目的:评估在急性卒中背景下使用内隐运动学习原理的康复实施。
方法:试点,评估员-盲,采用嵌套定性评价的集群随机对照试验。
方法:八个住院卒中单位,英国。
方法:中风发病14天内的人,表现为下肢偏瘫。
方法:对照组的参与者接受常规护理。干预组的参与者使用内隐学习方法(ILA)接受康复;主要包括减少频率的指令/反馈,和促进外部关注焦点。视频记录用于了解干预部位治疗师坚持内隐学习原则的能力,并比较组间差异。
方法:招募和保留集群/参与者的能力;数据收集过程的适宜性和可接受性;保真度监测方法的适宜性;以及所选结果指标的适宜性。
结果:八个卒中单元参与,每组4人(干预/对照)。纳入51名参与者(干预组21;对照组30)。自中风以来的平均时间为6天(SD3.42;0-14);平均年龄为73岁(SD14,25-94)。在那些接近参加的人中,72%同意。我们发现两组之间在教学陈述的频率和类型方面存在明显差异。患者和治疗师都可以接受ILA。
结论:评估运动学习原理在急性脑卒中康复中的应用和有效性是可行的,使用集群随机化设计。需要进行更大的研究来评估每种方法的好处;我们提供了为此所需的一系列样本量估计。
OBJECTIVE: To evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting.
METHODS: Pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation.
METHODS: Eight inpatient stroke units, UK.
METHODS: People within 14 days of stroke onset, presenting with lower limb hemiplegia.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.