Exploring factors influencing the consistent adoption of a post-stroke upper extremity outcome measure using Normalisation Process Theory

Abstract Background Stroke rehabilitation guidelines recommend using outcome measures like the Fugl-Myer Assessment (FMA) and the Action Research Arm Test for post-stroke upper extremity function assessment. Despite these recommendations, challenges persist in their integration into everyday clinical practice, highlighting the crucial need to comprehend and implement outcome measurement aligned with evolving healthcare models. Objective Our study aimed to use a theory-based approach to identify the barriers and facilitators to routine use of the FMA for post-stroke upper extremity function among hospital-based occupational therapists. Methods Employing a mixed-method sequential exploratory study design rooted in the Normalisation Process Theory (NPT), we gathered quantitative data through a validated survey followed by qualitative insights analysed with directed content analysis from focus group discussions involving occupational therapists from four hospitals. Results The online survey (n = 34) revealed barriers predominantly associated with NPT constructs collective action and coherence. Facilitators were primarily linked to the cognitive participation construct. Focus group discussion revealed key barriers including inadequate coaching, competing tasks and priorities, and the perceived limited value of the FMA by therapists. Key facilitators were legitimation of therapists’ role in outcome measurement and an open learning culture. Conclusions Through a theory-based approach, we identified distinct challenges and enablers to routine outcome measurement previously not reported in the literature. Our findings provide insights on designing implementation strategies to embed the use of the FMA into routine practice.