Article

This series of articles for rehabilitation in practice aims to cover a knowledge
element of the rehabilitation medicine curriculum. Nevertheless they are intended
to be of interest to a multidisciplinary audience.
The competency addressed in
this article is to transparently describe the process of developing a complex
intervention for people after stroke as part of a feasibility randomised
controlled trial. OBJECTIVE: To describe and justify the development of a
home-based, task-specific upper limb training intervention to improve
reach-to-grasp after stroke and pilot it for feasibility and acceptability prior
to a randomized controlled trial. INTERVENTION DESCRIPTION: The intervention is
based on intensive practice of whole reach-to-grasp tasks and part-practice of
essential reach-to-grasp components. A 'pilot' manual of activities covering the
domains of self-care, leisure and productivity was developed for the feasibility
study. The intervention comprises 14 hours of therapist-delivered sessions over
six weeks, with additional self-practice recommended for 42 hours (i.e. one hour
every day). As part of a feasibility randomized controlled trial, 24 people with
a wide range of upper limb impairment after stroke experienced the intervention
to test adherence and acceptability. The median number of repetitions in one-hour
therapist-delivered sessions was 157 (interquartile range IQR 96-211). The amount
of self-practice was poorly documented. Where recorded, the median amount of
practice was 30 minutes (interquartile range 22-45) per day. Findings
demonstrated that the majority of participants found the intensity, content and
level of difficulty of the intervention acceptable, and the programme to be
beneficial. Comments on the content and presentation of the self-practice
material were incorporated in a revised 'final' intervention manual. DISCUSSION:
A comprehensive training intervention to improve reach-to-grasp for people living
at home after stroke has been described in accordance with the Template for
Intervention Description and Replication (TIDieR) reporting guidelines. The
intervention has been piloted, and found to be acceptable and feasible in the
home setting. TRIAL REGISTRATION: ISRCTN56716589.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS