Authors: Kashish Surana, Pramod D. Lambor, Shashank Mehrotra
Categories: Neuroscience, Apps, Neurorehabilitation, Technology, Occupational therapy, Stroke rehabilitation, Parkinson’s disease, Good health and well-being, XXXXXXXXXXXXXXXX
Source: MethodsX
Authors: Kashish Surana, Pramod D. Lambor, Shashank Mehrotra
Mobile apps are increasingly used in healthcare and are transforming neurorehabilitation by supporting patient care and enhancing clinical practice. Apps have demonstrated significant potential for supporting patients with various neurological disorders. Occupational therapists play a crucial role in integrating apps to enhance patients' performance by selecting those that match their needs. Existing research highlights the potential of therapy-specific apps in occupational therapy to meet the patient’s unique needs. Most existing studies have been conducted in Western countries, and the experiences and perspectives of occupational therapists about using apps, their adoption, and implementation in Indian occupational therapy practice remain unexplored. The study aims to explore the experiences and perspectives of occupational therapists about the use of apps for neurorehabilitation in India. Occupational therapists who are working with patients having any neurological disorders in India will be recruited for this study. Braun and Clarke's approach to thematic analysis will be used to explore occupational therapists' experiences, investigated through an in-depth interview using a semi-structured interview guide.
Specifications tableSubject areaNeuroscienceMore specific subject areaOccupational Therapy in NeurorehabilitationName of your protocolOccupational Therapists’ Experiences and Perspectives about Using Apps in Neurorehabilitation in India: A Qualitative Study ProtocolReagents/toolsNot ApplicableExperimental designDescriptive qualitative, single-center research study. Occupational therapists from various clinical settings in India will be interviewed; participants will be recruited through purposeful and snowball sampling. Data will be collected through in-depth interviews.Trial registrationNot ApplicableEthicsThis study is approved by the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee 2 (Project reference IEC 182–2025). The study also complies with the ethical considerations laid out in the Declaration of Helsinki (2024). All the study participants will be informed about the objectives and the relevant details, including their voluntary participation and that withdrawal from the study or nonparticipation will have no negative consequences for them. An online informed consent will be obtained through a Google Forms link, and a copy of their filled consent form will be mailed to them. Participants will be assured about confidentiality and privacy of their data.Value of the Protocol• There is a limited exploration of occupational therapists’ experiences and perspectives regarding use of apps in neurorehabilitation. Most existing apps are developed in Western contexts, which may not align with the Indian clinical practice.• This study would help to gain a deeper understanding of occupational therapists’ experiences and perspectives about the use of apps in neurorehabilitation, and explore the perceived benefits, challenges of app usage, and clinical reasoning of therapists behind app integration in practice.• The findings of this study would guide occupational therapists for further in-depth research and may lead to better clinical decision-making during the therapy process.
An app or application refers to a computer program or software designed for a particular purpose and can be downloaded on a mobile phone or other mobile devices [1] The use of mobile devices and apps is increasing in healthcare, benefiting healthcare professionals in numerous ways; they are easy to use, help in better decision-making, and enhance the productivity of healthcare professionals [[2], [3], [4]]
By integrating apps into clinical practice, even the field of neurorehabilitation is transforming [[5], [6], [7], [8]] Apps have demonstrated significant potential for supporting physical activity, rehabilitation, cognitive exercise, medication adherence, and education in managing stroke, multiple sclerosis, and Parkinson’s disease, and also for evaluating range of motion, cognitive functions, and ADL performance in patients with stroke and Parkinson’s disease [[9], [10], [11], [12]]
Dexteria and Constant Therapy are apps that have shown significant improvements in hand functions and cognitive tasks in post-stroke patients, outperforming conventional therapy [13,14] Occupational therapists often use apps like Dexteria, Cognifit, Constant Therapy, and Luminosity to address neuromusculoskeletal and cognitive deficits [15]
App-based interventions focusing on task-oriented activities help post-stroke patients practice ADLs and improve functional, motor, communication, and cognitive skills [[16], [17], [18], [19]] Virtual reality-based mobile apps are more effective and engaging than conventional therapy [20] Apps like REACT support cognitive retraining by offering ADL tutorials, cognitive exercises, and personalized motor activities for patients, including those with Parkinson’s Disease [21]
Occupational therapists play a crucial role in integrating apps to enhance patients' performance by selecting those that match their needs [22] While apps are considered beneficial in stroke rehabilitation, certain challenges include high costs, complexity for patients with limited cognitive skills, and time-consuming app selection [23] Limited tablet accessibility and maintenance issues also hinder regular use. Therapists prioritize app compatibility, patient orientation, and long-term benefits [24] Apps requiring precise coordination can be difficult, prompting therapists to experiment with various options [25] Some therapists use everyday apps, like transportation and reminder tools, to make therapy more relevant [26] A study [27] found that Vigo, an AI-based app, holds potential for stroke survivors but requires specific cognitive and physical skills to be effective.
