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

OBJECTIVE This 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. DESIGN An open-label, single-arm, feasibility study. SETTING Convalescent rehabilitation hospitals. PARTICIPANTS Twenty-five patients with stroke (19 males; mean age 62.4 ± 11.9 years) were recruited from two convalescent rehabilitation hospitals. INTERVENTIONS The 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 MEASURES The 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. RESULTS No 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). CONCLUSIONS The application of the motivational instructional design model to occupational and swallowing therapies after stroke was feasible with the potential to improve physical outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial UMIN 000037324 and UMIN000037506 ### Funding Statement This work was supported by a grant from JSPS KAKENHI Grant Number JP20K21752 to S.T. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the appropriate ethics committees at the Tokyo Bay Rehabilitation Hospital (approval number: 216-2) and at the Hamamatsu City Rehabilitation Hospital (approval number: 18-62). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets used and/or analyzed during this study cannot be made publicly available due to the need for participant confidentiality. However, they are available from the corresponding author on reasonable request.