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Robot Assisted Training for the Upper Limb after Stroke (RATULS): study protocol for a randomised controlled trial

Lookup NU author(s): Emerita Professor Helen Rodgers, Dr Lisa Shaw, Dr Helen Bosomworth, Lydia Aird, Dr Natasha Alvarado, Professor Janet Eyre, Dr Tracy Finch, Jenni Hislop, Denise Howel, Professor Christopher PriceORCiD, Professor Lynn RochesterORCiD, Elaine Stamp, Professor Laura Ternent, Professor Luke ValeORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2017 The Author(s). Background: Loss of arm function is a common and distressing consequence of stroke. We describe the protocol for a pragmatic, multicentre randomised controlled trial to determine whether robot-assisted training improves upper limb function following stroke. Methods/design: Study design: a pragmatic, three-arm, multicentre randomised controlled trial, economic analysis and process evaluation. Setting: NHS stroke services. Participants: adults with acute or chronic first-ever stroke (1 week to 5 years post stroke) causing moderate to severe upper limb functional limitation. Randomisation groups: 1. Robot-assisted training using the InMotion robotic gym system for 45 min, three times/week for 12 weeks 2. Enhanced upper limb therapy for 45 min, three times/week for 12 weeks 3. Usual NHS care in accordance with local clinical practice Randomisation: individual participant randomisation stratified by centre, time since stroke, and severity of upper limb impairment. Primary outcome: upper limb function measured by the Action Research Arm Test (ARAT) at 3 months post randomisation. Secondary outcomes: upper limb impairment (Fugl-Meyer Test), activities of daily living (Barthel ADL Index), quality of life (Stroke Impact Scale, EQ-5D-5L), resource use, cost per quality-adjusted life year and adverse events, at 3 and 6 months. Blinding: outcomes are undertaken by blinded assessors. Economic analysis: micro-costing and economic evaluation of interventions compared to usual NHS care. A within-trial analysis, with an economic model will be used to extrapolate longer-term costs and outcomes. Process evaluation: semi-structured interviews with participants and professionals to seek their views and experiences of the rehabilitation that they have received or provided, and factors affecting the implementation of the trial. Sample size: allowing for 10% attrition, 720 participants provide 80% power to detect a 15% difference in successful outcome between each of the treatment pairs. Successful outcome definition: baseline ARAT 0-7 must improve by 3 or more points; baseline ARAT 8-13 improve by 4 or more points; baseline ARAT 14-19 improve by 5 or more points; baseline ARAT 20-39 improve by 6 or more points. Discussion: The results from this trial will determine whether robot-assisted training improves upper limb function post stroke. Trial registration: ISRCTN, identifier: ISRCTN69371850. Registered 4 October 2013.

Publication metadata

Author(s): Rodgers H, Shaw L, Bosomworth H, Aird L, Alvarado N, Andole S, Cohen DL, Dawson J, Eyre J, Finch T, Ford GA, Hislop J, Hogg S, Howel D, Hughes N, Krebs HI, Price C, Rochester L, Stamp E, Ternent L, Turner D, Vale L, Warburton E, van Wijck F, Wilkes S

Publication type: Article

Publication status: Published

Journal: Trials

Year: 2017

Volume: 18

Issue: 1

Online publication date: 20/07/2017

Acceptance date: 04/07/2017

Date deposited: 09/08/2017

ISSN (print): 1745-6215

Publisher: BioMed Central Ltd.


DOI: 10.1186/s13063-017-2083-4


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Funder referenceFunder name
NIHR Health Technology Assessment programme (project number 11/26/05)