Part 2: operationalising and standardising the Motor Training provided as part of the Sci-Mt Trial
fatigue, ’ goals•
SECONDARY
Whilst Motor Training will be individualised to the needs of each participant, it is important that the intervention is standardised within the SCI-MT Trial as far as possible, with trial therapists adhering to the key training principles. This is being achieved by articulating the key principles and guidelines of the SCI-MT in a 2 h online training package (delivered via Zoom) to all trial therapists. The training is compulsory and is provided to every SCI-MT site. The key principles of the SCI-MT Trial are summarised in Table A summary of the key principles of SCI-MT intervention.• Twelve hours of weekly therapy will be delivered in one-to-one sessions in the therapy gym for 10 weeks• The number and duration of sessions per week is not stipulated but typically the 12 h per week will be provided over 5 to 10 sessions of 1 to 2 h duration each• Therapy will target the Total Motor Score, secondary outcomes, and the participants’ goals• Practice Sheets will be used for every session• Exercise targets will be set for each exercise during each therapy session• Therapy will be progressed as much as possible• Participants will be challenged to work as hard as possible in every session• Each session will be spent with the participant actively engaged in exercise• The participants will be re-assessed regularly throughout the 10 weeks• Focus on high numbers of repetitions• Include part-task or whole-task practice• Provide manual assistance only if essential• Feedback will be used to provide knowledge of performance and knowledge of results• Clear instructions and demonstrations will be provided• Treadmills or robotics will be used to complement training when and if appropriate• The focus will be on high repetitions and low load• Effects of gravity and surface friction will be manipulated to enable active muscle contraction• Resistance/load will be increased as soon as possible• The strength training will be done within the context of a functional activity if possible• Manual assistance will only be provided if essential• Training will follow the principles of progressive resistance training (ie., 3 ×10–12RM)• The strength training will be done within the context of a functional activity if possibleIn addition, an Intervention Manual is provided to all trial therapists alongside the training package (see The SCI-MT intervention will be delivered by a healthcare professional (e.g., Physiotherapist, Occupational Therapist, Exercise Physiologist) appropriately qualified to deliver all or some aspects of Motor Training once they have completed the compulsory training. The 12 h per week of Motor Training will be provided to the intervention participants on a one-to-one basis by the therapists in a therapy gym. The time allocated to Motor Training will be dedicated to as much active exercise as possible, although it will also include rest, set-up, and chat. Management of fatigue will include rests as required, with encouragement to resume exercise as soon as possible. Mental practice [The use of Practice Sheets will be at the core of delivering the SCI-MT intervention. Therapists and participants will refer to the Practice Sheets together at the beginning of each week to review previously set goals and negotiate 2–4 new goals. Therapists will also use Practice Sheets to set exercise targets, and to document exercise intensity, set-up, and duration within each session. Dosage parameters documented in the Practice Sheets will be reviewed during each session, and this will be used to encourage the participants to work as hard as they can, and to progress the exercises from day to day, and week to week.The exercise dosage delivered during the 12 h of weekly SCI-MT Trial intervention will be documented as the Importantly, there will be ongoing auditing of the intervention by three trial clinical experts to ensure that the intervention is being delivered as intended. The audits will involve regular reviews of the Practice Sheets at each site, with provision of feedback and ongoing training of the trial therapists as required. In addition, the fidelity of the intervention will be examined in detail with a process evaluation that will run alongside the trial. The process evaluation will also involve exploring the barriers and facilitators to the future rollout of the intervention, as well as collecting data to explain the trial results and to summarise adherence to the key principles of the intervention.