Reimagining Stroke Rehabilitation and Recovery Across the Care Continuum: Results From a Design-Thinking Workshop to Identify Challenges and Propose Solutions

Julie A DiCarlo; Galina Gheihman; David J Lin; 2019 Northeast Cerebrovascular Consortium Conference Stroke Recovery Workshop Participants

doi:10.1016/j.apmr.2021.01.074

Reimagining Stroke Rehabilitation and Recovery Across the Care Continuum: Results From a Design-Thinking Workshop to Identify Challenges and Propose Solutions

Arch Phys Med Rehabil. 2021 Aug;102(8):1645-1657. doi: 10.1016/j.apmr.2021.01.074. Epub 2021 Feb 5.

Authors

Julie A DiCarlo¹, Galina Gheihman¹, David J Lin²; 2019 Northeast Cerebrovascular Consortium Conference Stroke Recovery Workshop Participants

Affiliations

¹ Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
² Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA; Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA. Electronic address: dlin7@mgh.harvard.edu.

PMID: 33556351
DOI: 10.1016/j.apmr.2021.01.074

Abstract

Systems for stroke rehabilitation and recovery are variable and fragmented; stroke survivors often experience gaps in care with detrimental effects on their recovery. We designed and hosted a multidisciplinary and interactive workshop to discuss challenges facing patients recovering from stroke and to brainstorm solutions. Forty-one participants including clinicians, researchers, and stroke survivors attended the workshop. Participants were surveyed beforehand about challenges facing stroke recovery and results were tabulated as a word cloud. An interactive, design-thinking exercise was conducted that involved completing workbooks, hands-on prototype designing, and presentations, which were then analyzed through qualitative content analysis using an inductive approach. High frequency words in the word cloud of survey responses included access, fragmented, and uncertainty. Qualitative analysis revealed 6 major challenge themes including poor (1) transitions in and (2) access to care; (3) barriers to health insurance; (4) lack of patient support; (5) knowledge gaps; and (6) lack of standardized outcomes. Eleven unique solutions were proposed that centered around new technologies, health care system changes, and the creation of new support roles. Analysis of the alignment between the challenges and solutions revealed that the single proposed solution that solved the most identified challenges was a "comprehensive stroke clinic with follow-up programs, cutting edge treatments, patient advocation and research." Through our interactive design-thinking workshop process and inductive thematic analysis, we identified major challenges facing patients recovering from stroke, collaboratively proposed solutions, and analyzed their alignment. This process offers an innovative approach to reaching consensus among interdisciplinary stakeholders.

Keywords: Delivery of health care; Education; Neurological rehabilitation; Rehabilitation; Stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Continuity of Patient Care*
Focus Groups
Health Services Accessibility
Humans
Recovery of Function*
Social Support
Stroke Rehabilitation / trends*