Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel.
Maccabi Health-Care Services, Tel-Aviv 6812509, Israel.
Int J Environ Res Public Health. 2021 Jul 28;18(15):7988. doi: 10.3390/ijerph18157988.
Mild stroke can cause subtle cognitive-behavioral symptoms, which although might be hidden, can restrict community reintegration and participation. Cognitive rehabilitation programs exist for stroke but not specifically for mild stroke and the research evidence varies. The Functional and Cognitive Occupational Therapy (FaCT) intervention was developed specifically for this population.
To examine the effectiveness of FaCT intervention for improving daily functioning and participation compared with standard care.
A single blind randomized controlled trial with assessments pre (T1), post (T2) and 3-month follow-up (T3). Individuals in the FaCT group received 10 weekly sessions practicing cognitive and behavioral strategies. The Canadian Occupational Performance Measure (COPM) was the primary outcome measure, IADL-questionnaire, Reintegration to Normal Living questionnaire (RNL) were secondary measures.
In total, 66 community-dwelling individuals with mild stroke were randomly allocated to FaCT ( = 33, mean (SD) age 64.6 (8.2), 33% women), or control group ( = 33, mean (SD) age 64.4 (10.8), 45% women). Time X Group interaction effects were found for the COPM performance ((1.4,90.3) = 11.75, < 0.000) and satisfaction ((1.5,96.8) = 15.70, < 0.000), with large effect size values. Significant between-group effects were found for RNL ( = 10.02, < 0.002, = 0.13). Most participants in FaCT achieved a clinically important difference in COPM between T1-T2, T1-T3, and in RNL between T1 to T3 compared with the control group.
FaCT intervention is effective to improve daily functioning, participation and satisfaction of individuals with mild stroke compared with standard care, therefore FaCT should be implemented in community rehabilitation settings.
轻度中风会导致轻微的认知行为症状，尽管这些症状可能隐藏，但会限制患者重新融入社区和参与社会活动。目前已经有针对中风患者的认知康复项目，但专门针对轻度中风的项目尚未开发，且相关研究结果也不一致。功能性和认知职业疗法（FaCT）干预措施就是专门为此人群开发的。
研究 FaCT 干预措施在提高日常生活功能和参与度方面与常规护理相比的有效性。
采用单盲随机对照试验，在基线（T1）、干预后（T2）和 3 个月随访（T3）进行评估。FaCT 组患者每周接受 10 次认知和行为策略练习。主要结局指标为加拿大职业表现量表（COPM），次要结局指标为日常生活活动问卷（IADL-questionnaire）和正常生活重返量表（RNL）。
共有 66 名居住在社区的轻度中风患者被随机分配到 FaCT 组（ = 33，平均年龄（标准差）64.6（8.2）岁，33%为女性）或对照组（ = 33，平均年龄（标准差）64.4（10.8）岁，45%为女性）。COPM 表现（（1.4，90.3） = 11.75， < 0.000）和满意度（（1.5，96.8） = 15.70， < 0.000）的时间与分组存在交互效应，且具有较大的效应值。在 RNL 方面也发现了显著的组间效应（ = 10.02， < 0.002， = 0.13）。与对照组相比，FaCT 组的大多数患者在 COPM 中 T1-T2、T1-T3 之间和 RNL 中 T1-T3 之间都取得了有临床意义的差异。
与常规护理相比，FaCT 干预措施可有效提高轻度中风患者的日常生活功能、参与度和满意度，因此 FaCT 应在社区康复环境中实施。
