A pilot cluster randomised controlled trial, of an IMPlicit learning approach versus standard care, on recovery of mobility following stroke (IMPS)
A pilot cluster randomised controlled trial, of an IMPlicit learning approach versus standard care, on recovery of mobility following stroke (IMPS)
Objectives: to evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting.
Design: pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation.
Setting: eight inpatient stroke units, UK.
Participants: people within 14 days of stroke onset, presenting with lower limb hemiplegia.
Interventions: participants at control clusters received usual care. Participants at intervention clusters received rehabilitation using an Implicit Learning Approach (ILA); primarily consisting of reduced frequency instructions/feedback, and promotion of an external focus of attention. Video recording was used to understand the ability of intervention site therapists to adhere to the implicit learning principles, and to compare differences between groups.
Measures: ability to recruit and retain clusters/participants; suitability and acceptability of data collection processes; appropriateness of fidelity monitoring methods; and appropriateness of chosen outcome measures.
Results: eight stroke units participated, with four assigned to each group (intervention/control). Fifty-one participants were enrolled (intervention group 21; control group 30). Mean time since stroke was 6 days (SD 3.42; 0–14); mean age was 73 years (SD 14, 25–94). Of those approached to take part, 72% agreed. We found clear differences between groups with respect to the frequency and type of instructional statement. The ILA was acceptable to both patients and therapists.
Conclusion: it is feasible to evaluate the application and effectiveness of motor learning principles within acute stroke rehabilitation, using a cluster randomised design. A larger study is required to evaluate the benefits of each approach; we provide a range of sample size estimates required for this.
Stroke, feedback, implicit learning, motor learning, rehabilitation
Johnson, Louise
9f854b21-5ab6-42b1-a11e-f9871128f8fa
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Demain, Sara
f4110e7c-223d-4b1e-b5f4-4024fdbc8a37
Johnson, Louise
9f854b21-5ab6-42b1-a11e-f9871128f8fa
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Demain, Sara
f4110e7c-223d-4b1e-b5f4-4024fdbc8a37
Johnson, Louise, Burridge, Jane, Ewings, Sean and Demain, Sara
(2024)
A pilot cluster randomised controlled trial, of an IMPlicit learning approach versus standard care, on recovery of mobility following stroke (IMPS).
Clinical Rehabilitation.
(doi:10.1177/02692155241267205).
Abstract
Objectives: to evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting.
Design: pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation.
Setting: eight inpatient stroke units, UK.
Participants: people within 14 days of stroke onset, presenting with lower limb hemiplegia.
Interventions: participants at control clusters received usual care. Participants at intervention clusters received rehabilitation using an Implicit Learning Approach (ILA); primarily consisting of reduced frequency instructions/feedback, and promotion of an external focus of attention. Video recording was used to understand the ability of intervention site therapists to adhere to the implicit learning principles, and to compare differences between groups.
Measures: ability to recruit and retain clusters/participants; suitability and acceptability of data collection processes; appropriateness of fidelity monitoring methods; and appropriateness of chosen outcome measures.
Results: eight stroke units participated, with four assigned to each group (intervention/control). Fifty-one participants were enrolled (intervention group 21; control group 30). Mean time since stroke was 6 days (SD 3.42; 0–14); mean age was 73 years (SD 14, 25–94). Of those approached to take part, 72% agreed. We found clear differences between groups with respect to the frequency and type of instructional statement. The ILA was acceptable to both patients and therapists.
Conclusion: it is feasible to evaluate the application and effectiveness of motor learning principles within acute stroke rehabilitation, using a cluster randomised design. A larger study is required to evaluate the benefits of each approach; we provide a range of sample size estimates required for this.
Text
IMPS Cluster Trial Paper RE-SUBMISSION COPY _SE
- Accepted Manuscript
More information
Accepted/In Press date: 19 June 2024
e-pub ahead of print date: 6 August 2024
Keywords:
Stroke, feedback, implicit learning, motor learning, rehabilitation
Identifiers
Local EPrints ID: 494802
URI: http://eprints.soton.ac.uk/id/eprint/494802
ISSN: 0269-2155
PURE UUID: 553c594b-2944-413d-9bcf-0da9874e54e3
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Date deposited: 15 Oct 2024 17:02
Last modified: 16 Oct 2024 01:46
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Contributors
Author:
Louise Johnson
Author:
Sara Demain
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