The effect of cognitive rehabilitation with a multicontextual treatment approach in stroke: a randomized controlled trial

What is your COMPETENT? DOCTORS' EXACT COGNTIVE TRAINING PROTOCOL? Doesn't have one, does s/he? So, you DON'T have a functioning stroke doctor, do you? Too bad, they are still getting paid for incompetence. Billable hours are everything; who fucking cares about recovery? Certainly not the president or board of directors or any of your doctors!

 The effect of cognitive rehabilitation with a multicontextual treatment approach in stroke: a randomized controlled trial

Özden Erkan Oğul1*, Esma Özkan2, Gonca Bumin3, Yakup Krespi4 Author Information: 1Özden Erkan Oğul, PT, PhD, Assist. Prof., Department of Ergotherapy, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye. ORCID: 0000-0002-7226-510X 2Esma Özkan, PT, PhD, Assoc. Prof., University of Health Sciences, Gülhane Faculty of Health Sciences, Department of Occupational Therapy, Ankara, Türkiye. ORCID: 0000-0001-6857-4084 3Gonca Bumin, PT, PhD, Prof, Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Türkiye. ORCID: 0000-0002-8241-2206 4Yakup Krespi, MD, Assoc. Prof., Department of Neurology, Faculty of Health Sciences, Istanbul Istinye University, Istanbul, Türkiye. ORCID: 0000-0001-5246-5908 Correspondence: [*] Address for correspondence: Özden Erkan Oğul, ORCID: 0000-0002-7226- 510X, Kavacık Mah. Ekinciler Cad. No.19 Kavacık Kavşağı-Beykoz 34810, Istanbul, Turkey. Tel.: +90 212 460 e-mail: oogul@medipol.edu.tr ARTICLE IN PRESS

ABSTRACT 

 Background: The multicontextual approach is a specific intervention that shapes cognitive functioning through interactions among individuals, activities, and the environment, utilizing metacognitive training and learning transfer. Aim: This study aimed to analyze the effects of a cognitive rehabilitation program based on a multicontextual approach, implemented alongside remedial approaches, on cognitive function, functional independence, and social participation. 

 Methods: 

Twenty individuals with chronic stroke were randomly assigned to two groups. The intervention group (n=10) received cognitive rehabilitation and standard physiotherapy. Cognitive rehabilitation program was grounded in a multicontextual approach, implemented alongside remedial approaches. The control group (n=10) received standard physiotherapy. Both groups participated in intervention sessions three times per week over an eight-week period. This study was registered at ClinicalTrials.gov (NCT06186661; December 9, 2022). 

 Results: 

One-way analysis of covariance and mixed-design analysis of variance were used for statistical analysis. The multicontextual approach, implemented alongside remedial approaches, improved the cognitive skills, occupational performance and satisfaction of individuals with chronic stroke (p<0.05). In addition, the training provided to the intervention group demonstrated moderate to large clinical effects (ɳ2 p =0.163; ɳ2 p =0.088), although no statistically significant difference was observed between the two groups in terms of functional independence and participation outcomes (p> 0.05). 

 Conclusion: 

This study provides preliminary evidence that cognitive rehabilitation, employing a multicontextual approach in combination with remedial strategies, may enhance cognitive functioning and occupational performance, and may positively affect functional independence and social participation among individuals with chronic stroke. ClinicalTrials.gov Identifier: NCT06186661; December 9, 2022.