Applying a Motivational Instructional Design Model to Stroke Rehabilitation: A Feasibility Study in Occupational Therapy and Swallowing Therapy Settings

Abstract

ABSTRACTOBJECTIVEThis feasibility study aimed to investigate the feasibility of applying a motivational instructional design model to stroke rehabilitation and its potential physical and mental health effects in occupational and swallowing therapy settings.DESIGNAn open-label, single-arm, feasibility study.SETTINGConvalescent rehabilitation hospitals.PARTICIPANTSTwenty-five patients with stroke (19 males; mean age 62.4 ± 11.9 years) were recruited from two convalescent rehabilitation hospitals.INTERVENTIONSThe intervention was to motivate participants during rehabilitation sessions based on the motivational instructional design model and was delivered to 12 and 13 participants in two hospitals during occupational and swallowing therapy sessions, respectively. The intervention was given for 40–60 min daily, 5 days weekly for 4 weeks (25 sessions).MAIN OUTCOME MEASURESThe primary outcome was feasibility, including the drop-out rate, an adverse event, and the participants’ acceptability of the intervention. Additionally, physical (activities of daily living, motor function of the paretic upper extremity, and swallowing ability) and mental health (depressive symptoms and apathy) outcomes were evaluated before and after the intervention.RESULTSNo participants dropped out of the intervention or experienced an adverse event. Twenty-one participants (84%) were satisfied with the intervention, and 19 (76%) hoped to continue receiving it. After the intervention, statistically significant improvements with a large effect size were found in physical outcomes (Cohen’s r = 0.68–0.85) but not in mental health outcomes (Cohen’s r = 0.31–0.34).CONCLUSIONSThe application of the motivational instructional design model to occupational and swallowing therapies after stroke was feasible with the potential to improve physical outcomes.