Stroke Clinical Trial
Official title:
Exploring the Feasibility of Problem Solving Training Paired With Transcranial Magnetic Stimulation to Improve Problem-solving Skills After Stroke
Verified date | February 2022 |
Source | University of Texas Southwestern Medical Center |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The objectives of this pilot project are to determine whether pairing rTMS with an evidence-based PST intervention is acceptable to and feasible for individuals with executive function deficits after stroke and whether rTMS enhances executive functioning and uptake of the PST intervention to improve generalization of the PST strategy and support long-term goal attainment. To achieve the objectives, the investigators propose two specific aims: AIM 1: Establish the acceptability and feasibility of delivering up to 6 sessions of PST+ rTMS to individuals with executive function deficits ≥ 6 months post stroke. Hypothesis 1a:80% participants will complete 6 PST sessions. Hypothesis 1b: 1b: Participants who receive rTMS directly prior to the PST intervention will report higher satisfaction with the overall intervention compared to those who receive rTMS simultaneously with PST. AIM 2: Assess the initial efficacy of PST+rTMS for improving patient outcomes in individuals with stroke. Hypothesis 2a Patients will demonstrate a significant increase in executive functioning (ie. attention, immediate memory and cognitive flexibility and reasoning) as measured by the Digit Span Test and Wisconsin Card Sorting Test. Hypothesis 2b: Patients will achieve 80% of self-set goals. Hypothesis 2c: Patients will demonstrate a significant increase in task-oriented coping skills as measured by the Brief Cope at 1-month post intervention.
Status | Withdrawn |
Enrollment | 0 |
Est. completion date | September 2023 |
Est. primary completion date | September 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - = 6 months since stroke - English fluency - >= 18 years old - executive function deficits present (BTACT z-score based on age must fall between -1.3 and 1.3 SD) - capacity of patient to self-consent. Exclusion Criteria: - severe aphasia (clinical judgement of inability to complete BTACT secondary to expressive/receptive aphasia) - severe depression (Patient Health Questionnaire-8 < 15) - self-reported dementia diagnosis, (4) contraindications of rTMS such as pacemaker implantation, history of epilepsy, major head trauma or seizures - use of pharmacologic agents targeting stroke-related cognitive deficits. All subjects must be screened for contraindications to TMS before any TMS can be performed. Subjects will be screened for known risk factors for seizure with rTMS using the TMS Adult Safety Screen (TASS) questionnaire. |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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University of Texas Southwestern Medical Center |
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Total number of sessions completed | The primary outcome to assess feasibility is total number of sessions completed, with a threshold of 90% completing a minimum of 6 sessions at the specified rTMS intensity as an indicator of feasibility. | Baseline to 1 month followup | |
Primary | Client Satisfaction Questionnaire-8 (CSQ-8) item mean score | The primary outcome for acceptability is satisfaction, with a Client Satisfaction Questionnaire-8 item mean of >3.5 as an indicator of high satisfaction. CSQ-8 is a standardized assessment of client satisfaction with an intervention. Scores range from 8-32. A higher scores indicates a better outcome. | Baseline to 1 month followup | |
Primary | Changes in coping style as measured by the Coping Orientation to Problems Experienced-Brief (Brief Cope) | To test the first hypothesis, the investigators will use intent-to-treat analyses to measure pre-post-test differences in coping between baseline and final intervention session using paired t-tests or Wilcoxon signed rank test. The Brief Cope is a 28 item self-reported questionnaire that measures effective and ineffective ways to cope with life events that cause stress. The assessment measures the degree to which a person utilizes a specific coping strategy. |
Baseline to 1 month followup | |
Primary | Percentage of attained goals using Goal Attainment Scaling (GAS) | To test the second hypothesis, the investigators will calculate the total percentage of attained goals (Goal Attainment Scaling outcome level >"as expected") out of all attempted goals for each participant. GAS is a method for developing patient-centered goals and measuring goal achievement. GAS has been found to be a valid, reliable and sensitive measure of goal attainment in an IRU population. GAS scale (-2, achieved less than expected outcome; -1, achieved somewhat less; 0, achieved expected level; +1, achieved somewhat more; +2, achieved much more) |
Baseline to 1 month followup | |
Primary | PST session completed or not | The investigators will descriptively compare results of PST+rTMS(simultaneous) to PST +rTMS(sequential). yes or no |
baseline to up to 8 weeks | |
Primary | Reasons for non-completion | The investigators will descriptively compare results of PST+rTMS(simultaneous) to PST +rTMS(sequential). descriptive, no scores |
baseline up to 8 weeks | |
Primary | Need to reduce rTMS intensity | The investigators will descriptively compare results of PST+rTMS(simultaneous) to PST +rTMS(sequential). yes or no |
baseline up to 8 weeks | |
Primary | report of side effects | The investigators will descriptively compare results of PST+rTMS(simultaneous) to PST +rTMS(sequential). yes or no |
baseline up to 8 weeks | |
Secondary | Changes in general self efficacy as measured by the General self-efficacy scale (GSE) | The GSE is a 10 item self-report measure of self-efficacy. Internal reliability for GSE = Cronbach's alphas between .76 and .90. The scale is designed to measure self-efficacy specifically as it relates to coping with stressful daily events. Scores range from 10 to 40. Higher score indicates more self efficacy. | baseline to 1 month follow-up | |
Secondary | Measure of intervention uptake as measured by the uptake questionnaire | A Likert scale assessment that the study team developed and has used in previous PST studies. (1) How confident do you feel using the PST strategy? (2) How confident do you feel that you will be able to apply the PST strategy to other problems now that the sessions are over? (3) How many sessions do you think it took before you felt confident using the PST strategy? | baseline up to 8 weeks | |
Secondary | Changes in attention and working memory as measured by the Digi-Span Test | The Digit Span Test is a subtest of the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale. Forward span captures attention efficiency and capacity. Backward span is an executive task dependent of working memory. | baseline up to 8 weeks | |
Secondary | Changes in executive function as measured by the Wisconsin Card Sorting Test (WCST) | The WCST measures ability to shift cognitive strategies in response to a changing environment as well of executive function (planning, organized searching, utilizing environmental feedback, directing behavior towards achieving a goal, and modulating impulsive response. This assessment has been validated in the stroke population. | baseline up to 8 weeks |
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