Guided Training Relative to Direct Skill Training for Individuals With Cognitive Impairments After Stroke: A Pilot Randomized Trial.

This was a pilot randomized trial, so it cannot establish that guided training works better than direct skill training. The primary comparison showed no overall intervention difference. Later higher guided scores were part of the change over time pattern. Both groups received usual inpatient rehabilitation and client-centered goal setting, so the study cannot separate guided training from those components. Usual care sessions sampled were mostly direct skill training, with 98% direct training and 2% guided training, which may have reduced the difference between guided and direct training. There was no prospectively randomized no-intervention or attention control group; the historical comparison was not randomized. People with severe aphasia, prior mild cognitive impairment or dementia, current major depression, recent substance abuse, or psychosis were excluded, so results may not apply to them. Dropouts were older, earlier after stroke, had shorter inpatient stays, and were more independent at baseline, though differences were not statistically significant. Small sample and limited post-discharge data constrain conclusions about later therapy exposure and confounding factors.

The supplied text does not include a conflicts of interest or funding declaration. The article is marked as NIH extramural research support.

Do not read the 10.57 point difference at 12 months as proof guided training works. This was a pilot, the overall primary outcome showed no intervention difference, and both groups received usual care plus client-centered goals, so guided training alone cannot be isolated.