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. and Taylor, Jenny L. (2012) The DRESS trial: a feasibility randomized controlled trial of a neuropsychological approach to dressing therapy for stroke inpatients. Clinical Rehabilitation, 26 (8). pp. 675-685. ISSN 0269-2155

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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.

Item Type: Article
Keywords: Stroke, Rehabilitation, Activities of daily living, Cognitive impairment, Occupational therapy
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rehabilitation and Ageing
Identification Number:
Depositing User: Chamberlain, Mr Dick
Date Deposited: 21 May 2014 10:25
Last Modified: 04 May 2020 20:21

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