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

7.项目概要/摘要 这项研究的长期目标是改善活动能力，减少运动障碍， 中风的人。当前中风康复实践中存在两个主要差距，必须 （1）目前基于损伤的方法（例如运动）没有得到改善 有意义的活动表现;（2）目前的中风康复干预措施往往不是为了 临床上可行，但很少付诸实践。这一建议的总体假设是， 临床上可行的，基于活动的干预，元认知策略培训（MCST），将产生显着的 活动表现和运动功能客观和主观测量比较的改进 一个普通的职业治疗组。这些收益将转移和推广到未经训练的任务， 新的环境。本课题的具体目的是：（1）评价MCST的疗效， 亚急性脑卒中患者的主观和客观活动表现;（2）评估 MCST改善亚急性卒中患者运动功能疗效亚急性 将招募生活在社区中的卒中患者，他们具有自我确定的活动表现目标和轻偏瘫 通过当地卒中登记处（n = 108）。符合入选和排除标准的受试者将 随机分为MCST组或常规护理职业治疗组。两组都将收到 10到45分钟的疗程治疗结局将在基线、干预后和 干预后三个月。将使用意向治疗模型分析治疗疗效结局， 协方差分析（ANCOVA）。潜在的协变量将包括年龄、卒中严重程度、认知功能障碍程度、 运动障碍和运动障碍的程度。独立样本t检验和卡方检验将用于 确保成功随机化和组间平衡。基线时的组间差异 统计学显著性也将被视为分析中的协变量。将采用事后检验， 适当将报告显著性水平、效应量和置信区间。完成本 这项研究可能会产生一种有效的、临床上可行的干预措施，以改善活动能力， 减少中风患者的运动缺陷，这可以切实地实施到当前的护理系统中。 拟议的研究和预期成果与国家中心的研究重点一致 医疗康复研究（NCMRR），这是重点识别，预防和治疗的关键 与身体损伤和残疾相关的继发性疾病，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.