Article

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. DESIGN: Secondary analysis of
randomized controlled trial. SETTING: Acute inpatient rehabilitation.
PARTICIPANTS: 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). MAIN OUTCOME MEASURES: 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 x 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.
CONCLUSION: Strategy training shows promise as an adjunct to usual rehabilitation
for maintaining low levels of poststroke apathy.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS