Background: Rehabilitation is a complex biopsychosocial process in which multidisciplinary professionals work in collaboration with a person and their family, with the shared objective of enhancing the person’s participation in valued life roles. Hence, rehabilitation is integral to the management of numerous health conditions. However, poor descriptions of rehabilitation interventions, including their essential elements and dosage parameters, pose a significant barrier to their replication in clinical practice. This further limits the synthesis of rehabilitation research and the consequent advancement of the field. The original Template for Intervention Description and Replication (TIDieR) checklist and guide provides a valuable foundation for reporting but is not specific to rehabilitation. The TIDieR-Rehab checklist, an extension of the original TIDieR, was developed to enhance the reporting of rehabilitation interventions. Objective: This paper presents the TIDieR-Rehab checklist and supplementary manual. Methods: In accordance with the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network and other relevant guidelines, the TIDieR-Rehab checklist and supplementary manual were developed through a modified Delphi process with individuals with rehabilitation expertise and was guided by an interdisciplinary Steering Committee. Results: The TIDieR-Rehab checklist and supplementary manual present seven original, three adapted and 12 new items to enhance the reporting of rehabilitation interventions. New items promote full descriptions of critical aspects of rehabilitation interventions, including the intended study population (Who) and timing of the intervention (When) , the planned intervention dosage (How much, How challenging and Regression/Progression) , person-centred care (Personalisation) and negative undesired effects (Harms) . Explanations and examples of good reporting, provided within the TIDieR-Rehab supplementary manual, provide comprehensive guidance to support users of the checklist. Conclusions: The TIDieR-Rehab checklist and supplementary manual present a systematic approach to the comprehensive reporting of rehabilitation interventions. The checklist is intended to support replication, evaluation and optimisation of rehabilitation interventions through improved reporting quality.

Objectives: Rehabilitation is essential for supporting the recovery from, and management of, a range of health conditions. However, interventions are often poorly reported in rehabilitation research, hindering advancement of the field. The Template for Intervention Description and Replication (TIDieR) checklist was developed to enhance the reporting of interventions, but does not specifically address the complexities and multifaceted nature of rehabilitation interventions. This study aimed to develop an extension of the TIDieR checklist to support better reporting of rehabilitation interventions. Design: A modified Delphi study overseen by a Steering Committee. Setting: Online. Participants: Rehabilitation experts were purposively sampled for diversity in discipline, practice setting, area of expertise and geographical location. Methods: Participants (n=35) provided both quantitative and qualitative feedback on drafts of the TIDieR-Rehab through online surveys. Quantitative data was descriptively analysed by percentage of agreement, while qualitative data was analysed using conventional content analysis. Quantitative and qualitative findings were subsequently triangulated to facilitate iterative refinement of the TIDieR-Rehab. Results: Consensus was achieved after two rounds of the modified Delphi process. The TIDieR-Rehab checklist comprises seven original, three adapted and 12 new reporting items, and is supported by a supplementary manual. Specific enhancements include more detailed descriptions of the study population ( Who ) and timing of the intervention ( When ), the planned intervention dosage ( How much , How challenging and Regression/Progression ), person-centred care ( Personalisation ) and negative undesired effects ( Harms ) which were considered critical for the comprehensive reporting of rehabilitation interventions. Conclusion: The TIDieR-Rehab checklist marks a significant advancement in enhancing and standardising the reporting of rehabilitation interventions. By offering a structured format for detailing complex rehabilitation interventions, the TIDieR-Rehab supports improvements in reporting quality to promote research replication and support the translation of research findings into clinical practice. Future research should validate the TIDieR-Rehab checklist across a variety of intervention types and clinical contexts.

Rehabilitation plays a critical role in minimising disability after stroke, with the concept of "challenge" proposed to be essential to rehabilitation efficacy and outcomes. This review unpacks how challenge is conceptualised in stroke rehabilitation literature from the perspectives of physiotherapy, occupational therapy, speech-language therapy and people with stroke. A secondary purpose was to provide a definition of challenge that is applicable to stroke rehabilitation. Principle-based concept analysis was utilised to examine challenge within the stroke rehabilitation literature. Forty-two papers were included. Data analysis involved immersion, analytical questioning, coding and synthesis to elicit the conceptual components of challenge. Challenge was understood as a multidimensional and dynamic concept with three facets: nominal, functional and perceived challenge. Functional and perceived challenge were integral to optimal challenge. Optimal challenge was central to enhancing the outcomes and experiences of people with stroke, in rehabilitation and everyday life. Challenge is a key concept which, when carefully optimised to the person's ability and experience, may positively influence their learning, recovery and engagement after stroke. This review lays a conceptual foundation for better understanding, operationalisation and advancement of challenge, offering important implications for addressing the growing burden of stroke disability, through rehabilitation.

