Evaluation of the enhanced upper limb therapy programme within the Robot-Assisted Training for the Upper Limb after Stroke trial: descriptive analysis of intervention fidelity, goal selection and goal achievement.
Helen Bosomworth, Helen Rodgers, Lisa Shaw and 21 others
PMID 32914639WHAT IT FOUND
Stroke survivors chose eating, dressing and range-of-motion goals most often.
Overall, only 51% of goals were achieved. Those under three months post-stroke achieved 73-88%, but those with severe arm limitation over a year post-stroke achieved just 27%, especially for self-care tasks.
Key findings
01The most common goals selected were self-care (54%), followed by impairment-based goals like range of movement (25%), productivity (14%) and leisure (7%).
02Only 51% of all goals were achieved overall, but participants less than three months post-stroke achieved between 73% and 88% of their goals.
03Participants with severe arm limitation (Action Research Arm Test 0-7) who were more than one year post-stroke achieved only 27% of goals, with just 23% of self-care goals met.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Goal achievement was recorded as a simple Yes/No based on therapist judgement, so partial progress was counted as failure. The study population was younger and more male than the general UK stroke population, limiting generalizability. Participants' self-practice outside formal sessions was not recorded, which could have influenced outcomes. No formal goal setting scale (like COPM) was used, reflecting routine clinical practice but lacking standardized measurement. The analysis was descriptive and did not test the efficacy of the intervention itself.
Declared interests
Funded by the NIHR Health Technology Assessment programme. One author (HIK) was the founder and former Chairman of Interactive Motion Technologies (a robotics company) and founder of 4Motion Robotics. Other authors declared fees or grants from various pharmaceutical and medical device companies (Bayer, AstraZeneca, Medtronic, Pfizer, Stryker, Amgen).
The easy way to misread this
Do not conclude that high repetition counts lead to better goal achievement. The study found no clear relationship between the number of repetitions performed and whether goals were met, particularly in chronic stroke survivors with severe impairment who achieved low goal rates despite high repetition numbers.