Effectiveness of the Functional and Cognitive Occupational Therapy (FaCoT) Intervention for Improving Daily Functioning and Participation of Individuals with Mild Stroke: A Randomized Controlled Trial.

Tal Adamit,Jeffrey Shames,Debbie Rand

doi:10.3390/ijerph18157988

Abstract

Background: Mild stroke can cause subtle cognitive–behavioral symptoms, which although might be hidden, can restrict community reintegration and participation. Cognitive rehabilitation programs exist for stroke but not specifically for mild stroke and the research evidence varies. The Functional and Cognitive Occupational Therapy (FaCoT) intervention was developed specifically for this population. Objective: To examine the effectiveness of FaCoT intervention for improving daily functioning and participation compared with standard care. Method: A single blind randomized controlled trial with assessments pre (T1), post (T2) and 3-month follow-up (T3). Individuals in the FaCoT group received 10 weekly sessions practicing cognitive and behavioral strategies. The Canadian Occupational Performance Measure (COPM) was the primary outcome measure, IADL-questionnaire, Reintegration to Normal Living questionnaire (RNL) were secondary measures. Results: In total, 66 community-dwelling individuals with mild stroke were randomly allocated to FaCoT (n = 33, mean (SD) age 64.6 (8.2), 33% women), or control group (n = 33, mean (SD) age 64.4 (10.8), 45% women). Time X Group interaction effects were found for the COPM performance (F(1.4,90.3) = 11.75, p < 0.000) and satisfaction (F(1.5,96.8) = 15.70, p < 0.000), with large effect size values. Significant between-group effects were found for RNL (F = 10.02, p < 0.002, ɳP2 = 0.13). Most participants in FaCoT achieved a clinically important difference in COPM between T1–T2, T1–T3, and in RNL between T1 to T3 compared with the control group. Conclusions: FaCoT intervention is effective to improve daily functioning, participation and satisfaction of individuals with mild stroke compared with standard care, therefore FaCoT should be implemented in community rehabilitation settings.

Highlights

Despite the high prevalence of mild stroke, very few studies have focused on this subgroup
This study aimed to examine the effectiveness of Functional and Cognitive Occupational Therapy (FaCo T) to enhance occupational performance and participation of individuals with mild stroke compared with standard care
A total of 33 individuals were allocated into FaCo T group (11 women; mean (SD) age 64.6 (8.2); 85% of them were in the chronic stage, MoCA 21.5 (3.9) points) and 33 individuals into the control group

Summary

Introduction

Despite the high prevalence of mild stroke, very few studies have focused on this subgroup. Mild strokes can be overlooked and many individuals do not benefit from rehabilitation services after acute care hospitalization [4,5]. These individuals experience difficulties in Instrumental Activities of Daily. Low levels of participation, restricted family and social involvement, and difficulties re-integrating into meaningful occupations [9,10] have been reported, leading to decreased satisfaction and low quality of life detected even up to 18-months post mild stroke [9,11,12]

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