Occupational Performance Coaching for Stroke Survivors (OPC-Stroke): A Novel Patient-centered Intervention to Improve Participation in Valued Activities

Abstract

Background: The majority of people living with the effects of stroke experience participation challenges. Occupational Performance Coaching for stroke survivors (OPC-Stroke) is designed to promote engagement in personally identified participation goals and develop the ability to address future participation goals. Purpose: This thesis explored the potential efficacy of OPC-Stroke, its mechanisms of action, and the feasibility and acceptability of the randomized controlled trial methods to inform the planning of a larger trial. Methods: A pilot randomized controlled trial with an embedded qualitative component. Twenty-one participants were randomly assigned to receive 10 sessions of OPC-Stroke or usual care. Participation, goal performance and satisfaction, goal self-efficacy, emotional well-being, and cognition were measured at pretest, posttest and six months follow-up. Qualitative interviews were conducted at posttest with individuals who were in the intervention group. Results: No significant between group differences were noted for any outcomes, although scores for cognition approached significance (p=0.065) and also showed a large effect size (partial eta squared =0.167). Examination of effect sizes indicated a moderate clinically significant benefit of OPC-Stroke for goal performance and satisfaction scores (partial eta squared = 0.075 and 0.078 respectively). Participation scores improved for both groups but the overall trajectory of participation seemed to be different between groups. Goal self-efficacy remained stable across time and groups, and emotional well-being declined in both groups. Qualitative findings confirmed that all components - emotional support, individualized education and goal-focused problem-solving - made important contributions to promote achievement of participant-selected participation goals. Recruitment, retention and outcome measure completion rates were satisfactory. Conclusion: Based on the effect sizes of goal performance and satisfaction, and cognition, a larger trial to examine the efficacy of OPC-Stroke is warranted. Further work to select the most appropriate tools to measure participation and goal self-efficacy is recommended prior to the next trial.