Introduction
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Cognitive impairment relates to challenges with memory, attention, language and perception and up to 38% of people demonstrate cognitive impairment one-year post-stroke. It is associated with poorer quality of life, reduced chance of survival, increased risk of institutionalisation, higher caregiver burden and increased costs. International consensus has highlighted it as an area of unmet need post-stroke. However, the focus of rehabilitation programmes post-stroke is often placed on physical difficulties, neglecting hidden cognitive impairment. Meta-analytic evidence demonstrates that existing cognitive rehabilitation interventions have not shown substantial or long-term improvements. Interventions that are individually-tailored to each person are recommended. However, there is no reliable information on the best way of developing interventions capable of adapting to individual response. This identifies a clear direction for future research.
Aim
To develop an adaptive cognitive rehabilitation intervention to tackle the urgent issue of cognitive impairment post-stroke. The feasibility of the adaptive intervention developed in the research will be subsequently evaluated against treatment-as-usual.
Methods
Experience-based co-design methods will be used to involve people with cognitive impairment post-stroke, family carers, healthcare professionals and patient advocates to develop a user-and evidence-informed adaptive cognitive rehabilitation intervention. A Sequential Multiple Assignment Randomised Trial will be used to examine the optimum adaptive cognitive rehabilitation intervention among people with cognitive impairment, living in the community post-stroke. An exploration of stakeholders’ perspectives on the acceptability of the intervention will be completed in a process evaluation.
Discussion
Poorly managed cognitive impairment post-stroke is a major public health problem. This internationally-renowned cross-disciplinary team will make a substantial contribution to stroke recovery research by pioneering the combination of co-design and a novel experimental design to empirically develop an adaptive cognitive rehabilitation intervention for future feasibility testing.