Strategy-training post-stroke via tele-rehabilitation: a pilot randomized controlled trial

Abstract

Purpose

Long-term limitations in social participation are common after stroke. Whether these can be attenuated through a tele-rehabilitation approach is unknown. We were particularly interested in examining transfer of learning effects which could result in broader improvements in social participation.

Methods

We adapted a strategy training rehabilitation approach (tele-CO-OP) for remote delivery. Participants with chronic stroke were randomized to receive the intervention (EXPT) or to a wait list (Control). Feasibility and acceptability were measured via attendance scores, satisfaction with the training and therapist evaluation of engagement with the training. The primary outcome measure was the Canadian Occupational Performance Measure (COPM), a standardized semi-structured interview which elicits difficulties in day-to-day life.

Results

Seventeen participants were randomized. Tele-CO-OP was found to be feasible and acceptable: participants reported high satisfaction and engagement, and missed few sessions. Large effect sizes for transfer of learning effects were observed in favor of receiving tele-CO-OP vs being waitlisted. Significant benefits were also conferred to the Control group following receipt of tele-CO-OP. The intervention also appeared to improve mood.

Conclusions

This exploratory study demonstrates the feasibility and acceptability of tele-CO-OP and provides preliminary evidence for transfer of learning effects to untrained everyday social participation activities. Trial registration number: NCT02724813

Implications for rehabilitation

• Stroke results in long-term limitations in social participation.

• The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach provides a potential avenue for ameliorating these limitations.

• This pilot randomized controlled trial demonstrated that it is feasible to deliver tele-CO-OP and that positive benefits may accrue to those receiving the intervention for both trained and untrained activities.

• Tele-CO-OP is a promising intervention for addressing long-term participation limitations in individuals with chronic stroke.

Keywords:

• Stroke
• tele-rehabilitation
• CO-OP approach
• cognition
• clinical trial

Acknowledgements

The investigators thank participants for their time and commitment to the study. At the time this study was conducted, AC and NG were trainees in the Dawson Lab.

Disclosure statement

DD and SM are editors and receive royalties related to a book published on the CO-OP Approach (Enabling participation across the lifespan: advancements, adaptations and extensions of the CO-OP Approach published in 2017 by the AOTA Press). SM is a certified CO-OP instructor and is associated with the International Cognitive Approaches Network (www.icancoop.org).

Additional information

Funding

This work was supported by a grant from the Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery to DD.