Development and feasibility evaluation of a repetitive functional task practice (RFTP) programme for upper limb recovery early after stroke

Abstract

Introduction: Loss of arm function is common after stroke. Systematic reviews suggest upper limb recovery following stroke may be improved by repetitive functional task practice (RFTP), but results fell short of statistical significance. Methods: Development and evaluation of an intervention to improve upper limb function post-stroke following the MRC Framework: 1. Development of an upper limb RFTP programme for patients with acute stroke based on published RCTs, motor learning theory, clinical expertise and stakeholder feedback. 2. Delivery of the RFTP programme to seven stroke patients by a research physiotherapist. Adaptations following feedback from patients and therapists. 3. A multicentre feasibility randomised controlled trial. Results: An evidence-based upper limb RFTP programme was developed, tested and refined. It commenced within 14 days of acute stroke and consisted of functional goal setting followed by independent activity practice (total 80 daily repetitions), for up to four weeks with twice weekly therapist reviews. In the multicentre feasibility RCT, 55 eligible patients were identified from three study sites representing 4-6% of patients screened. Twenty four participants were randomised to receive the RFTP programme delivered by NHS therapists + usual care (intervention group) or usual care (control group). Two sites met the recruitment target of 1-2 per month. The programme was delivered as intended at 2/3 sites. The median number of therapist sessions delivered was 6 [IQR 3-8]. Participants recorded a median 80 daily repetitions [IQR 39-80]. Outcome assessments were undertaken for 22/24 (92%) participants at 1 month and 20/24 (83%) at 3 months. Conclusion: A structured approach has been followed to develop and evaluate an upper limb RFTP programme which is acceptable to patients and NHS therapists. A multicentre ii RCT to evaluate an upper limb RFTP programme is feasible, but this project identified issues which need to be addressed when designing a Phase III study.