Restricted accessResearch articleFirst published online 2025
Comparing cognitive orientation to daily occupational performance and motivational interviewing in stroke rehabilitation: A protocol for a randomized controlled trial
Long-term disability following stroke significantly affects functional abilities and daily living activities. This protocol outlines a planned three-arm randomized controlled trial to compare effects of Motivational Interviewing (MI) and Cognitive Orientation to daily Occupational Performance (CO-OP) on occupational performance among individuals with chronic stroke.
Method:
Sixty individuals with chronic stroke will be randomly assigned to one of three groups: CO-OP, MI, or control. The primary outcome of interest is occupational performance, evaluated using the Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Secondary outcomes include functional independence, measured by Functional Independence Measurement (FIM), and self-efficacy, assessed with General Self-Efficacy Scale (GSES). Assessments will be conducted at baseline, postintervention (5 weeks), and 1-month follow-up. Data will be analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA). The Shapiro–Wilk test will assess data normality. For quantitative variables, ANOVA or Kruskal–Wallis tests will be used depending on distribution. Qualitative variables will be analyzed using Chi-square or Fisher’s exact test.
Discussion:
This protocol describes the methodology for comparing the effectiveness of CO-OP and MI in improving occupational performance in individuals with stroke. The findings from the planned study will inform future large-scale trials and may guide clinical decision-making in rehabilitation settings.
BaumC (2012) Occupational performance measures for health and wellbeing: Research and practice. British Journal of Occupational Therapy75(9): 402.
2.
BinderOHannumOMcCarthyO, et al. (2019) A Systematic Review of the Efficacy of Motivational Interviewing on Occupational Performance. Available at http://www.jdc.jefferson.edu/student_papers/32
3.
CamillieriS (2019) Cognitive-behavioral interventions for improving activity outcomes after stroke: A narrative review of the literature. Journal of Stroke Medicine2(1): 7–16.
4.
ChenHMLeeHLYangFC, et al. (2020) Effectiveness of motivational interviewing in regard to activities of daily living and motivation for rehabilitation among stroke patients. International Journal of Environmental Research and Public Health17(8): 2755
5.
ChengYLinYShiH, et al. (2024) Projections of the stroke burden at the global, regional, and national levels up to 2050 based on the global burden of disease study 2021. Journal of the American Heart Association13(23): e036142.
6.
ChowS-CShaoJWangH, et al. (2018) Sample Size Calculations in Clinical Research (2nd ed). Boca Raton, FL: CRC Press.
7.
CramerSCRichardsLGBernhardtJ, et al. (2023) Cognitive deficits after stroke. Stroke54(1): 5–9.
8.
DaiLChengC-wTianR, et al. (2019). Standard protocol items for clinical trials with traditional Chinese medicine 2018: Recommendations, explanation and elaboration (SPIRIT-TCM Extension 2018). Chinese Journal of Integrative Medicine25: 71–79.
9.
DehghanLDalvandHPourshahbazA (2015) Translation of Canadian occupational performance measure and testing Persian version validity and reliability among Iranian mothers of children with cerebral palsy. Journal of Modern Rehabilitation9(4): 25–31.
10.
Di PellegrinoGFadigaLFogassiL, et al. (1992) Understanding motor events: A neurophysiological study. Experimental Brain Research91: 176–180.
11.
EmsakiGMolaviHChitsazA, et al. (2011) Psychometric properties of the Montreal Cognitive Assessment (MoCA) in Parkinson’s disease patients in Isfahan. Journal of Isfahan Medical School29(158): 1606–1615.
12.
FarniaVAsadiRAbdoliN, et al. (2020) Psychometric properties of the Persian version of General Self-Efficacy Scale (GSES) among substance abusers the year 2019–2020 in Kermanshah city. Clinical Epidemiology and Global Health8(3): 949–953.
13.
GilesGMRadomskiMVWolfTJ (2019) Cognition, cognitive rehabilitation, and occupational performance. American Journal of Occupational Therapy73: 7312410010.
14.
