Abstract A128: Efficacy of Strategy Training to Enhance Participation in Stroke Survivors with Cognitive Impairments: A Randomized Controlled Trial in Taiwan

Introduction: Participation is an ultimate recovery goal for community-dwelling stroke survivors. However, the evidence for effective interventions remains limited and inconclusive, particularly for those with cognitive impairments, who are often excluded from previous studies. Purpose: This study aimed to evaluate the efficacy of a newly developed, community-based intervention— Optimizing Participation after Stroke through Strategy Training (OPASS)—on participation outcomes among stroke survivors with cognitive impairments. Methods: An assessor-blinded, parallel-group randomized controlled trial was conducted in the rehabilitation departments of six hospitals in northern Taiwan. Adults with post-stroke cognitive impairments were randomized to either the OPASS group (n = 96) or a control intervention (CI) group (n = 99), which received reflective listening. Both groups received 12–15 sessions over 8 weeks. The primary outcome was change in participation across productivity, social, and community domains, measured by the Participation Measure–3 Domains, 4 Dimensions (PM-3D4D). Secondary outcomes included activity performance, self-efficacy, and global cognition, assessed using the Activity Measure for Post-Acute Care , General Self-Efficacy Scale , and Montreal Cognitive Assessment , respectively. Assessments were conducted at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). Between-group differences were analyzed using analysis of covariance (ANCOVA). Results: A total of 195 participants were included in the intention-to-treat analysis (64 women; median age 62 years IQR: 52–68). Adjusted analyses showed that the OPASS group demonstrated significantly greater improvements from T1 to T2 in productivity difficulty (adjusted mean difference 95% CI: 7.89 2.61–13.13, p = 0.004) and social participation frequency (0.29 0.08–0.51, p = 0.009) compared to the CI group. However, these effects were not sustained at T3, and no significant between-group differences were observed in secondary outcomes. Conclusions: The OPASS program, a participation-focused strategy training intervention, effectively enhanced productivity and social participation in stroke survivors with cognitive impairments. Further research is needed to evaluate the long-term effects, especially among older stroke survivors and those with greater functional limitations.