Comparing cognitive orientation to daily occupational performance and motivational interviewing in stroke rehabilitation: A protocol for a randomized controlled trial

Abstract

Background:

Long-term disability following stroke significantly affects functional abilities and daily living activities. This protocol outlines a planned three-arm randomized controlled trial to compare effects of Motivational Interviewing (MI) and Cognitive Orientation to daily Occupational Performance (CO-OP) on occupational performance among individuals with chronic stroke.

Method:

Sixty individuals with chronic stroke will be randomly assigned to one of three groups: CO-OP, MI, or control. The primary outcome of interest is occupational performance, evaluated using the Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Secondary outcomes include functional independence, measured by Functional Independence Measurement (FIM), and self-efficacy, assessed with General Self-Efficacy Scale (GSES). Assessments will be conducted at baseline, postintervention (5 weeks), and 1-month follow-up. Data will be analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA). The Shapiro–Wilk test will assess data normality. For quantitative variables, ANOVA or Kruskal–Wallis tests will be used depending on distribution. Qualitative variables will be analyzed using Chi-square or Fisher’s exact test.

Discussion:

This protocol describes the methodology for comparing the effectiveness of CO-OP and MI in improving occupational performance in individuals with stroke. The findings from the planned study will inform future large-scale trials and may guide clinical decision-making in rehabilitation settings.

Trial Registration:

IRCT20180515039676N1.

Keywords

Cognition motivation occupational performance stroke rehabilitation

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References

Baum

(2012) Occupational performance measures for health and wellbeing: Research and practice. British Journal of Occupational Therapy 75(9): 402.

Binder

Hannum

McCarthy

, et al. (2019) A Systematic Review of the Efficacy of Motivational Interviewing on Occupational Performance. Available at http://www.jdc.jefferson.edu/student_papers/32

Camillieri

(2019) Cognitive-behavioral interventions for improving activity outcomes after stroke: A narrative review of the literature. Journal of Stroke Medicine 2(1): 7–16.

Chen

Lee

Yang

, et al. (2020) Effectiveness of motivational interviewing in regard to activities of daily living and motivation for rehabilitation among stroke patients. International Journal of Environmental Research and Public Health 17(8): 2755

Cheng

Lin

Shi

, et al. (2024) Projections of the stroke burden at the global, regional, and national levels up to 2050 based on the global burden of disease study 2021. Journal of the American Heart Association 13(23): e036142.

Chow

S-C

Shao

Wang

, et al. (2018) Sample Size Calculations in Clinical Research (2nd ed). Boca Raton, FL: CRC Press.

Cramer

Richards

Bernhardt

, et al. (2023) Cognitive deficits after stroke. Stroke 54(1): 5–9.

Dai

Cheng

C-w

Tian

, et al. (2019). Standard protocol items for clinical trials with traditional Chinese medicine 2018: Recommendations, explanation and elaboration (SPIRIT-TCM Extension 2018). Chinese Journal of Integrative Medicine 25: 71–79.

Dehghan

Dalvand

Pourshahbaz

(2015) Translation of Canadian occupational performance measure and testing Persian version validity and reliability among Iranian mothers of children with cerebral palsy. Journal of Modern Rehabilitation 9(4): 25–31.

10.

Di Pellegrino

Fadiga

Fogassi

, et al. (1992) Understanding motor events: A neurophysiological study. Experimental Brain Research 91: 176–180.

11.

Emsaki

Molavi

Chitsaz

, et al. (2011) Psychometric properties of the Montreal Cognitive Assessment (MoCA) in Parkinson’s disease patients in Isfahan. Journal of Isfahan Medical School 29(158): 1606–1615.

12.

Farnia

Asadi

Abdoli

, et al. (2020) Psychometric properties of the Persian version of General Self-Efficacy Scale (GSES) among substance abusers the year 2019–2020 in Kermanshah city. Clinical Epidemiology and Global Health 8(3): 949–953.

13.

Giles

Radomski

Wolf

(2019) Cognition, cognitive rehabilitation, and occupational performance. American Journal of Occupational Therapy 73: 7312410010.

14.

