{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:31:12Z","timestamp":1790181072984,"version":"4.1.0"},"reference-count":38,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CHRP 549680-20"],"award-info":[{"award-number":["CHRP 549680-20"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","award":["CHRP 549680-20"],"award-info":[{"award-number":["CHRP 549680-20"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,3,14]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individuals with stroke or spinal cord injury (SCI) often have poor balance control, leading to falls and activity limitations. One intervention that targets balance control\u2014functional electrical stimulation with visual feedback balance training (FES+VFBT)\u2014may improve balance control but needs modifications for clinical use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To use a participatory design approach to identify potential challenges and solutions for the clinical implementation of FES+VFBT as a balance intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design\/methods<\/jats:title>\n                    <jats:p>A descriptive qualitative study involving four semi-structured focus group meetings was conducted to explore the perspectives of individuals with stroke and SCI, physical therapists and a hospital administrator on the feasibility and challenges of implementing FES+VFBT into clinical settings. The interviews were transcribed and analysed using deductive and inductive content analyses. The deductive analysis was based on the social ecological model (SEM) levels, while the inductive approach was used to identify categories and codes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Virtual.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Two individuals with chronic SCI and one individual with chronic stroke who were able to stand but reported deficits in their balance control. Two physical therapists who had experience with FES and the rehabilitation of individuals with SCI or stroke. One hospital administrator who worked within a neurological rehabilitation setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Themes were organised according to the SEM\u2019s four levels: intrapersonal, interpersonal, organisational\/training environment and society\/policy. Identified categories included potential challenges at the intrapersonal level (ie, lack of knowledge, safety and tolerance of user) and organisational\/training environment level (ie, technical challenges, cost, physical space and time). The categories also included possible solutions at all SEM levels, such as intrapersonal (ie, reading and education), interpersonal (ie, practising together), organisational\/training environment (ie, technology characteristics and creating resources) and society\/policy (ie, purchasing options, guidelines and foundation grants).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>End-users identified anticipated challenges and solutions to using the FES+VFBT system clinically. The results will inform the design and clinical implementation of a revised version of the system and other FES devices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090791","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T10:00:43Z","timestamp":1743674443000},"page":"e090791","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Combining functional electrical stimulation with visual feedback balance training: a qualitative study of end-user perspectives on designing a clinically feasible intervention"],"prefix":"10.1136","volume":"15","author":[{"given":"Elina","family":"Nezon","sequence":"first","affiliation":[{"name":"Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada"},{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanha","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Benson","sequence":"additional","affiliation":[{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2356-4100","authenticated-orcid":false,"given":"Katherine","family":"Chan","sequence":"additional","affiliation":[{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae W","family":"Lee","sequence":"additional","affiliation":[{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"},{"name":"Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L","family":"Inness","sequence":"additional","affiliation":[{"name":"Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada"},{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"},{"name":"Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton L","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha L","family":"Benn","sequence":"additional","affiliation":[{"name":"Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada"},{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Masani","sequence":"additional","affiliation":[{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"},{"name":"Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-8211","authenticated-orcid":false,"given":"Kristin E","family":"Musselman","sequence":"additional","affiliation":[{"name":"Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada"},{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada"},{"name":"Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"2025121513280842000_15.4.e090791.1","unstructured":"Government of Canada . The cost of injury in Canada. 2020. Available: https:\/\/www.canada.ca\/en\/public-health\/services\/injury-prevention\/cost-injury-canada.html [Accessed 3 Aug 2025]."},{"key":"2025121513280842000_15.4.e090791.2","unstructured":"World Health Organization . WHO global report on falls prevention in older age. Ageing and Life Course, Family and Community Health; 2008."},{"key":"2025121513280842000_15.4.e090791.3","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1186\/s12877-023-04298-y","article-title":"Relationship between fear of falling and fall risk among older patients with stroke: a structural equation modeling","volume":"23","author":"Chen","year":"2023","journal-title":"BMC Geriatr"},{"key":"2025121513280842000_15.4.e090791.4","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1038\/s41393-019-0274-4","article-title":"Falls after spinal cord injury: a systematic review and meta-analysis of incidence proportion and contributing factors","volume":"57","author":"Khan","year":"2019","journal-title":"Spinal Cord"},{"key":"2025121513280842000_15.4.e090791.5","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.518563"},{"key":"2025121513280842000_15.4.e090791.6","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/sc.2015.125","article-title":"Concerns about falling in wheelchair users with spinal cord injury--validation of the Swedish version of the spinal cord injury falls concern scale","volume":"54","author":"Butler Forslund","year":"2016","journal-title":"Spinal Cord"},{"key":"2025121513280842000_15.4.e090791.7","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-019-0332-y"},{"key":"2025121513280842000_15.4.e090791.8","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2011.568667"},{"key":"2025121513280842000_15.4.e090791.9","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.apmr.2024.07.013","article-title":"Balance Interventions to Improve Upright Balance Control and Balance Confidence in People With Motor-Incomplete Spinal Cord Injury or Disease: A Systematic Review and Meta-analysis","volume":"106","author":"Benn","year":"2025","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121513280842000_15.4.e090791.10","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1167954","article-title":"Advances