# Efficacy of Metacognitive-Strategy Training to Improve Activity Performance and Reduce Motor Impairment in Sub-Acute Stroke.

> **NIH NIH R01** · UNIVERSITY OF MISSOURI-COLUMBIA · 2021 · $673,768

## Abstract

7. Project Summary/Abstract
 The long-term goal of this research is to improve activity performance and reduce motor impairment in
individuals with stroke. There are two primary gaps in current stroke rehabilitation practice that must be
addressed to achieve this goal: (1) current impairment-based approaches (e.g. motor) are not improving
meaningful activity performance; and (2) current stroke rehabilitation interventions are often not designed to be
clinically feasible and are rarely implemented into practice. The overall hypothesis of this proposal is that a
clinically-feasible, activity-based intervention, metacognitive strategy training (MCST), will produce a significant
improvement on objective and subjective measures of activity performance and motor function in comparison
to a usual care occupational therapy (OT) group. These gains will transfer and generalize to untrained tasks in
novel environments. The specific aims of this project are: (1) to evaluate the efficacy of MCST to improve
subjective and objective activity performance in individuals with subacute stroke; and (2) to evaluate the
efficacy of MCST to improve motor function in individuals with subacute stroke. Participants with subacute
stroke living in the community with self-identified activity performance goals and hemiparesis will be recruited
through a local stroke registry (n = 108). Those individuals who meet inclusion and exclusion criteria will be
randomized to either a MCST group or to a usual care occupational therapy group. Both groups will receive
ten, 45 minute sessions of treatment. Treatment outcomes will be assessed baseline, post-intervention, and at
three-months post-intervention. Treatment efficacy outcomes will be analyzed with an intent-to-treat model with
an analysis of covariance (ANCOVA). Potential covariates will include age, stroke severity, degree of cognitive
impairment, and degree of motor impairment. Independent samples t-test and chi-square test will be used to
ensure successful randomization and balance between groups. Group differences at baseline that are
statistically significant will also be considered as covariates in the analysis. Post-hoc tests will be employed as
appropriate. Significance levels, effect sizes, and confidence intervals will be reported. Completion of this
study is likely to result in an efficacious, clinically feasible intervention to improve activity performance and
reduce motor deficits in individuals with stroke that can be feasibly implemented into current systems of care.
The proposed study and anticipated outcomes are consistent with the research priority of the National Center
for Medical Rehabilitation Research (NCMRR), which is to focus on identifying, preventing, and treating key
secondary conditions that are associated with physical impairments and disabilities, including stroke.

## Key facts

- **NIH application ID:** 10215580
- **Project number:** 5R01HD097283-03
- **Recipient organization:** UNIVERSITY OF MISSOURI-COLUMBIA
- **Principal Investigator:** Timothy J. Wolf
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $673,768
- **Award type:** 5
- **Project period:** 2019-09-13 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10215580

## Citation

> US National Institutes of Health, RePORTER application 10215580, Efficacy of Metacognitive-Strategy Training to Improve Activity Performance and Reduce Motor Impairment in Sub-Acute Stroke. (5R01HD097283-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10215580. Licensed CC0.

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