The preliminary effect of person-centered stroke telerehabilitation that combines Rasch Analysis keyform-mapping with cognitive strategy training.

Abstract

Test the preliminary effect of an innovative, in-home person-centered stroke telerehabilitation program combining Rasch Keyform-Mapping with metacognitive strategy training. Single-group pre/post-test quasi-experimental design. University research laboratory and in-home telerehabilitation. Thirty (n=30) stroke survivors, age 59.7 years (SD 16), 3.92 years post-stroke (SD 5.76), with arm/hand hemiparesis. The Fugl-Meyer Upper Extremity Assessment (FMA-UE) keyform, derived via Rasch analysis, maps personalized motor-skill levels to the likelihood of successfully performing home/community activities of varying difficulty. Scored keyforms were made available to participants. Participants/therapists co-created an in-home telerehabilitation program (9 one-hour sessions/6 weeks) to address participant self-identified home activity goals via individualized cognitive strategy training using a metacognitive strategy training approach. Activity performance via the Patient Specific Functional Scale (PSFS); self-efficacy via the Stroke Self-Efficacy Questionnaire (SSEQ); skill generalization via the Performance Quality Rating Scale (PQRS); and paretic arm motor ability via the telerehabilitation-specific FMA-UE (tFMA-UE). Pre-to-Post mean score differences were compared with Wilcoxon Signed Ranks (p<0.05), and Cohen's-d indicated effect size. 90% of participants completed the intervention. The pre- to post- mean (SD) score differences were as follows: PSFS Pre 2.30 (1.67), Post 5.76 (1.99), p<0.001, d=1.73; SSEQ Pre 87.93 (18.24) to Post 99.96 (12.92), p<0.001, d=1.12; PQRS Completeness: Pre 9.19 (1.00), Post 9.33 (1.75), p=0.13, PQRS Quality: Pre 4.04 (2.09), Post 5.72 (2.24), p<0.001, d=1.25; tFMA-UE Pre 22.11 (9.12), Post 23.74 (9.43), p=0.01, d=0.55. Pre-to-post comparisons were significant and effect sizes for all measures were medium/large. Combining keyform-mapping with strategy-training during stroke telerehabilitation may facilitate co-creation of personalized intervention plans. The combined intervention may improve paretic UE motor skill and increase activity performance, self-efficacy and skill generalization.