Development of treatment schedules for research: a structured review to identify methodologies used and a worked example of ‘mobilisation and tactile stimulation’ for stroke patients

Effects of Mobilization and Tactile Stimulation on Chronic Upper-Limb Sensorimotor Dysfunction After Stroke

“…The lead researcher recorded all outcomes and provided all therapy except during periods of absence, when an alternate researcher covered this. Both researchers were qualified physiotherapists with extensive experience of working in stroke rehabilitation and trained in using the assessment tools, thus competent in delivering the therapy, recording its content on the treatment schedule, 11 and scoring all outcome measures. We collected data daily (Monday to Friday) in the participant's place of residence, attempting to record measurements at the same time of day to avoid instability resulting from diurnal variation.…”

“…10 Mobilization and Tactile Stimulation (MTS) is a module of routine therapy currently used in clinical practice to treat the contralesional UL after stroke. 11 It is a complex hands-on therapeutic intervention 12 that has been identified by expert neurophysiotherapists in the UK as a part of routine therapy. While not a novel intervention, MTS is a discrete module of therapy that has been modeled, described clearly, and its content summarized in a published treatment schedule, 11 and generalizability of this standardized schedule has been established (S.M.…”

“…11 It is a complex hands-on therapeutic intervention 12 that has been identified by expert neurophysiotherapists in the UK as a part of routine therapy. While not a novel intervention, MTS is a discrete module of therapy that has been modeled, described clearly, and its content summarized in a published treatment schedule, 11 and generalizability of this standardized schedule has been established (S.M. Hunter, PhD, unpublished data, January 2013).…”

“…The selection of such an appropriate combination is based on the clinical reasoning of a skilled therapist according to patient presentation. 11 A proof-of-principle phase I study 12 of MTS demonstrated potential benefits of MTS in improving motor impairment (measured by the Motricity Index [MI] arm section) and functional ability (measured by the Action Research Arm Test [ARAT]) in the contralesional UL. 14 A subsequent randomized, single-blind, phase I dose-modeling trial of MTS recommended a dose of 60 minutes daily in preference to a dose of 30 minutes, 120 minutes, or no MTS, in addition to a program of routine therapy.…”

“…13 Part of the modeling process 12,16 involves the identification of appropriate target groups. While evidence suggests that MTS may be effective in subacute stroke, 11,14 other subgroups of stroke survivors may also benefit. The aim of this study, therefore, was to explore the effects of MTS in chronic stroke (>12mo) when UL performance had reached a clear plateau.…”