On the Reporting of Experimental and Control Therapies in Stroke Rehabilitation Trials: A Systematic Review.

OBJECTIVE: To use the Centralized Open-Access Rehabilitation database for Stroke to explore reporting of both experimental and control interventions in randomized controlled trials for stroke rehabilitation (including upper and lower extremity therapies). DATA SOURCES: The Centralized Open-Access Rehabilitation database for Stroke was created from a search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cumulative Index of Nursing and Allied Health from the earliest available date to May 31, 2014. STUDY SELECTION: A total of 2892 titles were reduced to 514 that were screened by full text. This screening left 215 randomized controlled trials in the database (489 independent groups representing 12,847 patients). DATA EXTRACTION: Using a mixture of qualitative and quantitative methods, we performed a text-based analysis of how the procedures of experimental and control therapies were described. Experimental and control groups were rated by 2 independent coders according to the Template for Intervention Description and Replication criteria. DATA SYNTHESIS: Linear mixed-effects regression with a random effect of study (groups nested within studies) showed that experimental groups had statistically more words in their procedures (mean, 271.8 words) than did control groups (mean, 154.8 words) (P<.001). Experimental groups had statistically more references in their procedures (mean, 1.60 references) than did control groups (mean, .82 references) (P<.001). Experimental groups also scored significantly higher on the total Template for Intervention Description and Replication checklist (mean score, 7.43 points) than did control groups (mean score, 5.23 points) (P<.001). CONCLUSIONS: Control treatments in stroke motor rehabilitation trials are underdescribed relative to experimental treatments. These poor descriptions are especially problematic for "conventional" therapy control groups. Poor reporting is a threat to the internal validity and generalizability of clinical trial results. We recommend authors use preregistered protocols and established reporting criteria to improve transparency.

The effects of autonomous difficulty selection on engagement, motivation, and learning in a motion-controlled video game task.

This experiment investigated the relationship between motivation, engagement, and learning in a video game task. Previous studies have shown increased autonomy during practice leads to superior retention of motor skills, but it is not clear why this benefit occurs. Some studies suggest this benefit arises from increased motivation during practice; others suggest the benefit arises from better information processing. Sixty novice participants were randomly assigned to a self-controlled group, who chose the progression of difficulty during practice, or to a yoked group, who experienced the same difficulty progression but did not have choice. At the end of practice, participants completed surveys measuring intrinsic motivation and engagement. One week later, participants returned for a series of retention tests at three different difficulty levels. RM-ANCOVA (controlling for pre-test) showed that the self-controlled group had improved retention compared to the yoked group, on average, ß=46.78, 95% CI=[2.68, 90.87], p=0.04, but this difference was only statistically significant on the moderate difficulty post-test (p=0.004). The self-controlled group also showed greater intrinsic motivation during practice, t(58)=2.61, p=0.01. However, there was no evidence that individual differences in engagement (p=0.20) or motivation (p=0.87) were associated with learning, which was the relationship this experiment was powered to detect. These data are inconsistent with strictly motivational accounts of how autonomy benefits learning, instead suggesting the benefits of autonomy may be mediated through other mechanisms. For instance, within the information processing framework, the learning benefits may emerge from learners appropriately adjusting difficulty to maintain an appropriate level of challenge (i.e., maintaining the relationship between task demands and cognitive resources).