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

7.项目摘要/摘要 这项研究的长期目标是改善运动能力，减少运动损伤 中风患者。在目前的中风康复实践中，有两个主要差距必须是 致力于实现这一目标：(1)当前基于损害的方法(例如，运动)没有改善 有意义的活动表现；以及(2)目前的中风康复干预措施通常没有被设计成 临床上可行，很少付诸实践。这项提议的总体假设是 临床上可行的基于活动的干预，元认知策略培训(MCST)将产生显著的 比较活动能力和运动功能主客观测量方法的改进 常规护理作业疗法(OT)组。这些收获将转移并推广到未经训练的任务中 新颖的环境。本项目的具体目标是：(1)评估MCST的有效性，以改进 亚急性卒中患者的主观和客观活动表现；以及(2)评估 MCST改善亚急性卒中患者运动功能的疗效观察参与者患有亚急性 将招募生活在具有自我确定的活动表现目标和偏瘫的社区中的中风患者 通过本地卒中登记处(n=108)。符合纳入和排除标准的个人将是 随机分为MCST组或常规护理作业治疗组。两个小组都将收到 进行10到45分钟的治疗。治疗结果将评估基线、干预后和 干预后三个月。治疗效果结果将用意向治疗模型进行分析， 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 运动损伤和运动损伤程度。统计分析采用独立样本t检验和卡方检验。 确保成功的随机化和组之间的平衡。基线上的组差异是 在分析中，具有统计学意义的变量也将被视为协变量。临时后测试将用于 恰如其分。重要程度、效应大小和可信区间将被报告。完成这项工作 这项研究可能会导致一种有效的、临床上可行的干预措施，以改善活动能力和 减少中风患者的运动缺陷，这可以可行地实施到当前的护理系统中。 建议的研究和预期结果与国家中心的研究重点一致 医疗康复研究(NCMRR)，重点是识别、预防和治疗关键 与身体损伤和残疾(包括中风)相关的继发性疾病。

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.