Table 3 Functional Electrical Stimulation with Visual Feedback Balance Training (FES + VFBT) Themes, Categories and Quotes

Quotes for Theme 1: Perceived benefits across ICF levels

Category 1a Impact on impairment

[Q1] “…I honest to God believe it helped some kind of neural pathway…I honest to God believe that something happened between this muscle turning on and my brain because now it’s more active; I can control it to some extent…the stim actually activated that muscle where I might not have been able to do it just on my own…after having it stimulated for that amount of time…it’s for sure improved.” (Charlie, 8-Weeks Post-Training)

[Q2] “…I had a visit with [my doctor] last week and she said, ‘Oh my God, your legs!’ And I mentioned, I mentioned this program…she said that they are getting stronger and stronger…I haven’t had spasms for a while. I don’t know if it is because of the stim…I still have, but not as bad as before… I told her about the neuropathic pain, this leg, and she said keep an eye on it. When I saw her, because she told me to write down how many times, she said ‘So, how many?’ I said, ‘One time, but for a few minutes and it was gone’…I feel happy.” (Carol, Post-Training)

[Q3] “Just the increase of sensory, you know tactile, in my feet, and my skin and my muscles that weren’t…I wasn’t expecting that. I wasn’t expecting to have an increase in sensory. I was hoping that, you know, it would help my muscles and things, but that was a big thing.” (Charlie, Post-Training)

[Q4] “Feeling of accomplishment, I think. Like I say, some of the stuff was minute, but it’s big. And you have the feeling…like to have my muscles come back and have the feeling…like a sense of feeling down there, sensory, that was pretty big.” (Charlie, Post-Training)

Category 1b Impact on activity

[Q5] “It’s nice that I do things around the house. I do more things now…I walk out to the backyard a lot, with a walker…over uneven ground, but I’m solid…I BBQ on my own now…I use a walker when I’m there, but I’m standing…I didn’t enjoy my backyard last year as much as I did this year.” (Charlie, 8-Weeks Post-Training)

[Q6] “…it’s given me more confidence to get up and about around the apartment…in my home, I’m up and about more…taking stuff out of the washing machine and putting stuff in the dryer…yesterday I stood at the kitchen counter and peeled a mango. It doesn’t sound like much, but I stood there and I peeled it and I diced it and I put it into a container.” (Sharon, 8-Weeks Post-Training)

[Q7] “The standing endurance, and the walking endurance. I mean I stood up the other day, now it was mostly on my right leg, but I was standing at my walker out on the balcony for, I would say, 25 min the other day.” (Sharon, 8-Weeks Post-Training)

[Q8] “…I don’t use the chair anymore inside the home…only maybe once in a while, like very bad days; maybe then. But I avoid it and I am managing up to now. So I should say this [is] improvement, huge improvement for me…my mobility got [better], but once I get into the chair I don’t feel like to get up and do something…” (Ruth, 8-Weeks Post-Training)

Category 1c Impact on participation

[Q9] “…I actually think things are better, I can’t name an instance, but I feel better about my situation; I feel better about my legs. Like I say, just do more stuff and it’s not a problem. I’ve been to the beach twice…and I’m going golfing two weeks from now.” (Charlie, 8-Weeks Post-Training)

[Q10] “I went to the mall and I went to the bank, I went to that food court area…with the walker…if I go out, the next day I relax. Then after that I go out.” (Suzanne, Post-Training)

[Q11] “My friend has a van…big van. So of course I have to use the stool because it’s a high step…last Friday I put the stool, I have a folding stool, and immediately I told him to take the walker, put it in the trunk and he said, ‘Can you do it on your own?’ I said, ‘Of course I can do it on my own!’ You see, I was very confident. I’m not scared…he was surprised…I told him about this training session…those sessions helped me a lot.” (Carol, 8-Weeks Post-Training)

Category 1d Inter-related across ICF

[Q12] “I walk straighter because I know where my feet are…when I activate my toes now in my right foot …I know where it is so when I’m walking, I get easier feedback and I’ve found myself walking straighter.” (Charlie, Post-Training)

[Q13] “Standing more in the kitchen…if I have to cook, chop, do the dishes…before like I used to stand, but the walker used to be behind me. Now I forget about the walker; well, I have a cane. I feel stronger, and I feel that my legs are stronger…” (Carol, Post-Training)

Quotes for Theme 2: Change in perceived fall risk & confidence

Category 2a Risk of falling

[Q14] “Has it affected my risk? I don’t know. It’s minimized it more than ever. I’ve never really [been] afraid of falling, but I put myself in positions now where I don’t think that quite through…I don’t take risks, but I become less cautious sometimes…you’re more likely to try things” (Charlie, Post-Training)

[Q15] “If I fall, what can I do? Like I have to take the challenge…if I don’t challenge myself I cannot move forward. I can fall anytime, that is still there all the time, but since I did the study…like I am more vulnerable to get falls? That I don’t think so, no.” (Ruth, Post-Training)

Category 2b Willingness to try new activities

[Q16] “…when you’re on the walker you can cheat very easily because it’s there. But if you’re on walking sticks…your legs better be doing something and you better have a good balance, good cadence, because the sticks are going to help you a little bit but they’re not going to support you. You have to have the body working to support you.” (Charlie, 8-Weeks Post-Training)

[Q17] “…it may not be that I’m necessarily more or less confident, I’m more knowledgeable…what I thought 6 months ago I could do, I realize that I can’t now. And it’s not because I’m less confident, it’s because my expectations I think are more realistic…one of the questions is how confident do you feel that you can walk from the front door to the car. Well I’d never done it before; I was always in a wheelchair. But since I started walking more…not that I’ve tried it, I’m not that confident…I think I’m being realistic; I don’t think that I’m saying to myself you can’t do that therefore you’re not going to try.” (Sharon, 8-Weeks Post-Training)

Quotes for Theme 3: Motivation to keep going

Category 3a Ability to continue

[Q18] “…I’m a little nervous that maybe I’m not, you know at least here I come 2–3 times a week…trying to get better…once I stop coming here…I don’t have too much motivation to do, and it is not possible to do at home, to do those things, so I’m looking forward to, if I can, get another chance to do another study.” (Ruth, Post-Training)

Category 3b Factors driving motivation

[Q19] “…I don’t push myself to hurt myself, but if it’s hard, what gets me going is I think about that it’s doing me good and I look at the progress I have made…some things now that I do without even thinking, they were was hard as it was when I was in the FES. So, it just keeps me going.” (Sharon, 8-Weeks Post-Training)

[Q20] “…I did a lot of that activity before, but sometimes the complacency comes in and that’s when you get a program like this and all of a sudden things are waking up again and you have a feeling, ‘Hey, let’s go again…’ I think I’m motivated, but it’s pretty easy to say, ‘Well, I think I’ll stay home,’ but when new things happen, away you go.” (Charlie, 8-Weeks Post-Training)

[Q21] “To stand a little better, firm, so that I can walk better, while standing a little more time than before…I am looking forward to be getting independent by myself, to do my regular life chores, which I am still far, far back from my goal, but I am forwarding, that much I should say, but I still have to go a long way.” (Ruth, Post-Training)