in balance training to prevent falls in stroke patients: a scoping review","volume":"15","author":"Chen","year":"2024","journal-title":"Front Neurol"},{"key":"2025121513280842000_15.4.e090791.11","article-title":"Force platform feedback for standing balance training after stroke","volume":"2004","author":"Barclay-Goddard","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121513280842000_15.4.e090791.12","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/MRR.0000000000000376","article-title":"Effects of visual feedback training and visual targets on muscle activation, balancing, and walking ability in adults after hemiplegic stroke: a preliminary, randomized, controlled study","volume":"43","author":"Pak","year":"2020","journal-title":"Int J Rehabil Res"},{"key":"2025121513280842000_15.4.e090791.13","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1038\/sc.2010.41","article-title":"Positive effect of balance training with visual feedback on standing balance abilities in people with incomplete spinal cord injury","volume":"48","author":"Sayenko","year":"2010","journal-title":"Spinal Cord"},{"key":"2025121513280842000_15.4.e090791.14","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.00680","article-title":"Functional Electrical Stimulation Plus Visual Feedback Balance Training for Standing Balance Performance Among Individuals With Incomplete Spinal Cord Injury: A Case Series","volume":"11","author":"Houston","year":"2020","journal-title":"Front Neurol"},{"key":"2025121513280842000_15.4.e090791.15","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12938-020-00824-w","article-title":"Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation","volume":"19","author":"Milosevic","year":"2020","journal-title":"Biomed Eng Online"},{"key":"2025121513280842000_15.4.e090791.16","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1179\/2045772312Y.0000000058","article-title":"Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project","volume":"35","author":"Teeter","year":"2012","journal-title":"J Spinal Cord Med"},{"key":"2025121513280842000_15.4.e090791.17","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1080\/09593985.2019.1650856","article-title":"A survey of Canadian healthcare professionals\u2019 practices regarding reactive balance training","volume":"37","author":"Mansfield","year":"2021","journal-title":"Physiother Theory Pract"},{"key":"2025121513280842000_15.4.e090791.18","unstructured":"Spinuzzi C . The methodology of participatory design. Appl Res 2005;52."},{"key":"2025121513280842000_15.4.e090791.19","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s12883-023-03312-5","article-title":"Identifying priorities for balance interventions through a participatory co-design approach with end-users","volume":"23","author":"Benn","year":"2023","journal-title":"BMC Neurol"},{"key":"2025121513280842000_15.4.e090791.20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17975\/sfj-2017-016","article-title":"Development of Visual Feedback Training Using Functional Electrical Stimulation Therapy for Balance Rehabilitation","volume":"3","author":"Chow","year":"2017","journal-title":"STEM Fellowship Journal"},{"key":"2025121513280842000_15.4.e090791.21","doi-asserted-by":"publisher","DOI":"10.1177\/0269215509339004"},{"key":"2025121513280842000_15.4.e090791.22","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025121513280842000_15.4.e090791.23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/160940690900800301","article-title":"A Qualitative Framework for Collecting and Analyzing Data in Focus Group Research","volume":"8","author":"Onwuegbuzie","year":"2009","journal-title":"Int J Qual Methods"},{"key":"2025121513280842000_15.4.e090791.24","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-8-73","article-title":"Using reflexivity to enhance in-depth interviewing skills for the clinician researcher","volume":"8","author":"McNair","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"2025121513280842000_15.4.e090791.25","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/160940690600500107","article-title":"Demonstrating Rigor Using Thematic Analysis: A Hybrid Approach of Inductive and Deductive Coding and Theme Development","volume":"5","author":"Fereday","year":"2006","journal-title":"Int J Qual Methods"},{"key":"2025121513280842000_15.4.e090791.26","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1177\/1094428108324513","article-title":"Book Review: Krippendorff, K. (2004). Content Analysis: An Introduction to Its Methodology (2nd ed.). Thousand Oaks, CA: Sage","volume":"13","author":"Giannantonio","year":"2010","journal-title":"Organ Res Methods"},{"key":"2025121513280842000_15.4.e090791.27","unstructured":"Glanz K , Rimer BK , Viswanath K . Health behavior: theory, research, and practice. 5th edn. Jossey Bass, Wiley, 2015."},{"key":"2025121513280842000_15.4.e090791.28","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"2025121513280842000_15.4.e090791.29","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzab031","article-title":"What Factors Influence Clinicians\u2019 Use of Technology in Neurorehabilitation? A Multisite Qualitative Study","volume":"101","author":"Bower","year":"2021","journal-title":"Phys Ther"},{"key":"2025121513280842000_15.4.e090791.30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3138\/ptc.2013-63","article-title":"Incorporating research technology into the clinical assessment of balance and mobility: perspectives of physiotherapists and people with stroke","volume":"67","author":"Pak","year":"2015","journal-title":"Physiother Can"},{"key":"2025121513280842000_15.4.e090791.31","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20150464"},{"key":"2025121513280842000_15.4.e090791.32","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e318214f5d8"},{"key":"2025121513280842000_15.4.e090791.33","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1080\/01942638.2023.2197053","article-title":"Exploring the Experiences and Perceptions of Pediatric Therapists who use Functional Electrical Stimulation in their Clinical Practice","volume":"43","author":"Musselman","year":"2023","journal-title":"Phys Occup Ther Pediatr"},{"key":"2025121513280842000_15.4.e090791.34","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.00019"},{"key":"2025121513280842000_15.4.e090791.35","doi-asserted-by":"crossref","first-page":"121","DOI":"10.7861\/futurehosp.4-2-121","article-title":"Promoting innovation in healthcare","volume":"4","author":"Kelly","year":"2017","journal-title":"Future Healthc J"},{"key":"2025121513280842000_15.4.e090791.36","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-015-1949-1"},{"key":"2025121513280842000_15.4.e090791.37","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1093\/geront\/gny034","article-title":"Participatory Design in Gerontechnology: A Systematic Literature Review","volume":"59","author":"Merkel","year":"2019","journal-title":"Gerontologist"},{"key":"2025121513280842000_15.4.e090791.38","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-090791","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:28:23Z","timestamp":1765834103000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-090791"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,3]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bmjopen-2024-090791"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090791","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}