How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States

Purpose: Strategy training is a promising stroke rehabilitation intervention commonly delivered in Western countries. We examined the perspectives of rehabilitation therapists who have delivered strategy training in Taiwan and the United States to understand the influence of culture on strategy training implementation. Materials and methods: In this rapid ethnographic study, the maximum variation sampling approach was used to recruit seven therapists in Taiwan and seven therapists in the United States with experience delivering strategy training. Data was collected from multiple sources, including interviews, study documents, therapist notes, and reflective memos. Interviews with the recruited therapists in Taiwan and the United States were conducted in Mandarin and English, respectively. Data were analyzed using a constant comparative approach. Results: The following two themes were generated: (1) differences between conventional rehabilitation and strategy training, namely that conventional rehabilitation is therapist-directed and emphasizes impairment reduction, whereas strategy training empowers clients and focuses on real-life generalization, and (2) challenges in implementing strategy training in practice, including difficulty in achieving client buy-in and disengagement. Conclusions: Therapists from both countries shared similar perspectives on the perceived advantages of strategy training, such as enhancing client empowerment and engagement, and the generalization of strategies. Family involvement was more prominently discussed by therapists in Taiwan than by those in the United States.IMPLICATIONS FOR REHABILITATION Strategy training differs from conventional rehabilitation in its emphasis on clients’ life participation and empowerment, generalization of strategies, and enhancement of their engagement, confidence, and problem-solving skills. Therapists may face challenges related to client buy-in and disengagement as well as difficulties in establishing a therapeutic rapport at the beginning of strategy training because clients have different expectations from those of conventional rehabilitation. Cultural differences in norms and expectations and the clinical experiences of therapists may influence the delivery of strategy training to clients. Family support may influence the success of strategy training. Thoughtful conversations to reach a mutual understanding regarding the expectations of strategy training among clients, family, and rehabilitation practitioners are necessary prior to implementing strategy training.