Goal-oriented instructions increase the intensity of practice in stroke rehabilitation compared with non-specific instructions: a within-participant, repeated measures experimental study

• Main Authors: Tessa Hillig, Haotian Ma, Simone Dorsch
• Format: Article
• Language: English
• Published: Elsevier 2019-04-01
• Series: Journal of Physiotherapy
• Online Access: http://www.sciencedirect.com/science/article/pii/S1836955319300207

Questions: In stroke rehabilitation, do goal-oriented instructions increase the intensity of practice during therapy compared to a non-specific instruction? Is one type of goal-oriented instruction more effective at increasing the intensity of practice achieved by stroke survivors during therapy? Design: A within-participant, repeated measures experimental study. Participants: Twenty-four adults undertaking stroke rehabilitation at a metropolitan hospital as an inpatient or outpatient. Intervention: Participants were observed performing exercises across 3 days. On each day, they performed an exercise with a non-specific instruction (‘do some [exercise]’) as a baseline measure and the same exercise with one of three goal-oriented instructions, delivered in a randomised order. The three goal-oriented instructions were: ‘do [exercise] 25 times’ (instruction A), ‘do [exercise] 25 times as fast as you can’ (instruction B), and ‘do [exercise] 25 times, as fast as you can, aiming for a personal best’ (instruction C). The last instruction included verbal encouragement during the exercise. Outcome measures: The time taken to complete 25 repetitions under the baseline condition and each instruction was recorded and converted into repetitions per minute. Results: All of the goal-oriented instructions resulted in a significant increase in the rate of repetitions of the exercise being performed compared to the baseline measure: percentage increase from baseline (95% CI) was 62% (31 to 93) with instruction A, 116% (67 to 165) with instruction B, and 128% (84 to 171) with instruction C. Instruction C had a significantly greater effect than instruction A: mean difference in percentage increase 65% (95% CI 13 to 118). Conclusion: Goal-oriented instructions can result in significant increases in the rate of repetitions of exercise in stroke rehabilitation. The use of goal-oriented instructions is a simple, no-cost strategy that can be used to increase the intensity of practice in stroke rehabilitation. Trial registration: ACTRN12619000146190. Key words: Stroke, Practice, Communication, Rehabilitation, Physical therapy