title: Strategy Training During Inpatient Rehabilitation May Prevent Apathy Symptoms After Acute Stroke.
abstract: BACKGROUND
  Apathy, or lack of motivation for goal-directed activities, contributes to reduced engagement in and benefit from rehabilitation, impeding recovery from stroke.
  
  
  OBJECTIVE
  To examine the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke.
  
  
  METHODS
  Secondary analysis of randomized controlled trial.
  
  
  METHODS
  Acute inpatient rehabilitation.
  
  
  METHODS
  Participants with acute stroke who exhibited cognitive impairments (Quick Executive Interview Scores ≥3) and were admitted for inpatient rehabilitation were randomized to receive strategy training (n = 15, 1 session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (n = 15, same dose).
  
  
  METHODS
  Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following, and responding).
  
  
  METHODS
  Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 months, and 6 months. Data were analyzed with repeated-measures fixed-effects models.
  
  
  RESULTS
  Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission (strategy training, mean = 25.79, standard deviation = 7.62; reflective listening, mean = 25.18, standard deviation = 4.40). A significant group × time interaction (F2,28 = 3.61, P = .040) indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large (d = -0.99, t28 = -2.64, P = .013) at month 3 and moderate to large (d = -0.70, t28 = -1.86, P = .073) at month 6.
  
  
  CONCLUSIONS
  Strategy training shows promise as an adjunct to usual rehabilitation for maintaining low levels of poststroke apathy.
authors.affiliation: Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA(∗). Electronic address: skidmore@pitt.edu.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Skidmore
authors.affiliation: Department of Physical Medicine & Rehabilitation and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA(†).
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Whyte
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA(‡).
authors.forename: Meryl A
authors.initials: MA
authors.lastname: Butters
authors.affiliation: Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA(§).
authors.forename: Lauren
authors.initials: L
authors.lastname: Terhorst
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA(‖).
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D057565:Apathy; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation