an independent interviewer, on 10 carers and 13 patients using a focused topic guide. Interpretative Phenomenological Analysis was used as a framework for thematic analysis of the transcripts. Rigour was ensured by using participant verification and checking of themes. Quality of Life “Its made an awfy difference – its given him total independence” “I think it’s lessened my workload” Quality of Life “As a family we tend to enjoy walking…..so it’s nice to be able to do that again” Results The general consensus from patients was that they found FES of value with improvements in functional ability, participation and quality of life. These effects also impacted positively on the lives of carers. While they felt that positives outweighed the negatives, some limitations were identified as areas for development. Further themes were identified in relation to the dedicated clinic, including value placed on expert consultation and peer support, as well as barriers to initial referral. FES Joint Quotes Clinic “If anything goes wrong I phone them up and see them” “Every now and then it’s really important that we have those appointments where they review and look at it…….without that it would just deteriorate I think” Conclusions Negatives “It can cause the skin to break and if your skin breaks you can’t wear it at all” “If it was given to a design engineer to design properly it could be so much smaller, so much neater” “Just the pads, the positioning of the pads I think maybe I’m missing the nerve again because sometimes I feel that it musnae be right because he is flicking his foot or his foot shakes a wee bit” This qualitative research has supported the evidence gained from the previous quantitative evaluation of the clinic. The positive impacts articulated by both patients and carers have provided in-depth insights into the benefits demonstrated by the application of FES beyond the physical improvements of gait.