title: Guided Training Relative to Direct Skill Training for Individuals With Cognitive Impairments After Stroke: A Pilot Randomized Trial.
abstract: To examine the effects of direct skill training and guided training for promoting independence after stroke.
  
  
  
  Single-blind randomized pilot study.
  
  
  
  Inpatient rehabilitation facility.
  
  
  
  Participants in inpatient rehabilitation with acute stroke and cognitive impairments (N=43).
  
  
  
  Participants were randomized to receive direct skill training (n=22, 10 sessions as adjunct to usual inpatient rehabilitation) or guided training (n=21, same dose).
  
  
  
  The FIM assessed independence at baseline, rehabilitation discharge, and months 3, 6, and 12.
  
  
  
  Linear mixed models (random intercept, other effects fixed) revealed a significant intervention by time interaction (F4,150=5.11, P<.001), a significant main effect of time (F4,150=49.25, P<.001), and a significant effect of stroke severity (F1,150=34.46, P<.001). There was no main effect of intervention (F1,150=.07, P=.79). Change in FIM scores was greater for the direct group at rehabilitation discharge (effect size of between-group differences, d=.28) and greater for the guide group at months 3 (d=.16), 6 (d=.39), and 12 (d=.53). The difference between groups in mean 12-month change scores was 10.57 points.
  
  
  
  Guided training, provided in addition to usual care, offered a small advantage in the recovery of independence, relative to direct skill training. Future studies examining guided training in combination with other potentially potent intervention elements may further advise best practices in rehabilitation for individuals with cognitive impairments after acute stroke.
authors: Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: skidmore@pitt.edu.
authors: Elizabeth R
authors: ER
authors: Skidmore
authors: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors: Meryl
authors: M
authors: Butters
authors: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors: Ellen
authors: E
authors: Whyte
authors: Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
authors: Emily
authors: E
authors: Grattan
authors: Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors: Jennifer
authors: J
authors: Shen
authors: Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA.
authors: Lauren
authors: L
authors: Terhorst
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology* / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
keywords: Activities of daily living; Cognition; Rehabilitation; Stroke