Cognitive strategies for improving activity-level outcomes post stroke: an integrative review

Area of Science:

• Neurorehabilitation
• Cognitive Psychology
• Evidence Synthesis

Background:

• Stroke survivors often experience cognitive impairments affecting rehabilitation engagement and functional outcomes.
• Cognitive strategy interventions are explored to enhance recovery and improve daily activity levels post-stroke.

Purpose of the Study:

• To identify and categorize cognitive strategy interventions that support rehabilitation engagement and activity-level outcomes in individuals with post-stroke cognitive impairments.
• To synthesize evidence on the effectiveness and application of different cognitive strategies in stroke rehabilitation.

Main Methods:

• An integrative review following Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines.
• Comprehensive literature searches across multiple databases (Embase, CINAHL, Scopus, MEDLINE, PsycINFO).
• Independent study selection, data extraction (TIDieR checklist), and quality assessment (QuADS) by two reviewers.

Main Results:

• 40 studies met inclusion criteria, with 20 randomized controlled trials, investigating interventions delivered from 6 days to 9.5 years post-stroke.
• Identified 3 categories of cognitive strategies: 20 domain-specific, 12 mental practice, and 8 global approaches.
• Global approaches showed consistency, but applicability varies; domain-specific strategies target impairments directly, while mental practice suits milder cognitive deficits. Functional Independence Measure and Barthel Index were common outcome measures.

Conclusions:

• Three main categories of cognitive strategy interventions were identified for post-stroke cognitive impairments.
• Inconsistency in outcome measures and lack of stakeholder involvement were noted.
• Standardization of interventions and outcome measures is recommended for future research to inform clinical guidelines.