Efficacy of strategy training in left hemisphere stroke patients with apraxia: a randomized clinical trial.

The objective of the present study was to determine in a controlled study the efficacy of strategy training in left hemisphere stroke patients with apraxia. 113 Left hemisphere assigned to two treatment groups: i) strategy training integrated into usual occupational therapy and ii) usual occupational therapy only. Assessments took place at baseline, after an 8 week treatment period and 5 months after baseline (follow up). Patients were assessed on apraxia, motor functioning, and activities of daily living (ADL). The primary outcome measure was a standardized ADL-observation by a blinded research assistant. Additional ADL measures were used as secondary outcome measures (Barthel ADL Index, ADL-rating by occupational therapist and by patient). After 8 weeks of treatment, patients who received strategy training (n=43) improved significantly more than patients in the usual treament group (n=39) on the ADL-observations (mean change 0.24; 90% Cl [0.15-0.34] vs 0.12 [0.03-0.21]). This shows a small to medium effect (effect size 0.37) of strategy training on ADL-functioning. With respect to the secondary outcome measures, a medium effect (effect size 0.47) was found on the Barthel ADL Index. No beneficial effects of strategy training were found after 5 months (at follow up). Thus, evidence was found for the short-term effectiveness of strategy training in left hemisphere stroke patients with apraxia. (aut.ref.)