Strategy Training During Inpatient Rehabilitation May Prevent Apathy Symptoms After Acute Stroke
Year: 2015
Type: article
Abstract: BACKGROUND: Apathy, or lack of motivation for goal-directed activities, contributes to reduced engagement in and benefit from rehabilitation, impeding recovery from stroke. OBJECTIVE: To examine the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke. DESIGN: Secondary analysis of randomized controlled trial. SETTING: Acute inpatient rehabilitation. PARTICIPANTS: Participants with acute stroke who exhibited cognitive impairments (Quick Executive Interview Scores ≥3) and were admitted for inpatient rehabilitation were randomized to receive strategy training (n = 15, 1 session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). METHODS: Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following, and responding). MAIN OUTCOME MEASURES: Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 months, and 6 months. Data were analyzed with repeated-measures fixed-effects models. RESULTS: Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission (strategy training, mean = 25.79, standard deviation = 7.62; reflective listening, mean = 25.18, standard deviation = 4.40). A significant group × time interaction (F2,28 = 3.61, P = .040) indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large (d = -0.99, t28 = -2.64, P = .013) at month 3 and moderate to large (d = -0.70, t28 = -1.86, P = .073) at month 6. CONCLUSION: Strategy training shows promise as an adjunct to usual rehabilitation for maintaining low levels of poststroke apathy.
Source: PM&R
Institutions: Boston University, National Institutes of Health, Shirley Ryan AbilityLab, University of Pittsburgh, RTI International, University of Pittsburgh Medical Center, Rotman Research Institute, University of Oklahoma, Eunice Kennedy Shriver National Institute of Child Health and Human Development, American Association for Geriatric Psychiatry, Patient-Centered Outcomes Research Institute, Bristol-Myers Squibb (United States), National Palliative Care Research Center, Medscape, Université Pierre-et-Marie-Curie
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: National Institutes of Health, U.S. Public Health Service, National Institute on Aging, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Guided Versus Directed Training in Acute Stroke Rehabilitation, Closing Gap in Stroke Rehabilitation: Early Intervention for Cognitive Disability, ACISR for Late-Life Depression Prevention, University of Pittsburgh Clinical and Translational Science Institute, University of Pittsburgh Clinical and Translational Science Institute, G6412245845, Donepezil to promote functional recovery post-stroke, Developing Cognitive Training and Rehabilitation Paradigms for Experimental TBI, MULTICENTER CAREER DEVELOPMENT PROGRAM FOR PHYSICAL AND OCCUPATIONAL THERAPY, Optimizing Environmental Enrichment to Model Preclinical Neurorehabilitation, Pittsburgh Older Americans Independence Center
OpenAlex ID: W2075652726