Applying a Motivational Instructional Design Model to Stroke Rehabilitation: A Feasibility Study on Occupational and Swallowing Therapies.

Single-arm study with no control group, so improvements cannot be attributed to the ARCS motivation-support process. All participants received usual inpatient physical therapy and occupational therapy, and the swallowing therapy group also received usual swallowing therapy; effects of any single component cannot be separated. The same therapist performed assessments and delivered the intervention, so possible observer bias cannot be ruled out. Small sample: 25 participants, with a stated target of 24 for useful feasibility information. Participants had Mini-Mental State Examination scores of at least 24, so findings may not apply to people with more severe cognitive impairment. Participants were recruited from convalescent rehabilitation wards, where the insurance-covered maximum length of stay is 180 days for patients with stroke and severe disabilities, so results may not generalize to acute or community rehabilitation. Mental health outcomes were limited by few participants having depressive symptoms or apathy at baseline: 5 had depressive symptoms and 12 had apathy. The primary outcome was feasibility, not efficacy.

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Do not conclude that the ARCS motivation-support process improved stroke rehabilitation outcomes. The study had no control group, and all participants also received usual physical therapy and occupational therapy, with usual swallowing therapy added for the swallowing therapy group, so changes cannot be separated from conventional care.