Existing research highlights the potential of therapy-specific apps in occupational therapy to meet the patient’s unique needs. Occupational therapists are important stakeholders in this process, as they are the ones who select and use the apps in practice. However, most existing studies have been conducted in Western countries, and the experiences and perspectives of occupational therapists about using apps, their adoption, and implementation in Indian occupational therapy practice remain unexplored.
The present study aims to address the following research •What are the experiences and perspectives of occupational therapists about use of apps for neurorehabilitation in India?•What are occupational therapists’ perspectives on the enablers and barriers associated with use of app for neurorehabilitation in India?
This study will be conducted online and will recruit Indian occupational therapists currently working in neurorehabilitation. Over the past decade, occupational therapy in India has grown significantly in clinical practice, education, and research, focusing on evidence-based practice. The integration of occupational therapy into multidisciplinary teams and the expansion of community-based practice have further improved the accessibility and effectiveness of therapy across India [28] Among various specialties, neurorehabilitation has been identified as the second most common area of practice for occupational therapists in India [29]
A qualitative descriptive approach will be employed for this study. This design will help to explore the experiences and perspectives of occupational therapists on use of apps in neurorehabilitation. Data will be collected using a semi-structured interview guide to allow participants to freely express their experiences and perspectives [30] In-depth interviews with occupational therapists, working in neurorehabilitation, will be conducted by the primary investigator online via Microsoft Teams. Since the participants will be recruited from different parts of India, a face-to-face interview method will not be feasible. Interviews will be conducted between July 2025 to January 2026.
For the current study, occupational therapists who are working with patients having any neurological disorders in India will be recruited. Participants will be identified through the investigators’ professional networks. Primary investigator will approach potential participants through purposive and snowball sampling. Purposive sampling will enable the researchers to intentionally select participants who may give rich information on the studied objectives, while through snowball sampling, the participants will refer to other occupational therapists who meet the study's inclusion criteria, thereby helping the researchers by increasing access to relevant participants [31] The primary investigator will provide a brief overview of the study t to the potential participants via phone. Those expressing interest in participating in the study will be further screened for eligibility, ensuring that they meet the inclusion criteria.
Participants will be recruited only if they meet the following criteria, as mentioned in Table 1.Table 1Participant inclusion and exclusion criteria.Table 1Inclusion criteriaExclusion criteria• Occupational therapists currently using or have used apps for assessments and/or intervention in neurorehabilitation in India.• Occupational therapists who work part-time in neurorehabilitation and are also engaged in other clinical settings.• Occupational therapists with a minimum bachelor’s degree or higher, having at least 3 years’ experience of working with patients with neurological disorders in India.• Occupational therapists who use social media apps solely for communicating with patients.
The sample size proposed for the current study is 12–15 occupational therapists, depending on when we achieve data saturation. This is as per the recommendations of Hennink and Kaiser [32] which states that data saturation for qualitative studies is commonly achieved between 9 and 17 interviews.
Initially, a participant information sheet and an online informed consent form will be emailed to the eligible participants. If the participants have doubts about the study, the primary investigator will clear them. After obtaining the consent, an online interview will be scheduled at a date and time convenient for the participants. A demographic sheet will be used to collect participants' background information. In-depth interviews will be conducted using a semi-structured interview guide, which will be developed by the investigating team. The primary investigator will conduct all interviews in English. Each interview may last for 45 min to 60 min, depending on the responses from the participants. At the start of the interview, the study's objectives will be explained again to the participants. The interviews will focus on participants’ experiences and perspectives regarding using apps in neurorehabilitation, and the interviews will be audio-recorded for analysis of the data. The audio recordings and the transcripts of all the interviews will be securely stored in a password-protected file accessible only to the investigators, thus maintaining the privacy and confidentiality of the participants.
A semi-structured interview guide will be developed based on existing relevant literature. The draft of the interview guide will then be reviewed by two occupational therapists who have a background of working in neurorehabilitation for at least two years. Based on the suggestions of the subject experts, the interview guide will be revised to ensure that the questions in the guide are clear and align with the study’s objectives. We will conduct 2–3 mock interviews to practice and assess the comprehensiveness and accuracy of the interview questions. The interview guide will be revised continuously throughout the duration of the study to enhance the depth and quality of data gathered, thus improving the credibility of the data collection process.
