Abstract Number: Esoc2026a473 Strategy Training Improves Participation and Function in Stroke Survivors With Cognitive Impairment: A 1-Year Randomized Trial Follow-Up

Abstract Background and aims The OPASS (Optimizing Participation after Stroke through Strategy training) intervention employs therapist-guided metacognitive strategies to enhance problem-solving in daily life. This study aims to examine the long-term effects of OPASS on participation, activity, self-efficacy, and cognitive functioning in community-dwelling stroke survivors with cognitive impairment. Methods This follow-up, parallel-group, randomized study was conducted across six hospitals in northern Taiwan. Participants received either OPASS or a dose-matched control intervention delivered in 12–15 biweekly sessions. The primary outcome measure was the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). Secondary outcomes included the Activity Measure for Post-Acute Care (AM-PAC), General Self-Efficacy Scale, Montreal Cognitive Assessment, Trail Making Tests, and the Stroop Color-Naming (SCN) or Color-Word Test. Assessments were conducted through 12 months and analyzed using linear mixed-effects models. Results Among 195 analyzed participants (64 women, 32.8%; mean age 60.3 ± 12.2), 96 received OPASS. From baseline to 12 months, estimated mean between-group differences (95% CI) favored the OPASS group in PM-3D4D frequency (P ≤ 0.003): productivity 0.2 (0.1–0.3), social 0.5 (0.2–0.7), and community 0.2 (0.1–0.4). Significant benefits for the OPASS group were also observed in PM-3D4D difficulty (P ≤ 0.007): productivity 9.6 (4.2–15.1), social 6.2 (1.7–10.7), and community 8.5 (4.5–12.4). The OPASS group further showed superior gains on the AM-PAC cognitive subdomain (3.6 1.6–5.5; P 0.001) and SCN (5.3 1.4–9.1; P = 0.007). Non-significant differences occurred among the remaining outcomes. Conclusions OPASS produced significant 12-month improvements in participation frequency, participation difficulty, and selected cognitive outcomes compared with the dose-matched control intervention. Conflict of interest Shih-Pin Hsu: nothing to disclose; Tz-Ting Huang: nothing to disclose; Valeria Chiu: nothing to disclose; Jiunn-Horng Kang: nothing to disclose; Tsan-Hon Liou: nothing to disclose; Yen-Nung Lin: nothing to disclose; Yi-Hsuan Wu: nothing to disclose; Te-Hsun Hung: nothing to disclose; Feng-Hang Chang: nothing to disclose.