Cognitive oriented strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study.
Timothy J Wolf, Meghan Doherty, Anna Boone and 4 others
PMID 31155969WHAT IT FOUND
Adding cognitive strategy training to task-specific stroke rehab showed no advantage over task-specific training alone.
Both groups improved similarly on primary outcomes, though dropout was high. The added cognitive components did not produce measurable gains in activity performance or maintenance at follow-up.
Key findings
01Cognitive strategy training augmented rehabilitation (COSTAR) was not associated with significant positive effects over task-specific training (TST) on primary or secondary outcomes.
02Attrition was high, with 50% of the COSTAR group and 25% of the TST group dropping out, largely due to loss at follow-up.
03Both groups showed positive change on most outcome measures, but effect sizes were generally small with no clear advantage for either intervention.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study was underpowered and exploratory, meaning results cannot be generalized. Follow-up testing was limited to phone interviews and self-report, failing to adequately measure transfer and generalization of skills, which is the theoretical advantage of cognitive strategies. The TST control group was modified to use client-chosen goals and activity-based tasks rather than traditional impairment-focused graded activities, making it more similar to COSTAR than a standard TST protocol. Fidelity data for the COSTAR intervention could not be empirically confirmed due to lost video records. Baseline depression scores differed between groups (more moderate/severe depression in COSTAR), which may have confounded results. High attrition rates (50% COSTAR, 25% TST) reduce the reliability of the findings.
Declared interests
The authors report no conflicts of interest. The study was funded by the National Center for Medical Rehabilitation Research (NCMRR) in the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH).
The easy way to misread this
Do not conclude that cognitive strategy training is ineffective for stroke rehabilitation. The study failed to measure the primary theoretical benefit of this approach (transfer and generalization) due to limited follow-up methods, and the control group was modified to be more similar to the experimental group than standard task-specific training.