GittinsMLugo-PalaciosDVailA, et al. (2021). Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments. Clinical Rehabilitation, 35(3), 446–458.
15.
HaghdoostABaneshiMMarzbanM (2011) How to estimate the sample size in special conditions? (Part two). Iranian Journal of Epidemiology7(2): 67–74.
16.
Heeb DesaiRKiserowRMullingsA, et al. (2023) Exploring the perspectives of adults aging with long-term physical disabilities on physical activity: A qualitative study. American Journal of Health Promotion37(5): 654–663.
17.
KhaledianMQaribiHGholizadehZ, et al. (2013) The impact of group Cognitive Behavioral Therapy (CBT) on depression decrease and hopefulness increase of empty nest syndrome. Family Counseling and Psychotherapy3(2): 261–281.
18.
KiriakouAPsychouliP (2024) Effects of the CO-OP approach in addressing the occupational performance of adults with stroke: A systematic review. The American Journal of Occupational Therapy78(2): 1–7.
19.
KwakkelGStinearCEssersB, et al. (2023) Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework. European Stroke Journal8(4): 880–894.
20.
MartiniRRiosJPolatajkoH, et al. (2015) The performance quality rating scale (PQRS): Reliability, convergent validity, and internal responsiveness for two scoring systems. Disabilty and Rehabilitation37(3): 231–238.
21.
McCollMAPatersonMDaviesD, et al. (2000) Validity and community utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy67(1): 22–30.
22.
MillerWR (2023) The evolution of motivational interviewing. Behavioural and Cognitive Psychotherapy51(6): 616–632.
23.
MillerWRRoseGS (2009) Toward a theory of motivational interviewing. American Psychologist64(6): 527.
24.
NaghdiSAnsariNNRajiP, et al. (2016) Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke. Disability and Rehabilitation38(3): 289–298.
25.
PolatajkoHJMandichADMillerLT, et al. (2001). Cognitive orientation to daily occupational performance (CO-OP) part II the evidence. Physical & Occupational Therapy in Pediatrics20(2–3): 83–106.
26.
PolatajkoHJMandichADMissiunaC, et al. (2001) Cognitive orientation to daily occupational performance (CO-OP) part III-the protocol in brief. Physical & Occupational Therapy in Pediatrics20(2–3): 107–123.
27.
PrustMLFormanROvbiageleB (2024) Addressing disparities in the global epidemiology of stroke. Nature Reviews Neurology20(4): 207–221.
28.
RajanS (2022) The Impact of Motivation on Occupational Performance of Stroke Patients. Bachelor Thesis, Lithuanian University of Health Sciences, Lithuania.
29.
RudbergASBergeELaskaAC, et al. (2021) Stroke survivors’ priorities for research related to life after stroke. Topics in Stroke Rehabilitation28(2): 153–158.
30.
Saeidi BorujeniMHosseiniSAAkbarfahimiN, et al. (2020) Cognitive orientation to daily occupational performance approach for Iranian elderly without cognitive impairments: A Single Subject Study. Archives of Rehabilitation21(4): 526–543.
31.
SchmidtSNHassJKirschP, et al. (2021) The human mirror neuron system—A common neural basis for social cognition?Psychophysiology58(5): e13781.
32.
SchulzKFAltmanDGMoherD and Consort Group (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Journal of Clinical Epidemiology63(8): 834–840.
33.
SelfKJBorsariBLaddBO, et al. (2023) Cultural adaptations of motivational interviewing: A systematic review. Psychological Services20(S1): 1–33.
34.
SoritaETarruellaABossardC, et al. (2011) Contribution of occupational therapy intervention with stroke patients. Annals of Physical and Rehabilitation Medicine54(1): e66.
35.
StinearCMLangCEZeilerS, et al. (2020) Advances and challenges in stroke rehabilitation. The Lancet Neurology19(4): 348–360.
36.
TynterovaAShusharinaNBarantsevichE, et al. (2024) Impact of early post-stroke affective and motivational disorders on functional outcome of ischemic stroke patients. The European Physical Journal Special Topics233: 717–722.
