Participation is an ultimate rehabilitation goal that is important to patients, providers, and insurance payers. Since the International Classification of Functioning, Disability, and Health (ICF) published, a growing body of literature has emerged to investigate participation among people with functional limitations in diverse service settings. However, no research to date has developed an effective intervention that show promise to successfully enhance participation among individuals with cognitive impairments after stroke and traumatic brain injury (TBI).
The purpose of this study is to examine the feasibility of applying an intervention strategy that has shown promise to increase functional independence of rehabilitation patients with cognitive impairments, the guided training, to enhance participation performance among individuals with cognitive impairments after stroke and TBI in the outpatient rehabilitation settings in Taiwan.
A mixed-methods (quantitative and qualitative) design, including a repeated measures design, will be used in this feasibility study. Adults (n=45-60) who had a first-time stroke or TBI within the past six months and have cognitive impairments will be recruited from the great Taipei area. These participants will receive 2 to 3 intervention sessions per week for 10 to 15 sessions. Standardized assessments, including the Participation Measure--3 Domains, 4 Dimensions (PM-3D4D), the Activity Measure for Post-Acute Care (AM-PAC), and the Wisconsin Card Sorting Task (WCST), will be used to assess participation and other functional outcomes at baseline, post-intervention, and 3-month and 6-month follow-up. The feasibility indicators, such as recruitment rates and intervention attendance and adherence, will be evaluated by questionnaires, field notes, and qualitative interviews after the interventions are completed.
Quantitative data will be analyzed descriptively; while data obtained from the outcome measures will be examined using Wilcoxon signed rank test and effect size (r) to compare the differences between the pre- and post-intervention scores. Qualitative data will be analyzed using thematic analysis method.
- Guided Training Behavioral
Intervention Desc: Guided training is an intervention strategy designed to help individuals identify barriers in their daily life and guide them to generate their own strategies to address these barriers. This intervention strategy is different from traditional direct skill training, in which rehabilitation practitioners are responsible for identifying their patients' challenges to perform activities and teaching them task-specific problem-solving strategies. Guided training has been applied in a variety of clinical populations, including individuals with stroke and TBI, and has demonstrated significant effect on improving independence with daily activities among persons with acute stroke-related cognitive impairments enrolled in inpatient rehabilitation. ARM 1: Kind: Experimental Label: Guided Training
|Type||Measure||Time Frame||Safety Issue|
|Primary||Participation||From baseline to 6 months following the completion of the intervention|
|Secondary||Activities||From baseline to 6 months following the completion of the intervention|
|Secondary||Cognitive functioning||From baseline to 6 months following the completion of the intervention|