A Multicenter Randomized Controlled Trial to Compare Subacute 'Treatment as Usual' With and Without Mental Practice Among Persons With Stroke in Dutch Nursing Homes

Objective: Systematic reviews suggest that mental practice as an additional therapy for people with stroke might be effective and suggest that more trials with better defined interventions are needed. This study investigated whether imagining the skilled movement systematically can contribute to a quicker and/or better recovery of stroke patients in long term care. Design: A multicenter randomized controlled trial. Setting: Dutch nursing homes. Participants: Stroke patients in the subacute phase of recovery. Interventions: Study participants were randomly assigned to the control or experimental group. Over a 6-week intervention period, both groups received multi professional therapy as usual. Additionally, patients in the experimental group had instruction on mental practice with a 4-step framework embedded in regular therapy time. Main Outcome: Outcomes were assessed at 6 weeks and 6 months with the patient-perceived effect on performance of daily activities (10-point Numeric Rating Scale). Six secondary outcomes on impairment and activity level were also assessed. Primary analyses were performed according to the intention-totreat principle. Generalized estimating equations (GEE) were used to analyze effects. Results: Thirty-six adult stroke patients (average age 77.8, +/-7.2 years) participated in the trial. No effect in favor of the mental practice intervention on any outcome measure could be detected at either measuring points. Conclusions: This study could not show differences between embedded mental practice and current standard of care. However, stroke pathways in Dutch nursing homes select specific and frail patients, which might have reduced the effects of training.