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Gopaul U.1,2, Carey L.3, Hudson I.4, Nilsson M.2, Callister R.5, van Vliet P.1,2
1University of Newcastle, Health Sciences, Newcastle, Australia, 2Hunter Medical Research Institute, Newcastle, Australia, 3The Florey Institute of Neuroscience and Mental Health, Stroke, Melbourne, Australia, 4University of Newcastle, School of Mathematical & Physical Sciences, Newcastle, Australia, 5University of Newcastle, School of Biomedical Sciences and Pharmacy, Newcastle, Australia
Background: Stroke is a leading cause of disability worldwide. 77% of people demonstrate arm motor impairment following stroke, making everyday tasks like doing up buttons impossible for many. 50% of these people also experience impairment of tactile sensations making it difficult for them to grasp objects safely without crushing them or dropping them. Only 50% of stroke survivors regain functional arms; so there is a critical need for the development of new and more effective treatments to improve long-term recovery after stroke and thus improve quality of life. Currently, upper limb interventions target motor and sensory deficits independently, often resulting in only modest improvements. One as yet unexplored way to improve outcomes could be to provide simultaneous motor and sensory training, based on the knowledge that overlapping networks exist for the perception of sensation and sensation to guide motor activity, in tasks performed in everyday life. Furthermore, complex interventions used in stroke rehabilitation trials are often described in insufficient detail to allow their application to clinical practice. Improving the reporting of research-based interventions may improve their translation to practice.
Purpose: The primary aim was to develop a new upper limb stroke rehabilitation intervention “Combined Physical and SEnsOry training” (COMPoSE) for use in a Phase I trial. The template for intervention description and replication (TIDieR) checklist was designed to guide the reporting of therapeutic interventions in randomised controlled trials. In this study, the TIDieR checklist is used to provide the description and rationale for the COMPoSE intervention.
Methods: The COMPoSE intervention was developed through the following stages: 1) Generation of performance objectives used in training sensation and movement after stroke; 2) Development of sensory and motor variables and methods to give feedback about these to enhance skill acquisition; and 3) Combination of sensory and motor variables, and feedback, into a standardised training matrix. The description and rationale for the components of the COMPoSE intervention are described using the TIDieR checklist.
Results: The essential features of COMPoSE include: a reach-to-grasp movement with combined sensorimotor training variables (grasp pressure, distance, object size, crushability, surface texture and friction), intensive practice (216 repetitions/session), feedback using a wearable device providing kinematic measures and a haptic device providing measures of grasp pressure. Progressive and systematic grading of sensorimotor tasks, i.e., easy to harder, are practiced under vision and no-vision conditions and with varied practice, i.e., practice sequences are randomly ordered. Ten sessions of treatment (1.5 hours each) are delivered over 3 weeks, using a standardised matrix for treatment delivery.
Conclusion(s): The COMPoSE intervention combines sensation and movement training, delivered synchronously, within the same treatment and within the same task. The TIDieR checklist ensures adequate reporting of the COMPoSE intervention for high fidelity replication in future trials.
Implications: The COMPoSE intervention is described in sufficient detail to be implemented in a Phase I trial and replicated in the future. TIDieR is an efficient and thorough way to describe the development and content of a complex intervention in stroke rehabilitation research to support future implementation in clinical practice.
Funding acknowledgements: This study was supported by the University of Newcastle.
Topic: Neurology: stroke
Ethics approval: The Hunter New England Human Research Health Committee and the Human Research Ethics Committee, University of Newcastle approved the protocol.
All authors, affiliations and abstracts have been published as submitted.
