Task-specific reach-to-grasp training after stroke: development and description of a home-based intervention.
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.


METHODS
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.


CONCLUSIONS
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.


BACKGROUND
ISRCTN56716589.
Department of Allied Health Professions, University of the West of England, Bristol, UK paul6.cunningham@uwe.ac.uk.
Paul
P
Cunningham
Department of Allied Health Professions, University of the West of England, Bristol, UK.
Ailie J
AJ
Turton
Institute for Applied Health Research, Glasgow Caledonian University, UK.
Frederike
F
Van Wijck
School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Hunter Medical Research Institute, Australia.
Paulette
P
Van Vliet
D005240:Feasibility Studies; D018737:Hand Strength; D006699:Home Care Services; D006801:Humans; D009043:Motor Activity / Q000502:physiology*; D000071939:Stroke Rehabilitation; D034941:Upper Extremity
Stroke; arm; grasp; hand; home; occupational therapy; physical therapy; practice; reach; rehabilitation; repetitive; task-specific training; upper limb