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BackgroundSixty percent of people have non-functional arms 6 months after stroke. More effective treatments are needed. Cochrane Reviews show low-quality evidence that task-specific training improves upper limb function. Our feasibility trial showed 56 h of task-specific training over 6 weeks resulted in an increase of a median 6 points on the Action Research Arm test (ARAT), demonstrating the need for more definitive evidence from a larger randomised controlled trial. Task-AT Home is a two-arm, assessor-blinded, multicentre randomised, controlled study, conducted in the home setting.AimThe objective is to determine whether task-specific training is a more effective treatment than usual care, for improving upper limb function, amount of upper limb use, and health related quality of life at 6 weeks and 6 months after intervention commencement. Our primary hypothesis is that upper limb function will achieve a ≥ 5 point improvement on the ARAT in the task-specific training group compared to the usual care group, after 6 weeks of intervention.MethodsParticipants living at home, with remaining upper limb deficit, are recruited at 3 months after stroke from sites in NSW and Victoria, Australia. Following baseline assessment, participants are randomised to 6 weeks of either task-specific or usual care intervention, stratified for upper limb function based on the ARAT score. The task-specific group receive 14 h of therapist-led task-specific training plus 42 h of guided self-practice. The primary outcome measure is the ARAT at 6 weeks. Secondary measures include the Motor Activity Log (MAL) at 6 weeks and the ARAT, MAL and EQ5D-5 L at 6 months. Assessments occur at baseline, after 6 weeks of intervention, and at 6 months after intervention commencement. Analysis will be intention to treat using a generalised linear mixed model to report estimated mean differences in scores between the two groups at each timepoint with 95% confidence interval and value of p.DiscussionIf the task-specific home-based training programme is more effective than usual care in improving arm function, implementation of the programme into clinical practice would potentially lead to improvements in upper limb function and quality of life for people with stroke.Clinical Trial RegistrationANZCTR.org.au/ACTRN12617001631392p.aspx

Within occupational therapy, the complex process of transitioning from clinician to clinician-researcher often presents challenges demanding critical contemplation. Methodological issues and ethical challenges can arise throughout the emergent transition into role duality, potentially impacting upon novice clinician-researcher development, influencing research processes and quality. As part of the Task-AT Home qualitative study, a reflexive critique of interview processes, guided by the reflection-on-action rubric and a typology of catalysts for dual-role experiences was conducted. The reflective critique identified commonalities and differences between clinical and research interviewing. Additionally, through three exemplars of experience, the critique provided insights into how clinical reasoning processes were used during interviews, influencing qualitative research processes. Having explored what can happen when an experienced clinician utilises clinical reasoning skills within a qualitative research project, skills and strategies have been identified, aiming to inform and support occupational therapists transitioning from clinician to clinician-researcher. Acknowledging the sometimes-imperfect realities of engaging in qualitative research, made visible by practicing reflection on action and sharing messy examples or occasions of personal conflict, can provide instructive moments for future clinicians looking to make the transition from clinician to clinician-researcher.