Occupation-based strategy training for adults with traumatic brain injury: a pilot study

Abstract

Objective: To evaluate, before undertaking a larger trial, feasibility of the study processes to determine the effectiveness of occupation-based strategy training for producing changes on trained real-world behaviors, and to determine whether far transfer of training effects to measures of real-world impact, including participation in everyday life, could be achieved.

Design: Partially randomized controlled trial with pre- and postintervention assessments done by assessors masked to the treatment arm.

Setting: Testing occurred at a research institute, interventions at participants' homes.

Participants: People (N=13) with chronic traumatic brain injury (TBI), 7 in the experimental group (mean age, 42.6y; mean time post-TBI, 9.8y; 4 men) and 6 in the control arm (mean age, 40.5y; mean time post-TBI, 10.8y; 3 men), were assessed immediately before and after the intervention phase.

Intervention: Occupation-based strategy training, an adapted version of the Cognitive Orientation to daily Occupational Performance (CO-OP), was provided in two 1-hour sessions per week for 10 weeks.

Main outcome measures: Canadian Occupational Performance Measure, Dysexecutive Questionnaire, Mayo-Portland Adaptability Inventory-4 Participation Index, and Assessment of Motor and Process Skills.

Results: The study processes (testing and intervention) were acceptable to all participants. Evidence of far transfer was found as the experimental group improved significantly more than the control group on performance and satisfaction with performance ratings on untrained goals (P<.05), and reported increased levels of participation (P<.01).

Conclusions: Findings must be interpreted with caution since the sample is small and comparisons are made with a no-treatment control. Nevertheless, they suggest that the training is feasible and a larger trial warranted.

Keywords: AMPS; Assessment of Motor and Process Skills; Brain injuries; CO-OP; COPM; Canadian Occupational Performance Measure; Cognition therapy; Cognitive Orientation to daily Occupational Performance; DEX; Dysexecutive Questionnaire; Executive function; M2PI; Mayo-Portland Adaptability Inventory-4 Participation Index; Rehabilitation; Rehabilitation outcome; TBI; traumatic brain injury.