Coding framework and descriptors (Focus group).
fits, acute stroke, challenge”–keenness
REGRESSION, SECONDARY, ACUTE STROKE, POSITIVE
Understanding of the core components of the approach.Description of how these components were contextualised.Interpretation of specific components–e.g. handling, task specificity.Examples of participants confirming ILA to be different to their usual practice.Reinforced by other themes–requires time to think/plan; difficult to do.Judgements (in early coherence phase) on how difficult (or not) it might be to apply the approach; and in what contexts.Reflection on how this might feel (e.g. reducing communication).Reported activity that would support communal specification, e.g.Sharing ideas at service level—sharing ideas about the practical application of the approachSharing ideas at patient level—team treatment planning for individual patientsMore likely to adopt an approach if others around you practice in a similar way.Positive culture towards research; changing practice; different approaches.Examples of work done by teams to support the application of principles, e.g. time spent reflecting on treatment application, problem solving.Judgements about who the approach might work well for, and where other approaches might be better.Acknowledging that there are differences between therapist and patient views, e.g. in evaluation of movementHow the approach fits with past experienceHow the approach fits with underpinning values, e.g. in relation to the role of communicationTherapeutic relationshipsClinical scenarios (patient characteristics or activity characteristics) where therapists would deem the approach to be more or less applicable.Patient characteristicsActivity characteristicsExamples of teams wanting to “rise to the challenge”–keenness to give it a go.Individuals or teams with positive/constructive attitude towards the research–they see difficulties but are looking for solutions.Examples of teams/individuals taking action to move implementation forwardChampions and their influenceOrganisation of space and equipmentTrue implementation needs the development of expertise.Becomes easier to apply and to adapt with practice.Training opportunities.Examples where participants reported translating/integrating principles into practice (with non-research patients)Individuals and/or teams demonstrating the intention to continue to use what they have learned as part of their normal practice.Therapists compartmentalising the therapy aspect of rehabilitation–applying the principles in a controlled space.Using “kit” as an enabler–therapists tried to incorporate the basic kit into their sessions. When doing this, felt more able to apply IMPS principles–because it was something tangible and different.Harder (for the therapist) to achieve the desired movement.Challenging not to use internally focussed terminologyReporting it to be more challenging to apply in certain patient groups.Reporting it to be easier to apply with certain patient groups.Therapists conscious of how treatment session appears to others (patient, carers, other members of the MDT)Communication as an inherent part of physiotherapy–perceptions on the impact of changing communication (e.g. on therapeutic relationships)Therapist thoughts on patient experience, e.g. in recognising progress.Examples of resources that participants perceived would aid integration–e.g. broader exercise toolkit, progression/ regression examples.Recognition that to be beneficial, likely to require wider implementation (i.e. over 24 hour period)Perceived as likely to be very difficult to change nursing practice to align with the approach–report that nursing practice is typically explicit.Therefore question value if only applied during therapy.Informal methods used to evaluate benefit—observation of movement; judgements about progress/success.Therapists sense of value of the interventionPerceived secondary benefits that fit with other treatment aims, for example increased intensity of practice; increased patient autonomy.Examples of teams working together to reflect on and/or evaluate the benefits.Learning about the approach prompted therapists to be more creative.Stimulated critique of usual careExamples where therapists discussed how they might adapt the approach to further implementation, or what they might need to know in order to do this.Focus group participants were from four centres, each of which were similar in terms of rehabilitation context (all provided hyperacute and acute stroke care), and unit size.Findings are presented below according to each of the four NPT constructs, and how they are represented through participant views and experiences.