Occupational therapy coaching via telehealth supports cognitive strategy use in meaningful occupations of rural stroke survivors

Introduction: People living in rural communities are 17% more likely to experience a stroke yet have limited access to specialist stroke treatment. Clinical Guidelines for Stroke Management promote interventions that are client centred, are goal oriented, and optimise self management skills. Furthermore, cognitive strategy training is recommended for stroke survivors, and the use of telehealth is recommended for people who cannot access local specialist rehabilitation. This study wove together these key elements into a telehealth delivered occupational therapy coaching intervention for stroke survivors living in regional and rural communities.
Objectives: Evaluate the effectiveness of a telehealth delivered, 12-week, occupational therapy coaching intervention with embedded cognitive strategy training for enhancing engagement of stroke survivors in meaningful occupations within their home and community.
Method: A sample of 48 stroke survivors participated in a pre–post evaluation. Primary outcomes included the Canadian Occupational Performance Measure and Stroke Impact Scale (subscales: cognition, instrumental activities of daily living, and participation). The secondary outcome was assessment of cognitive strategy application using the Perceive, Recall, Plan and Perform (PRPP) Assessment (n = 25 participants).

Results: Seventy per cent of participants lived in rural or remote locations; 30% lived in a regional centre. Statistically significant improvements on all primary and secondary outcome measures were observed (P = 0.001–0.002) with moderate to large treatment effects (Cohen’s d = 0.47–1.48), supporting efficacy of this intervention.

Conclusion: An evidence-informed occupational therapy coaching intervention with embedded cognitive strategy training can be effectively delivered via telehealth to enhance occupational participation of adult stroke survivors in rural areas.