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

7. 项目总结/摘要 这项研究的长期目标是提高活动表现并减少运动障碍 中风患者。当前的中风康复实践存在两个主要差距，必须予以纠正 为实现这一目标而采取的措施：(1) 当前基于损伤的方法（例如运动）没有得到改进 有意义的活动表现； (2) 当前的中风康复干预措施通常并非旨在 临床上可行，但很少付诸实践。该提案的总体假设是 临床上可行的、基于活动的干预、元认知策略训练（MCST）将产生显着的效果 相比之下，活动表现和运动功能的客观和主观测量有所改善 到常规护理职业治疗 (OT) 组。这些收益将转移并推广到未经训练的任务 新颖的环境。该项目的具体目标是：（1）评估MCST改善的功效 亚急性中风患者的主观和客观活动表现； (2) 评估 MCST 改善亚急性中风患者运动功能的功效。亚急性参与者 将招募生活在社区中、具有自我确定的活动表现目标和偏瘫的中风患者 通过当地卒中登记处（n = 108）。那些符合纳入和排除标准的个人将被 随机分为 MCST 组或常规护理职业治疗组。两组都将获得 十次，每次 45 分钟的治疗。治疗结果将在基线、干预后和治疗后进行评估 干预后三个月。将使用意向治疗模型分析治疗效果结果 协方差分析 (ANCOVA)。潜在的协变量包括年龄、中风严重程度、认知程度 损伤和运动损伤的程度。独立样本t检验和卡方检验将用于 确保成功的随机化和组间平衡。基线时的组差异为 统计显着性也将被视为分析中的协变量。事后测试将被用作 适当的。将报告显着性水平、效应大小和置信区间。完成此 研究可能会产生有效的、临床上可行的干预措施，以改善活动表现和 减少中风患者的运动缺陷，这可以切实可行地实施到当前的护理系统中。 拟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、预防和治疗关键疾病 与身体损伤和残疾相关的次要疾病，包括中风。

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.