Occupational Performance Coaching for Stroke Survivors: A Novel Patient-centered Intervention to Improve Participation in Personally Valued Activities

Introduction Approximately 300,000 Canadians live with the effects of stroke. Following hospital discharge, stroke survivors attempt to return to participation in valued activities but this can be quite challenging. In fact, the majority of stroke survivors, across all disability levels, report problems occupying their time in meaningful ways.

Current interventions to enhance participation in valued activities have been limited and studies of these have had mixed results. This may be due to lack on consideration of important factors. As well, it is possible that success has been limited because there is not yet an efficient way to provide the kind of long term, individualized support that is required for successful return to valued activities. Effective and efficient interventions must be designed to build competence and provide stroke survivors with the skills and the tools they need to allow them to plan and manage their own return to personally valued activities over several months of recovery.

Occupational Performance Coaching (OPC) is a new approach in occupational therapy whereby individuals are guided to solve problems critical to the achievement of self-identified goals related to participation. OPC draws on concepts from personal coaching, solution-focused therapy, problem solving interventions and emotional support. A positive, strengths-based approach is used to promote patient self-efficacy and self-management. This individualized approach provides a time-limited intervention to address current participation goals, while allowing individuals to develop the skills to address future participation goals. OPC has been tested with families of children who face challenges participating in age appropriate activities but has not been tested with adults who have experienced stroke. Following review of the literature, an adaptation of OPC for stroke survivors (OPC-Stroke) was developed that emphasizes individualized education and metacognitive strategies during both goal setting and problem solving, and broadens how support is considered beyond the family.

The purpose of this research is to explore the effectiveness of OPC-Stroke with adults who have experienced stroke and to examine the feasibility and acceptability of the research methods in preparation for a larger randomized controlled trial (RCT). This objective will be attained through answering the following questions:

1. Do stroke survivors receiving OPC-Stroke following discharge to the community report increased participation compared with those receiving standard care.
2. Do stroke survivors receiving OPC-Stroke following discharge to the community report increased performance and satisfaction with individually identified participation goals, emotional wellbeing, goal self-efficacy, cognition and mobility compared with those receiving standard care?
3. What is the experience of research participants receiving OPC-Stroke?
4. Which components and processes of OPC-Stroke promote achievement of self-identified participation goals?
5. Are the research procedures feasible to implement and are they acceptable to participants and therefore appropriate for testing OPC-Stroke in a larger trial.