Gittins

Lugo-Palacios

Vail

, et al. (2021). Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments. Clinical Rehabilitation, 35(3), 446–458.

15.

Haghdoost

Baneshi

Marzban

(2011) How to estimate the sample size in special conditions? (Part two). Iranian Journal of Epidemiology 7(2): 67–74.

16.

Heeb Desai

Kiserow

Mullings

, et al. (2023) Exploring the perspectives of adults aging with long-term physical disabilities on physical activity: A qualitative study. American Journal of Health Promotion 37(5): 654–663.

17.

Khaledian

Qaribi

Gholizadeh

, et al. (2013) The impact of group Cognitive Behavioral Therapy (CBT) on depression decrease and hopefulness increase of empty nest syndrome. Family Counseling and Psychotherapy 3(2): 261–281.

18.

Kiriakou

Psychouli

(2024) Effects of the CO-OP approach in addressing the occupational performance of adults with stroke: A systematic review. The American Journal of Occupational Therapy 78(2): 1–7.

19.

Kwakkel

Stinear

Essers

, et al. (2023) Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework. European Stroke Journal 8(4): 880–894.

20.

Martini

Rios

Polatajko

, et al. (2015) The performance quality rating scale (PQRS): Reliability, convergent validity, and internal responsiveness for two scoring systems. Disabilty and Rehabilitation 37(3): 231–238.

21.

McColl

Paterson

Davies

, et al. (2000) Validity and community utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy 67(1): 22–30.

22.

Miller

(2023) The evolution of motivational interviewing. Behavioural and Cognitive Psychotherapy 51(6): 616–632.

23.

Miller

Rose

(2009) Toward a theory of motivational interviewing. American Psychologist 64(6): 527.

24.

Naghdi

Ansari

Raji

, et al. (2016) Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke. Disability and Rehabilitation 38(3): 289–298.

25.

Polatajko

Mandich

Miller

, et al. (2001). Cognitive orientation to daily occupational performance (CO-OP) part II the evidence. Physical & Occupational Therapy in Pediatrics 20(2–3): 83–106.

26.

Polatajko

Mandich

Missiuna

, et al. (2001) Cognitive orientation to daily occupational performance (CO-OP) part III-the protocol in brief. Physical & Occupational Therapy in Pediatrics 20(2–3): 107–123.

27.

Prust

Forman

Ovbiagele

(2024) Addressing disparities in the global epidemiology of stroke. Nature Reviews Neurology 20(4): 207–221.

28.

Rajan

(2022) The Impact of Motivation on Occupational Performance of Stroke Patients. Bachelor Thesis, Lithuanian University of Health Sciences, Lithuania.

29.

Rudberg

Berge

Laska

, et al. (2021) Stroke survivors’ priorities for research related to life after stroke. Topics in Stroke Rehabilitation 28(2): 153–158.

30.

Saeidi Borujeni

Hosseini

Akbarfahimi

, et al. (2020) Cognitive orientation to daily occupational performance approach for Iranian elderly without cognitive impairments: A Single Subject Study. Archives of Rehabilitation 21(4): 526–543.

31.

Schmidt

Hass

Kirsch

, et al. (2021) The human mirror neuron system—A common neural basis for social cognition? Psychophysiology 58(5): e13781.

32.

Schulz

Altman

Moher

and Consort Group (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Journal of Clinical Epidemiology 63(8): 834–840.

33.

Self

Borsari

Ladd

, et al. (2023) Cultural adaptations of motivational interviewing: A systematic review. Psychological Services 20(S1): 1–33.

34.

Sorita

Tarruella

Bossard

, et al. (2011) Contribution of occupational therapy intervention with stroke patients. Annals of Physical and Rehabilitation Medicine 54(1): e66.

35.

Stinear

Lang

Zeiler

, et al. (2020) Advances and challenges in stroke rehabilitation. The Lancet Neurology 19(4): 348–360.

36.

Tynterova

Shusharina

Barantsevich

, et al. (2024) Impact of early post-stroke affective and motivational disorders on functional outcome of ischemic stroke patients. The European Physical Journal Special Topics 233: 717–722.