The effect of cognitive rehabilitation with a multicontextual treatment approach in stroke: a randomized controlled trial

Background: The multicontextual approach is a specific intervention that shapes cognitive functioning through interactions among individuals, activities, and the environment, utilizing metacognitive training and learning transfer. Aim: This study aimed to analyze the effects of a cognitive rehabilitation program based on a multicontextual approach, implemented alongside remedial approaches, on cognitive function, functional independence, and social participation. Methods: Twenty individuals with chronic stroke were randomly assigned to two groups. The intervention group (n = 10) received cognitive rehabilitation and standard physiotherapy. Cognitive rehabilitation program was grounded in a multicontextual approach, implemented alongside remedial approaches. The control group (n = 10) received standard physiotherapy. Both groups participated in intervention sessions three times per week over an eight-week period. This study was registered at ClinicalTrials.gov (NCT06186661; December 9, 2022). Results: One-way analysis of covariance and mixed-design analysis of variance were used for statistical analysis. The multicontextual approach, implemented alongside remedial approaches, improved the cognitive skills, occupational performance and satisfaction of individuals with chronic stroke (p < 0.05). In addition, the training provided to the intervention group demonstrated moderate to large clinical effects (ɳ² p = 0.163; ɳ² p = 0.088), although no statistically significant difference was observed between the two groups in terms of functional independence and participation outcomes (p > 0.05). Conclusion: This study provides preliminary evidence that cognitive rehabilitation, employing a multicontextual approach in combination with remedial strategies, may enhance cognitive functioning and occupational performance, and may positively affect functional independence and social participation among individuals with chronic stroke. ClinicalTrials.gov Identifier NCT06186661; December 9, 2022.