Enhancing Societal Participation for Stroke Survivors With Cognitive Impairments: A Randomized Controlled Trial

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Abstract
Background: Returning to societal participation is an important goal for stroke survivors, but evidence for effective rehabilitation remains inconclusive. This study evaluated the efficacy of participation‐focused strategy training in improving poststroke participation among community‐dwelling survivors with cognitive impairments. Methods: This multicenter, randomized trial enrolled stroke survivors with executive function impairments between January 2019 and March 2023. Participants received either strategy training (n=96) or an attention‐control intervention (n=99) in 12 to 15 sessions over 8 weeks. The primary outcome was the postintervention change in participation across productivity, social, and community domains from the baseline, measured by the Participation Measure‐3 Domains, 4 Dimensions. Secondary outcomes included changes in activity performance, self‐efficacy, and global cognition from baseline. Results: Eligible 195 participants were included in the intention‐to‐treat analysis (64 women, 32.8%; median [interquartile range] age: 62 [52–68] years). After adjusting for baseline primary outcome, stroke severity, and dose of regular rehabilitation, the strategy training group showed greater improvements in productivity and social participation compared with the control group (adjusted mean difference between groups [95% CI]: 7.89 [2.61–13.16] ( P =0.004) and 0.29 [0.08–0.51] ( P =0.009), respectively) from baseline to postintervention. These effects remained without adjustment, but did not persist at 3‐month follow‐up. No significant between‐group differences were observed for any other outcomes. Conclusions: Participation‐focused strategy training significantly improved productivity and social participation among enrolled stroke survivors compared with the control intervention postintervention. Further research is warranted to confirm these findings in the oldest survivors and to explore approaches for enhancing the long‐term benefits of strategy training. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03792061.

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