Implicit Learning in Stroke Study (IMPS)

A Pilot Cluster Randomised Controlled Trial, of an Implicit Learning Approach (ILA) Versus Standard Care, on Recovery of Mobility Following Stroke

This trial will compare an Implicit Learning Approach (ILA) to usual care, during the rehabilitation of mobility post stroke. It is a multicentre, assessor blind, cluster randomised controlled pilot trial, with embedded feasibility study. It also includes a nested qualitative evaluation, designed to explore the views of participants and therapists.

All mobility focussed rehabilitation sessions will utilise the Implicit Learning Approach (ILA), as usual care. This includes rehabilitation (delivered by a physiotherapist, occupational therapist or therapy assistant) that focusses on sitting, sit to stand, standing, stepping, transfers and walking. The content of therapy will be based on the treatment guidelines and intervention manual - and primarily involves changing the quantity and focus of attention of instructions and feedback. As this is a clinically grounded, pragmatic trial, therapists will have freedom to tailor the specific content of each treatment session to patient need, whilst remaining true to the ILA.

Measure of functional mobility in people with stroke. Ordinal scale, measured through direct observation of function. Score range from 0-40, with a higher score indicating better functional mobility status.

Measure of postural control in people with stroke, from lying, sitting and standing postures. Ordinal scale, measured through direct observation of function. Score range from 0-36, with a higher score indicating better postural control.

Able to sit for 1 minute unsupported? Able to transfer from bed to chair independently? Able to walk 10m independently? Time from stroke to achieving each milestone, assessed with standardised set up. Earlier achievement of milestones indicated better outcome.

Measure of sensori-motor function in the lower limb (impairment level) Range 0-28, with higher score indicating better outcome.

Measure of disability and dependence in people who have suffered a stroke. Score 0-6, with higher score indicating a worse outcome.

Standardised measure of health related quality of life. Self-administered questionnaire. Higher score indicates a better outcome.

Inclusion Criteria: Clinical diagnosis of stroke, presenting with hemiplegia Within 14 days of stroke onset Medically stable Able to... tolerate daily therapy for a minimum of 30 minutes per session sit for more than 5 seconds without support understand and follow 1 stage commands Exclusion Criteria: Previous stroke with residual impairments Other neurological diagnosis (e.g. PD, MS) Clinically relevant pre-morbid disability levels

Johnson L, Burridge J, Ewings S, Westcott E, Gayton M, Demain S. Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation. Physiotherapy. 2023 Mar;118:20-30. doi: 10.1016/j.physio.2022.06.002. Epub 2022 Jun 20.

Johnson L, Burridge J, Demain S, Ewings S. Comparing the Impact of an Implicit Learning Approach With Standard Care on Recovery of Mobility Following Stroke: Protocol for a Pilot Cluster Randomized Controlled Trial. JMIR Res Protoc. 2019 Nov 5;8(11):e14222. doi: 10.2196/14222.