A randomised controlled trial of combined Cognitive Rehabilitation and Psychological Intervention following stroke.

INTERVENTION: The manualised Making the Most of your Memory: An everyday Memory Skills Program (Radford, et al., 2012) adapted for Telehealth delivery (Lawson, et al., 2020), will be modified to include psychological intervention for managing distress, mood and anxiety commonly exacerbated following stroke. Weekly sessions will be 2.5 hours for 6 weeks in length and follow a consistent structure each week: (i) Psychoeducation on cognitive functioning, (ii) Introduction and practice of internal and external cognitive compensatory strategies, (iii) Education on Lifestyle factors (diet, sleep and exercise on cognitive function and wellbeing), and (iv) Psychoeducation and Practice of Psychological Strategies for mood and anxiety (eg. psychoeducation on emotional changes following stroke, including stress, depression and anxiety, cognitive and behavioural interventions including cognitive challenging of unhelpful thinking, behavioural interventions for low mood, stress management strategies including relaxation and mindfulness, and Value‐based action). The mode of delivery will be telehealth sessions of 8 participants. They will be conducted by Clinical Psychologists and/or Clinical Neuropsychologists via PEXIP, a NSW Health approved platform with the capability to provide secure group‐based intervention with presentation capabilities to display content and for interactive participant engagement. We will monitor attendance, engagement in skills practice during Group, and completion of homework tasks. Reference: Radford, K., Lah, S., Thayer, Z., Say, M. J., & Miller, L. A. (2012). Improving memory in outpatients with neurological disorders using a group‐based training program. Journal of the International Neuropsychological Society: JINS, 18(4), 738. Lawson, D. W., Stolwy CONDITION: Stroke ‐ Haemorrhagic Stroke ‐ Ischaemic stroke; ; stroke PRIMARY OUTCOME: Rey Auditory Verbal Learning Test (RAVLT) long delay recall [This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] ; [This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] visual impulse control assessed by Trail Making Test. ; ; ; [This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] visual working memory assessed by WMS Symbol Span subtest[This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] INCLUSION CRITERIA: Participants (i) must be at least 18 years of age, (ii) have a confirmed diagnosis of stroke within the previous 6 months and no longer in hospital, (iii) self‐reported cognitive difficulties and/or adjustment concerns, which are confirmed by neuropsychological and clinical assessment on pre‐testing, (iv) English as preferred language of use, (v) estimated premorbid full scale IQ greater than or equal to 80, (vi) access to a technology suitable for Telehealth, and (vii) ability to attend weekly sessions over a 6 week period, and an assessment session before and immediately after the intervention, as well as at 3 month follow up. SECONDARY OUTCOME: abstract reasoning WAIS‐IV Matrix Reasoning subtest[This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] auditory working memory assessed by WAIS‐IV Digit Span Subtest [This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] Comprehensive Assessment of Prospective Memory[This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] Everyday Memory Questionnaire (EMQ)[This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] Oxford Cognitive Screen[This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] Rivermead Behavioural Memory test ‐ version II)[This will be assessed post‐enrolment (1‐2 weeks prior to intervention), after 7 to 8 weeks (1‐2 weeks post intervention completion) and again after a further 3 months. ] verbal impulse control assessed by Hayling’s sentence completion test,