Intervention parameters such as the challenge, amount, and dosage (challenge × amount) have the potential to alter the efficacy of rehabilitation interventions after stroke. This systematic review investigated the effect of intervention parameters of challenge, amount, and dosage on improvements in walking outcomes following treadmill training (TT) and comparison interventions in people with stroke. Randomized controlled trials were included if they: (i) investigated interventions of TT or bodyweight-supported TT (BWSTT); (ii) made comparisons with other physiotherapy interventions, other types of TT, or no intervention; (iii) studied people with stroke; (iv) reported sufficient data on challenge and amount parameters; and (v) measured walking speed or endurance. Completeness of reporting was evaluated using the TIDieR-Rehab checklist and risk of bias was assessed using the revised Cochrane risk-of-bias tool. The review included 26 studies; 15 studies compared TT or BWSTT with other physiotherapy interventions and 11 studies compared different types of TT. Meta-analyses provided evidence with low to moderate certainty that greater differences in challenge and dosage between treadmill and comparison physiotherapy interventions produced greater effects on walking endurance (p < 0.01). However, challenge and dosage did not influence walking speed outcomes. The analysis of intervention amount was limited by the lack of studies that manipulated the amount of intervention. Overall, the findings indicate that, after stroke, some of the efficacy of TT on walking endurance can be explained by the challenge level during training. This supports the implementation of TT at higher challenge levels in stroke rehabilitation practice.

Background: Upper-limb impairment is a major cause of post-stroke disability, limiting participation in meaningful activities. Robotic rehabilitation may address this by delivering high-dosage, task-oriented training while reducing clinician workload. However, limited clinical translation of robotic interventions may be partly due to poor reporting in the literature. This systematic review evaluated the intervention-reporting quality (completeness and consistency) of randomized controlled trials (RCTs) comparing robotic and conventional upper-limb stroke rehabilitation. Methods: Four databases were searched for RCTs investigating robotic upper-limb interventions compared with dose-matched conventional interventions for people with stroke. Intervention reporting was assessed using the TIDieR-Rehab checklist. Trained reviewers independently extracted and evaluated data, resolving discrepancies through consensus. Completeness and consistency were analyzed descriptively. Results: Among 25 RCTs, the overall reporting completeness was low (43%). Robotic interventions were better described (50%) than conventional interventions (36%). While timing and total dose were commonly reported, critical details on provider expertise, active dose, progressive challenge, personalization, and harms were often omitted. Reporting consistency was moderate (68%), with key information dispersed across article sections. Conclusions: Inadequate reporting limits the transparency, replication, and implementation of robotic upper-limb interventions. Adopting structured reporting frameworks like TIDieR-Rehab is essential for advancing the field.

Background: Task challenge is recognized as a core principle of neurorehabilitation and is frequently mentioned within stroke rehabilitation guidelines. However, guidance for operationalizing challenge in clinical practice remains limited. Examining how therapists and people with stroke currently use challenge in practice may help address this gap. Objective: To examine how challenge is operationalized in routine stroke rehabilitation practice. Methods: This study used focused video analysis to examine eight video-recorded stroke rehabilitation sessions across physiotherapy, occupational therapy, and speech-language therapy contexts. Video data were supplemented by observational memos. Analysis was conducted iteratively through four stages: immersion, detailed transcription, in-depth episode analysis, and comparative analysis. These stages enabled examination of material, embodied, social, and contextual aspects of challenge-related interactions as they unfolded during rehabilitation. Results: Twenty individuals, comprising four patient–therapist dyads and four triads participated. Challenge was operationalized through three intersecting practices: (i) Structuring challenge-related work through temporal phases determined when challenge was introduced, experienced, and consolidated across the session and within tasks; (ii) Establishing the macro-architecture of challenge guided what and how it was operationalized by constructing a challenge plan, shaping an optimal bandwidth by tailoring challenge to the person’s abilities and/or experiences, and facilitating its transfer beyond the session; (iii) Modulating challenge through micro-calibrations involved moment-to-moment adjustments (e.g., adapting physical assistance, communication style, environmental setup) to modulate active practice, navigate differing perspectives, and cultivate an atmosphere conducive to engaging with challenge. These overarching practices were dynamically enacted through a range of explicit and implicit practices. Conclusion: Challenge in stroke rehabilitation is not merely a task parameter; it is operationalized through an interplay of explicit and implicit practices that structure and enable its responsive implementation. Considering challenge through these practices may help therapists and people with stroke co-construct meaningful experiences of challenge, both within and beyond formal stroke rehabilitation sessions.