Effect of participation-focused strategy training on post-stroke cognitive functions and quality of life: results from a randomized trial

Background: Post-stroke cognitive impairment is prevalent and disabling, yet evidence for the benefits of participation-focused strategy training for cognitive function and health-related quality of life (HRQoL) is limited. Objectives: To evaluate the effects of the Optimizing Participation after Stroke through Strategy training (OPASS) program on cognitive and HRQoL outcomes in stroke survivors with cognitive impairments, and to examine associations between cognitive and HRQoL outcomes over time. Methods: In an assessor-blinded randomized controlled trial, 195 community-dwelling adults with post-stroke cognitive impairments were allocated to the OPASS group (n = 96) or a dose-matched control intervention (DMCI) group (n = 99). Both groups received 12–15 sessions over 6–8 weeks, with assessments at baseline, post-intervention, and 3 months post-intervention. Cognitive outcomes included the Trial Making Tests (TMT-A, TMT-B, and TMT B-A), Stroop Color-Naming Test (SCN), Stroop Color-Word Interference Test (SCW), and Stroop ratio score (SCW/SCN). HRQoL outcomes included time trade-off (TTO) and visual analog scale (VAS) values from the EQ-5D-3L. A modified intention-to-treat analysis was conducted using non-parametric statistics. Results: OPASS led to greater improvements in TMT-B immediately post-intervention (r = 0.19; P = 0.007), though the effect did not persist at follow-up (r = 0.09; P = 0.231). No significant between-group differences were found for other outcomes. At follow-up, TMT-A was moderately associated with TTO (rho = −0.45; P < 0.001) and weakly with VAS (rho = −0.21; P = 0.003). Conclusions: The OPASS program may produce immediate benefits in executive function among stroke survivors with cognitive impairments. Further trials are warranted. Trial registration: ClinicalTrials.gov (NCT03792061).