The DRESS trial: a feasibility randomized controlled trial of a neuropsychological approach to dressing therapy for stroke inpatients

Walker, Marion F.; Sunderland, Alan; Fletcher-Smith, Joanne; Drummond, Avril E.R.; Logan, Pip; Edmans, Judi A.; Garvey, Katherine; Dineen, Robert A.; Ince, Paul; Horne, Jane; Fisher, Rebecca J.; Taylor, Jenny L.

Abstract

Objective: To investigate two approaches to treating patients with persistent dressing problems and cognitive difficulties following stroke.

Design: Pilot randomized controlled trial.

Setting: Inpatient stroke rehabilitation service.

Subjects: Seventy consecutive stroke patients with persistent dressing problems and accompanying cognitive difficulties at two weeks after their stroke.

Interventions: Patients were randomly allocated to six weeks of either a systematic neuropsychological approach, based on analysis of dressing problems and further cognitive testing, or to the control group who received conventional (functional) dressing practice. Both groups received treatment three times a week in accordance with two separately prepared manuals.

Main measures: Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after randomization by an independent assessor masked to group allocation.

Results: Both neuropsychological and functional groups improved performance on the NSDA over the treatment period (31% and 22%, respectively) but there was no significant difference between groups at six weeks. However, the neuropsychological group showed a significantly greater improvement on a line cancellation test of visual neglect (t(62) = 2.1, P < 0.05) and a planned subanalysis for those with right hemisphere damage showed a trend towards better dressing outcome (P = 0.07, one-tailed).

Conclusions: Results demonstrate the potential benefits of a systematic neuropsychological approach to dressing therapy, particularly for patients with right hemisphere damage. This study suggests the need for a phase III study evaluating the efficacy of a systematic neuropsychological approach in treating dressing difficulties, targeting patients with right hemisphere stroke and visuospatial impairments.

• Journal Article Type: Article
• Publication Date: Aug 1, 2012
• Deposit Date: May 21, 2014
• Publicly Available Date: May 21, 2014
• Journal: Clinical Rehabilitation
• Print ISSN: 0269-2155
• Electronic ISSN: 0269-2155
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 8
• DOI: https://doi.org/10.1177/0269215511431089
• Keywords: Stroke, Rehabilitation, Activities of daily living, Cognitive impairment, Occupational therapy
• Public URL: https://nottingham-repository.worktribe.com/output/1006946
• Publisher URL: http://cre.sagepub.com/content/26/8/675