Implicit and explicit motor learning interventions for gait in people after stroke: a process evaluation on fidelity and feasibility performed alongside a randomized controlled trial

PurposeTo evaluate whether the implicit and explicit motor learning walking interventions for people after stroke delivered in a randomized controlled trial were performed as intended (fidelity) and to report the therapist and participant experiences with regard to feasibility.MethodsDose delivered and content of instructions were assessed by evaluating the therapist logs and audio recordings of the training sessions. The therapist and participant experiences were assessed by means of self-developed questionnaires.Results79 people were included of which seven people (9%) dropped out. The remaining participants all received the required minimum of seven sessions. Overall therapists adhered to the intervention guideline. On average 5.2 and 0.4 explicit rules were used within the explicit group and implicit group respectively. Therapists and participants were generally positive about the feasibility but frequent comments were made by the therapists regarding “therapy time restrictions” and “tendency of the participants to develop explicit rules”. A variety of changes were observed ranging from improvements in spatiotemporal parameters to cognitions and emotions.ConclusionThe delivery of the implicit and explicit motor learning walking interventions were successful in terms of fidelity. Therapists and participants were generally positive about the feasibility of the intervention.