Errorless learning is superior to trial and error when learning a practical skill in rehabilitation: a randomized controlled trial

Objective: Errorless learning is an effective strategy for the cognitive rehabilitation of memory impairment, but there is little evidence to support its use for skill learning. This preliminary study investigates whether errorless learning is superior to treatment as usual (trial and error), when teaching people with amputations and comorbid risk of vascular cognitive impairment to fit a prosthetic limb. Design: A randomized control design. Setting: A regional limb-fitting clinic at the West of Scotland Mobility and Rehabilitation Centre in Glasgow. Participants: Thirty adults with transtibial amputations, recruited from a regional limb-fitting clinic. Of these 42% were cognitively impaired. Intervention: Random assignment to an errorless learning intervention (n = 15) or a treatment as usual control (n = 15). There were five training trials within a single session. Participants were then asked to fit their limb without assistance. Main measures: Performance was scored from videotape recording of the first occasion when the participant attempted to fit their limb without assistance. Addenbrookes Cognitive Examination - Revised (ACE-R) was used to assess general cognitive functioning. Results: The errorless learning group remembered more correct steps (mean 90.9, SD 12.1) than the control group (77.9; 8.4; P<0.001) and made fewer errors (mean 0.93, SD 1.3) than controls (2.1; 0.95); P=0.002). Conclusions: Errorless learning can benefit people with amputations in learning the practical skill of fitting a prosthetic limb. Further study that includes follow-up is warranted.