Background

1. The establishment of a new Lothian Functional Electrical Stimulation Clinic – an evaluation and exploration 1Jane Shiels;1Katie Wilkie; 2Lisa Salisbury ; 2Dr Stephen Smith; 3Cathy Bulley; 1Caroline McGuire 1Physiotherapy Department, Astley Ainslie Hospital, Edinburgh; 2Edinburgh University, Edinburgh; 3Physiotherapy Subject Area, Queen Margaret University, Edinburgh. Background Approximately 20% of stroke patients present with dropped foot. Functional electrical stimulation (FES) is a recognised clinical option for management of dropped foot, though not widely available in Scotland. Clinic Development An extensive review of the literature highlighted positive quantitative results supporting the use of FES in stroke. This evidence then informed the development of a multi disciplinary FES tertiary outpatient service for the Lothian stroke population. However, no formal qualitative exploration regarding FES had been carried out in this diagnostic group. Evaluation and exploration The effectiveness of the service was evaluated on 40 consecutive patients using pre and post intervention quantitative analysis. Gait velocity and cadence were the primary outcome measures implemented. A supplementary qualitative research exploration was undertaken on 13 patients and 10 carers. Semi-structured interview methodology was applied to capture the views of service users. Figure 1 Mean Cadence Figure 2 Mean Gait Velocity Results Quantitative data was routinely collected. Highly statistically significant improvements (p<0.001) were demonstrated, with a 39% improvement in gait velocity and 14% increase in cadence. (See figures 1 & 2) Following thematic analysis of the qualitative data relating to 13 patient and 10 carer interviews, both groups highlighted positive impacts on participation, stamina, confidence, independence and mood. (See patient and carer quotes) Patient and Carer Quotes Confidence “But certainly much more likely to do things that involved walking as a result of having an increased level of confidence in my abilities which the FES gives me” (patient) Stamina “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” (patient) Participation “She likes to go places now, before she’d just sit in the wheelchair. Now she can walk a lot of the way” (carer) Independence “No, but it’s made an awfy difference. It’s given him total independence” (carer) Mood “That was half a mile she walked. And she got in the car and she was absolutely exhausted but you couldnae take the smile off her face with a chisel” (carer) Negatives “But the one thing that I did find after using the pads I had terrible rashes and the skin started to break out” (patient) Conclusions • The combination of quantitative audit and qualitative research provided a global evaluation of the service. • A dedicated FES service positively impacts on functional ability and quality of life after stroke. • Implications • These robust results informed strategic development of the service. • A Lothian based FES clinic assessing 24 patients per annum has been set up for 2 years, whilst recurrent funding is sought.