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

Abstract

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? A within-participant, repeated measures experimental study. Twenty-four adults undertaking stroke rehabilitation at a metropolitan hospital as an inpatient or outpatient. 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. The time taken to complete 25 repetitions under the baseline condition and each instruction was recorded and converted into repetitions per minute. 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). 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. ACTRN12619000146190.