Sustaining gains following post-stroke memory rehabilitation using eHealth maintenance interventions: The Memory-SuSTAIN pilot randomized controlled trial.

Abstract

We aimed to evaluate the acceptability, feasibility, preliminary effectiveness and costs of two eHealth maintenance interventions to sustain the longer-term effects of post-stroke memory rehabilitation compared to usual care. An observer-blinded pilot randomized controlled trial was conducted with community-dwelling stroke survivors experiencing everyday memory problems. Following a 6-week memory skills group, participants were randomly allocated to Telehealth Booster sessions, Electronic Reminders prompting strategy use, or Usual Care control (no active maintenance). Outcomes were acceptability ratings, recruitment and attrition rates, nine efficacy measures (e.g., Goal Attainment Scaling), intervention delivery costs and total costs (including service utilization). Efficacy outcomes were assessed post-memory-group (T1), post-waiting-period-1 (T2), post-maintenance-intervention (T3), and post-waiting-period-2 (T4). 38 participants were randomized (median_age 53 years, median_{time-since-stroke} 13 months). Acceptability was high across conditions, and feasibility thresholds were mostly met. Post-memory-group gains were maintained over time across all conditions. Participants receiving usual care also unexpectedly sustained gains, possibly due to regular monitoring across four trial assessments. Within-group effect sizes were largest for Telehealth Booster sessions for most outcomes. Intervention delivery costs were greatest for Telehealth Boosters, but total costs greatest for Electronic Reminders due to more service utilization. Therefore, booster sessions may have the greatest maintenance effect without increasing total costs.