Supporting Re-engagement in Life: Coaching to Enhance Participation in Valued Activities Following Stroke

Most stroke survivors, access of all levels of impairment, have difficulty returning to valued activities and social roles, leading to loss of sense of self and purpose in life and impacting both physical and mental health. Occupational Performance Coaching (OPC) shows promise in quickly returning people to their valued activities, thereby offering hope and improving well-being. This project asks, "Will OPC, an innovative adaptive approach to returning people quickly to their valued activities, lead to increased participation for individuals with stroke?"

The experience of stroke is devastating for both stroke survivors and their families. The process of picking up the pieces, adjusting, and finding ways to engage in activities that provide meaning and purpose is complex, requiring emotional and practical support, access to information, and opportunities to test abilities and try new ways of doing. With much of the focus of rehabilitation practice and guidelines being on reducing impairment, it is not surprising that stroke survivors feel lost and ill-prepared to participate in their valued activities when formal rehabilitation ends. Effective adaptive interventions are needed to return people quickly to activities to prevent negative outcomes associated with decreased participation.

OPC is a person-centred, strengths-based, adaptive approach that focuses on providing emotional support, collaborative goal setting, solution-focused problem-solving, and experimentation to build knowledge, skills, and self-efficacy for participation. OPC capitalizes on modifiable factors influencing participation after stroke. and builds the skills needed for stroke survivors to continue setting and achieving goals on their own.

OPC is the most widely researched coaching intervention in occupational therapy and stroke rehabilitation. PI Kessler the lead international researcher testing OPC with adults with neurological conditions, namely stroke and multiple sclerosis. Pilot feasibility studies demonstrated the potential of OPC, delivered in person or virtually, to return individuals living with stroke to valued activities within 8-10 sessions.

Based on previous participation research, through enhancing participation in personally valued activities, OPC may enhance self-efficacy, physical activity, cognitive abilities, and emotional well-being.

The proposed study will establish the efficacy of OPC for improving participation in valued activities (Canadian Occupational Performance Measure), self-efficacy (Participation Strategeis Self-Efficacy Scale), physical activity (AcivPal activity monitor), cognition (CogniFit computerized assessments : a)Trail Making Test measures processing speed, shifting and visual attention; b) the Stroop test measures inhibition, updating, visual perception, naming, processing speed and response time; and c) the Visual Working Memory Span Test measures spatial perception, short-term memory, visual short-term memory, non-verbal memory, working memory, planning, processing speed, and response time), and emotional well-being (Generalized Anxiety Disorders Scale-7 and Brief Patient Health Questionnaire ). In addition, wthe investigators will conduct a process evaluation to examine characteristics of participants that act as mediators or moderators to improve participation in valued activity goals and to explore how OPC works with different subgroups of stroke participants (e.g., stroke severity, age, sex, and gender).

The investigators will conduct a double-blind randomized controlled trial to test whether OPC delivered virtually enhances participation in valued activities among people with stroke compared to an active control condition.

The investigators will recruit 118 patients from inpatient stroke rehabilitation and randomly assign them (stratified by stroke severity) to OPC (intervention group) or computerized cognitive therapy with check-ins (active control group) at the end of publicly funded rehabilitation. Participants will be 3 to 12 months post-stroke. A blinded research assistant will administer outcomes at baseline, post-intervention, and at 3-month follow-up. The primary outcome will be participation in valued activities. Secondary outcomes will be participation self-efficacy, physical activity, cognition, and emotional well-being. The investigators will examine mediators and moderators that impact the outcome of OPC and interview a subsample of 20 participants who receive OPC to better understand how OPC works with people of different stroke severity, age, sex, and gender.

Participants, blinded to study purposes, will receive 10 one-hour sessions of either OPC or an active control delivered virtually using Zoom over 15 weeks.

Between-group differences across the three timepoints for each outcome will be tested using repeated measures ANOVA. Interview transcripts will be analyzed using content analysis.

This project addresses an important knowledge gap related to improving participation among patients with stroke. The investigators will establish the efficacy of OPC, an established adaptive intervention, and expand our understanding of how it works. Without evidence-based interventions to promote participation, stroke survivors will continue to struggle to return to valued activities and miss out on associated health benefits (physical, cognitive, emotional). This work will also build on evidence for virtual approaches to stroke rehabilitation; these approaches have the potential to improve accessibility to rehabilitation for stroke survivors.