Delphi round 3.

BackgroundMore than half of stroke survivors in lower-middle income countries lack access to stroke rehabilitation services. The promotion of self-rehabilitation could be promising for addressing stroke rehabilitation inadequacies in lower-middle income countries. Self-rehabilitation interventions are more readily acceptable to community-dwelling stroke survivors, and therefore, have the potential to boost the successful realization of the Sustainable Development Goals and other WHO rehabilitation goals. We report a consensus-building process that sought to identify which task trainings are relevant to include in a task-specific self-rehabilitation strategy for rural community-dwelling stroke survivors.MethodsAn iterative two-stage mixed-method consensus-building approach was used: (1) focus group discussions (n = 5) with rural community-dwelling chronic stroke survivors were conducted to explore personal life experiences in performing daily activities, and the results were used to develop a list of candidate task trainings that could be included in a task-specific self-rehabilitation intervention model for improving functional ability of survivors; (2) a three-round Delphi exercise with a panel of stroke rehabilitation experts to establish consensus on the importance/relevance of the developed task trainings. Consensus was pre-defined to be the point where the proportion of items given a rating of 3 (quite relevant) or 4 (highly relevant) by expert panellists is ≥ 0.8. Kendall’s coefficient of concordance (W) was used to assess the level of agreement among the expert panellists.ResultsA list of 74 task trainings was generated from the results of the focus group discussions involving 29 chronic stroke survivors. The tasks were classified as follows: training for the upper extremity (37); lower extremity training (21); trunk training (7); and balance training (9). A panel of 13 stroke rehabilitation experts reviewed these task trainings using the Delphi method and consensus was reached on keeping 28 task trainings in the first round (Kendall’s W = 0.252, p ConclusionThe study provides a consensus-based view of the features of a task-specific self-rehabilitation training strategy to improve outcomes following a stroke. This self-rehabilitation training strategy can be used as an intervention approach to augment and promote stroke rehabilitation among rural community-dwelling stroke survivors, especially in sub-Saharan Africa.**背景**：中低收入国家中，超半数脑卒中幸存者无法获得脑卒中康复服务。推广自我康复方案，或可有效解决中低收入国家脑卒中康复资源不足的困境。居家社区脑卒中幸存者更易接受自我康复干预措施，因此该方案有望助力可持续发展目标（Sustainable Development Goals, SDGs）以及世界卫生组织（World Health Organization, WHO）各项康复目标的顺利达成。本研究报告一项共识构建流程，旨在明确针对农村居家脑卒中幸存者的任务导向型自我康复策略中应纳入的相关任务训练内容。 **方法**：本研究采用迭代式两阶段混合方法共识构建流程：（1）针对5组农村居家慢性脑卒中幸存者开展焦点小组讨论（focus group discussions），探索其日常活动中的个人生活体验；基于讨论结果拟定候选任务训练清单，用于构建可改善幸存者功能能力的任务导向型自我康复干预模型；（2）邀请脑卒中康复专家组成专家组，开展三轮德尔菲（Delphi）法调研，以就已拟定任务训练的重要性与相关性达成共识。本研究预先定义共识标准为：专家组成员给出3分（较为相关）或4分（高度相关）的条目占比≥0.8。采用肯德尔和谐系数（Kendall’s coefficient of concordance, W）评估专家组内的一致性水平。 **结果**：通过对29名慢性脑卒中幸存者的焦点小组讨论结果分析，共生成74项任务训练清单。这些任务被划分为以下类别：上肢训练（37项）、下肢训练（21项）、躯干训练（7项）以及平衡训练（9项）。由13名脑卒中康复专家组成的专家组采用德尔菲法对上述任务训练进行评审，首轮评审即达成共识，保留28项任务训练（肯德尔和谐系数W=0.252，p）。 **结论**：本研究明确了任务导向型自我康复训练策略的核心特征，该策略可改善脑卒中患者的康复结局。此自我康复训练方案可作为干预手段，用于推广并强化农村居家脑卒中幸存者的脑卒中康复服务，尤其适用于撒哈拉以南非洲地区。