Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

What is “challenge”? An interdisciplinary concept analysis of task difficulty in stroke rehabilitation. (#160)

Emeline (Emma) M Gomes 1 , Gemma Alder 1 , Felicity Bright 2 , Nada Signal 1
  1. Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
  2. Centre for Person Centred Research, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand

Background: The growing burden of stroke disability has prompted researchers to rethink our understanding of rehabilitation concepts1. Researchers are now considering how the concept of “challenge” influences outcomes and experiences of stroke rehabilitation. However, challenge is poorly understood and holds various meanings in the literature, including overlapping descriptions of task difficulty, physiological intensity, cognitive load and perceived effort2. This conceptual confusion risks suboptimal implementation of challenge in practice3. 

Aim: To explore how challenge is conceptualised in stroke rehabilitation literature from the perspectives of people with stroke, physiotherapy, occupational therapy and speech-language therapy.  

Methods: Penrod and Hupcey’s3 principle-based concept analysis method was used to explore challenge within the stroke rehabilitation literature. Following a systematic search of electronic databases, papers were screened using the Breadth and Depth method to select literature with high informational value4. All papers were analysed; codes were synthesised to elicit understandings of the range of purposes, meanings and uses of challenge, within and across perspectives. 

Results: A total of 3031 papers were retrieved, with 42 included following screening. Challenge appeared to be a multidimensional, progressive and fluid concept which was understood through three components: nominal, functional and perceived challenge. Nominal challenge was understood as the task difficulty based solely on characteristics of the task itself. Functional challenge was defined as an interaction between the nominal challenge and the person’s ability. A third emerging component was identified, perceived challenge. Perceived challenge was considered as the person’s experience of challenge. Functional and perceived challenge were predominantly used to create optimal challenge. Optimal challenge was central to enhancing (re)learning, both in the experience of rehabilitation and everyday life for people with stroke. 

Conclusion: Challenge is an important concept, that when carefully optimised to the person’s ability and perception of challenge, may positively influence engagement with and outcomes from stroke rehabilitation.

  1. Hayward, K. S., Churilov, L., Dalton, E. J., Brodtmann, A., Campbell, B. C. V., Copland, D., Dancause, N., Godecke, E., Hoffmann, T. C., Lannin, N. A., McDonald, M. W., Corbett, D., & Bernhardt, J. (2021). Advancing stroke recovery through improved articulation of nonpharmacological intervention dose. Stroke, 52(2), 761–769. https://doi.org/10.1161/STROKEAHA.120.032496
  2. Page, S. J., Schmid, A., & Harris, J. E. (2012). Optimizing terminology for stroke motor rehabilitation: Recommendations from the American Congress of Rehabilitation Medicine Stroke Movement Interventions Subcommittee. Archives of Physical Medicine and Rehabilitation, 93(8), 1395–1399. https://doi.org/10.1016/j.apmr.2012.03.005
  3. Penrod, J., & Hupcey, J. E. (2005). Enhancing methodological clarity: Principle-based concept analysis. Journal of Advanced Nursing, 50(4), 403–409. https://doi.org/10.1111/j.1365-2648.2005.03405.x
  4. Davidson, E., Edwards, R., Jamieson, L., & Weller, S. (2019). Big data, qualitative style: A breadth-and-depth method for working with large amounts of secondary qualitative data. Quality & Quantity, 53(1), 363–376. https://doi.org/10.1007/s11135-018-0757-y