Efficacy of Metacognitive-Strategy Training to Improve Activity Performance and Reduce Motor Impairment in Sub-Acute Stroke.

元认知策略训练对改善亚急性中风活动表现和减少运动障碍的功效。

• 批准号: 10018057
• 负责人: Timothy J. Wolf
• 金额: $ 68.75万
• 依托单位: UNIVERSITY OF MISSOURI-COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-13 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10018057
• 关键词: Achievement; Activities of Daily Living; Address; Age; Ambulatory Care; Analysis of Covariance; Chi-Square Tests; Clinical; Clinical Trials; Cognitive; Communities; Confidence Intervals; Control Groups; Data; Dose; Educational Intervention; Ensure; Environment; Equilibrium; Exclusion Criteria; Foundations; Future; Goals; Healthcare; Hour; Impaired cognition; Impairment; Individual; Intention; Intervention; Lead; Life; Longitudinal Studies; Measures; Medical center; Modality; Modeling; Motor; Occupational; Occupational Therapy; Outcome; Outpatients; Participant; Performance; Physiatrist; Problem Solving; Protocols documentation; Psychological Transfer; Quality of life; Randomized; Randomized Clinical Trials; Registries; Rehabilitation therapy; Reporting; Research; Research Priority; Sampling; Self Care; Severities; Single-Blind Study; Stroke; Task Performances; Testing; Time; Training; Translating; Treatment Efficacy; Treatment outcome; Upper Extremity; Visit; Work; acute stroke; base; care systems; clinical trial participant; disability; hemiparesis; improved; inclusion criteria; innovation; medical specialties; motor deficit; motor function improvement; motor impairment; novel; post intervention; post stroke; prevent; recruit; rehabilitation research; remediation; satisfaction; stroke rehabilitation; stroke survivor; treatment as usual; treatment effect; treatment group

7. Project Summary/Abstract The long-term goal of this research is to improve activity performance and reduce motor impairment in individuals with stroke. There are two primary gaps in current stroke rehabilitation practice that must be addressed to achieve this goal: (1) current impairment-based approaches (e.g. motor) are not improving meaningful activity performance; and (2) current stroke rehabilitation interventions are often not designed to be clinically feasible and are rarely implemented into practice. The overall hypothesis of this proposal is that a clinically-feasible, activity-based intervention, metacognitive strategy training (MCST), will produce a significant improvement on objective and subjective measures of activity performance and motor function in comparison to a usual care occupational therapy (OT) group. These gains will transfer and generalize to untrained tasks in novel environments. The specific aims of this project are: (1) to evaluate the efficacy of MCST to improve subjective and objective activity performance in individuals with subacute stroke; and (2) to evaluate the efficacy of MCST to improve motor function in individuals with subacute stroke. Participants with subacute stroke living in the community with self-identified activity performance goals and hemiparesis will be recruited through a local stroke registry (n = 108). Those individuals who meet inclusion and exclusion criteria will be randomized to either a MCST group or to a usual care occupational therapy group. Both groups will receive ten, 45 minute sessions of treatment. Treatment outcomes will be assessed baseline, post-intervention, and at three-months post-intervention. Treatment efficacy outcomes will be analyzed with an intent-to-treat model with an analysis of covariance (ANCOVA). Potential covariates will include age, stroke severity, degree of cognitive impairment, and degree of motor impairment. Independent samples t-test and chi-square test will be used to ensure successful randomization and balance between groups. Group differences at baseline that are statistically significant will also be considered as covariates in the analysis. Post-hoc tests will be employed as appropriate. Significance levels, effect sizes, and confidence intervals will be reported. Completion of this study is likely to result in an efficacious, clinically feasible intervention to improve activity performance and reduce motor deficits in individuals with stroke that can be feasibly implemented into current systems of care. The proposed study and anticipated outcomes are consistent with the research priority of the National Center for Medical Rehabilitation Research (NCMRR), which is to focus on identifying, preventing, and treating key secondary conditions that are associated with physical impairments and disabilities, including stroke.

7。项目摘要/摘要 这项研究的长期目标是改善活动性能并减少运动障碍 中风的人。目前的中风康复实践中有两个主要差距必须是 解决该目标的解决方案：（1）当前基于损害的方法（例如电动机）没有改善 有意义的活动表现； （2）当前的中风康复干预措施通常不是设计为 临床上可行，很少实施实践。该提议的总体假设是 临床上基于活动的干预措施，元认知策略培训（MCST）将产生重要的 相比 对通常的护理职业治疗（OT）组。这些收益将转移并概括为未经训练的任务 新颖的环境。该项目的具体目的是：（1）评估MCST改善的功效 亚急性中风的个体的主观和客观活动表现； （2）评估 MCST提高亚急性中风个体的运动功能的功效。参加亚急性的参与者 居住在社区中的中风将招募具有自我识别的活动性能目标和偏瘫的中风 通过局部冲程注册表（n = 108）。那些符合包容性和排除标准的人将是 随机分为MCST组或通常的护理职业治疗组。两组将收到 十，45分钟的治疗。将评估治疗结果的基线，干预后和 干预后三个月。治疗效率结果将通过意图对治疗模型进行分析 协方差分析（ANCOVA）。潜在的协变量将包括年龄，中风严重程度，认知程度 障碍和运动障碍程度。独立样本t检验和卡方检验将用于 确保成功的随机分配和平衡。基线时的群体差异 在分析中，统计学上的显着意义也将被视为协变量。事后测试将被用作 合适的。显着性水平，效果大小和置信区间将报告。完成此操作 研究可能会导致有效的，临床上可行的干预措施，以提高活动性能和 减少可以在当前护理体系中可行地实施的中风患者的运动不足。 拟议的研究和预期的结果与国家中心的研究优先级一致 用于医疗康复研究（NCMRR），该研究将重点放在识别，预防和治疗密钥上 与身体障碍和残疾有关的次要条件，包括中风。