Dataset Information

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation.

ABSTRACT:

Objective(s)

To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics.

Design

Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively.

Setting

6 UK Stroke Units PARTICIPANTS: 89 therapy sessions were observed, involving 55 clinicians and 57 patients.

Results

Proportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1-8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset.

Conclusions

To optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke.

Trial registration number

Clinicaltrials.gov (NCT03792126). CONTRIBUTION OF THE PAPER.

SUBMITTER: Johnson L

PROVIDER: S-EPMC9907222 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation.

Johnson Louise L Burridge Jane J Ewings Sean S Westcott Ellie E Gayton Marianne M Demain Sara S

Physiotherapy 20220620

<h4>Objective(s)</h4>To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics.<h4>Design</h4>Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activi ...[more]

PMID: 36306569

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Project description:BackgroundWearable powered exoskeletons are a new and emerging technology developed to provide sensory-guided motorized lower limb assistance enabling intensive task specific locomotor training utilizing typical lower limb movement patterns for persons with gait impairments. To ensure that devices meet end-user needs it is important to understand and incorporate end-users perspectives, however research in this area is extremely limited in the post-stroke population. The purpose of this study was to explore in-depth, end-users perspectives, persons with stroke and physiotherapists, following a single-use session with a H2 exoskeleton.MethodsWe used a qualitative interpretive description approach utilizing semi-structured face to face interviews, with persons post-stroke and physiotherapists, following a 1.5 h session with a H2 exoskeleton.ResultsFive persons post-stroke and 6 physiotherapists volunteered to participate in the study. Both participant groups provided insightful comments on their experience with the exoskeleton. Four themes were developed from the persons with stroke participant data: (1) Adopting technology; (2) Device concerns; (3) Developing walking ability; and, (4) Integrating exoskeleton use. Five themes were developed from the physiotherapist participant data: (1) Developer-user collaboration; (2) Device specific concerns; (3) Device programming; (4) Patient characteristics requiring consideration; and, (5) Indications for use.ConclusionsThis study provides an interpretive understanding of end-users perspectives, persons with stroke and neurological physiotherapists, following a single-use experience with a H2 exoskeleton. The findings from both stakeholder groups overlap such that four over-arching concepts were identified including: (i) Stakeholder participation; (ii) Augmentation vs. autonomous robot; (iii) Exoskeleton usability; and (iv) Device specific concerns. The end users provided valuable perspectives on the use and design of the H2 exoskeleton, identifying needs specific to post-stroke gait rehabilitation, the need for a robust evidence base, whilst also highlighting that there is significant interest in this technology throughout the continuum of stroke rehabilitation.

Project description:ObjectivesTo (1) characterize study paradigms used to investigate motor learning (ML) poststroke and (2) summarize the effects of different ML principles in promoting skill acquisition and retention. Our secondary objective is to evaluate the clinical utility of ML principles on stroke rehabilitation.Data sourcesMedline, Excerpta Medica Database, Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception on October 24, 2018 and repeated on June 23, 2020. Scopus was searched on January 24, 2019 and July 22, 2020 to identify additional studies.Study selectionOur search included keywords and concepts to represent stroke and "motor learning. An iterative process was used to generate study selection criteria. Three authors independently completed title, abstract, and full-text screening.Data extractionThree reviewers independently completed data extraction.Data synthesisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews were used to guide our synthesis. Thirty-nine studies were included. Study designs were heterogeneous, including variability in tasks practiced, acquisition parameters, and retention intervals. ML principles investigated included practice complexity, feedback, motor imagery, mental practice, action observation, implicit and explicit information, aerobic exercise, and neurostimulation. An additional 2 patient-related factors that influence ML were included: stroke characteristics and sleep. Practice complexity, feedback, and mental practice/action observation most consistently promoted ML, while provision of explicit information and more severe strokes were detrimental to ML. Other factors (ie, sleep, practice structure, aerobic exercise, neurostimulation) had a less clear influence on learning.ConclusionsImproved consistency of reporting in ML studies is needed to improve study comparability and facilitate meta-analyses to better understand the influence of ML principles on learning poststroke. Knowledge of ML principles and patient-related factors that influence ML, with clinical judgment can guide neurologic rehabilitation delivery to improve patient motor outcomes.

Project description:IntroductionBased on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke.Material and methodsThis study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke.ResultsAt 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs.ConclusionsESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

Dataset Information

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation.

Objective(s)

Design

Setting

Results

Conclusions

Trial registration number

Publications

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation.

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