Helen Bosomworth1, Helen Rodgers1,2,3, Lisa Shaw1, Leanne Smith2, Lydia Aird2, Denise Howel4, Nina Wilson4, Natasha Alvarado5, Sreeman Andole6, David L Cohen7, Jesse Dawson8, Cristina Fernandez-Garcia4, Tracy Finch9, Gary A Ford10, Richard Francis1, Steven Hogg11, Niall Hughes12, Christopher I Price1,2, Laura Ternent4, Duncan L Turner13, Luke Vale4, Scott Wilkes14, Hermano I Krebs15, Frederike van Wijck16. 1. Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. 2. Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK. 3. Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. 4. Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. 5. School of Healthcare, University of Leeds, Leeds, UK. 6. Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK. 7. London North West Healthcare NHS Trust, Northwick Park, UK. 8. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 9. Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK. 10. Medical Sciences Division, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 11. Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. 12. NHS Greater Glasgow and Clyde, Glasgow, UK. 13. School of Health, Sport and Bioscience, University of East London, London, UK. 14. School of Medicine, University of Sunderland, Sunderland, UK. 15. Massachusetts Institute of Technology, Cambridge, USA. 16. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Abstract
OBJECTIVE: To report the fidelity of the enhanced upper limb therapy programme within the Robot-Assisted Training for the Upper Limb after stroke (RATULS) randomized controlled trial, the types of goals selected and the proportion of goals achieved. DESIGN: Descriptive analysis of data on fidelity, goal selection and achievement from an intervention group within a randomized controlled trial. SETTING: Out-patient stroke rehabilitation within four UK NHS centres. SUBJECTS: 259 participants with moderate-severe upper limb activity limitation (Action Research Arm Test 0-39) between one week and five years post first stroke. INTERVENTION: The enhanced upper limb therapy programme aimed to provide 36 one-hour sessions, including 45 minutes of face-to-face therapy focusing on personal goals, over 12 weeks. RESULTS: 7877/9324 (84%) sessions were attended; a median of 34 [IQR 29-36] per participant. A median of 127 [IQR 70-190] repetitions were achieved per participant per session attended. Based upon the Canadian Occupational Performance Measure, goal categories were: self-care 1449/2664 (54%); productivity 374/2664 (14%); leisure 180/2664 (7%) and 'other' 661/2664 (25%). For the 2051/2664 goals for which data were available, 1287 (51%) were achieved, ranging between 27% by participants more than 12 months post stroke with baseline Action Research Arm Test scores 0-7, and 88% by those less than three months after stroke with scores 8-19. CONCLUSIONS: Intervention fidelity was high. Goals relating to self-care were most commonly selected. The proportion of goals achieved varied, depending on time post stroke and baseline arm activity limitation.
OBJECTIVE: To report the fidelity of the enhanced upper limb therapy programme within the Robot-Assisted Training for the Upper Limb after stroke (RATULS) randomized controlled trial, the types of goals selected and the proportion of goals achieved. DESIGN: Descriptive analysis of data on fidelity, goal selection and achievement from an intervention group within a randomized controlled trial. SETTING: Out-patient stroke rehabilitation within four UK NHS centres. SUBJECTS: 259 participants with moderate-severe upper limb activity limitation (Action Research Arm Test 0-39) between one week and five years post first stroke. INTERVENTION: The enhanced upper limb therapy programme aimed to provide 36 one-hour sessions, including 45 minutes of face-to-face therapy focusing on personal goals, over 12 weeks. RESULTS: 7877/9324 (84%) sessions were attended; a median of 34 [IQR 29-36] per participant. A median of 127 [IQR 70-190] repetitions were achieved per participant per session attended. Based upon the Canadian Occupational Performance Measure, goal categories were: self-care 1449/2664 (54%); productivity 374/2664 (14%); leisure 180/2664 (7%) and 'other' 661/2664 (25%). For the 2051/2664 goals for which data were available, 1287 (51%) were achieved, ranging between 27% by participants more than 12 months post stroke with baseline Action Research Arm Test scores 0-7, and 88% by those less than three months after stroke with scores 8-19. CONCLUSIONS: Intervention fidelity was high. Goals relating to self-care were most commonly selected. The proportion of goals achieved varied, depending on time post stroke and baseline arm activity limitation.
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