Developing upper limb functional electrical stimulation clinical practice guidelines for stroke rehabilitation.

This thesis explores the use of upper limb (UL) functional electrical stimulation (FES) in clinical settings in people with stroke and information that supports the development of clinical practice guidelines. Chapter 1 introduces the thesis and provides an overview of this multimethod programme of research. Chapter 2 presents the background literature, outlining the context of the rehabilitation of the UL post-stroke and the use of functional electrical stimulation in the management of post-stroke UL impairments to drive functional recovery. Chapter 3 outlines the research paradigm, focusing particularly on the epistemological and ontological positions taken and the rationale for adopting a pragmatic approach with multimethods. Chapter 4 is the first study in the thesis and is a systematic review of the treatment parameters for UL FES post-stroke. The systematic review highlighted that there was too much variance between functional electrical stimulation applications to indicate recommended UL treatment parameters. The resulting gaps relating to UL FES treatment parameters in the literature indicated the need for a better understanding of UL clinical presentations that informed prescription/use of UL FES, and this helped shape the methodology used in chapter 5. Chapter 5 is a review of the medical records within an NHS Foundation Trust stroke pathway. This medical records review indicated the lack of detail within the medical documentation relating to the management of the post-stroke UL and the limited use of UL FES across the stroke pathway, which supported the justification for chapter 6 methodology. Chapter 6 is a qualitative study exploring the views of physiotherapists, occupational therapists and rehabilitation assistants working within two large NHS Foundation Trust stroke pathways about the management of the UL post-stroke and the use of UL FES. Chapter 7 concludes the data collection in the thesis using a Delphi method to gain consensus on best practice in the use of UL FES in the management of people with stroke. The findings of this chapter establish a set of consensus statements that will support the development of clinical practice guidelines. Chapter 8 concludes the thesis by presenting a critical review of the research findings and highlights future research possibilities.