Descriptive statistics using frequency distribution tables and charts will be used to describe the participants’ demographic details. The six-step thematic analysis process by Braun and Clark [33] as presented in Table 2 will be followed to best represent the data in relevant themes. The primary investigator will prepare transcripts after listening to the audio recordings of the interviews and get familiarized with the data to understand the data thoroughly; then, inductive coding will be performed by the investigating team to label the relevant data using codes. All the related data will be grouped to form themes, and the themes will be refined, defined, and named to reflect the participants’ experiences accurately. The results of the collected data will be reported based on the “Consolidated Criteria for Reporting Qualitative Research (COREQ)” [34]Table 2Steps of thematic analysis as given by Braun and Clark (2006).Table 2Steps of Thematic AnalysisDescription1. Data FamiliarizationActively reading and re-reading the data to gain a deeper understanding of the content. Notes will be prepared for initial ideas and patterns to support the coding process.2. Generating initial codesInductive coding will be performed using Microsoft Word, and statements relevant to the research question will be identified and labeled as codes. Statements like previous codes will be grouped together, while new codes will be formed when the statements do not fit the earlier codes.3. Searching for themesPotentially related codes will be grouped together to form themes.4. Reviewing themesThe audio recording will be and the initial themes will be reviewed again by the investigating team to ensure the data is correctly represented. New themes will be generated if the existing ones do not represent the data accurately.5. Defining and naming themesThe themes will be further refined to ensure they accurately reflect the data.6. Producing a reportA descriptive report will be prepared, and the themes will be presented. The report will explain the meaning of the data along with its significance and implications.
We will ensure the rigour of the study by adhering to the established criteria for assuring the trustworthiness of the research process and findings [35] Members of the research team will be involved in the data analysis process independently, followed by group discussions to ensure that the participants' experiences and views are accurately and fairly reflected in the findings. Additionally, the primary investigator will undergo training in qualitative research methodology to improve interviewing and analytical skills. Participants will be chosen from various parts of India through purposive sampling to capture a range of perspectives from different practice settings and levels of experience as an attempt to improve the transferability of the findings. To ensure reliability, an audit trail of the development of the interview guide, the codes, and themes will be maintained. The research findings will be supported by direct quotes of the participants to ensure that interpretation is grounded in the data and to ensure objectivity of the findings.
This study adheres to the ethical guidelines to protect participants' protection and privacy. The study has been approved by Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee 2, Manipal (DHR Registration Number: EC/NEW/INST/2024/KA/0509), Project reference IEC 182–2025. Online informed consent will be taken from all participants through Google Forms. Participants will be fully informed about the study's objectives, procedure, role in the study, and the right to withdraw at any time without any consequences. Confidentiality will be maintained by anonymizing the participants' identities, changing their names to code numbers. Any relevant identifiers will be changed in the transcripts and during the dissemination of the study findings. The data will be stored securely in a password-protected file for at least 3 years, and the files will be accessible only to the principal investigator and co-investigators. The study will be conducted responsibly to maintain participant trust and data integrity; the participants will also be informed about the above-mentioned measures. The study's findings and understanding of occupational therapists’ experiences and perspectives concerning app usage for neurorehabilitation will be disseminated via peer-reviewed publications and/or conference presentations.
This study would enhance the understanding of occupational therapists’ experiences and perspectives on using apps in neurorehabilitation. Gaining these insights can help ensure whether apps can effectively support occupational therapy and improve client outcomes. Additionally, this study will explore the challenges and benefits of app usage, the clinical reasoning skills of therapists, and how they integrate apps into neurorehabilitation practice in India. The findings may contribute to the effective integration of apps into neurorehabilitation, helping occupational therapists in India better understand their usability.
We anticipate a few limitations in this study. Some participants may hesitate to share sensitive or negative experiences about their workplace openly, even though confidentiality measures are taken. Additionally, the study depends on participants’ memory and personal perspectives, which may not always be accurate or free from self-bias or recall bias.
Kashish Surana: Conceptualization, Methodology, Resources, Visualization, Writing- Original draft preparation, Writing- Reviewing and Editing.
Pramod D. Lambor: Writing- Reviewing and Editing, Project Administration, Supervision
Shashank Mehrotra: Conceptualization, Methodology, Resources, Visualization, Writing- Original draft preparation, Writing- Reviewing and editing, Supervision, Project Administration
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.