JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

The DRESS trial: a feasibility randomized controlled trial of a neuropsychological approach to dressing therapy for stroke inpatients

Marion F Walker, Alan Sunderland, Joanna Fletcher-Smith, Avril Drummond, Pip Logan, Judi A Edmans, Katherine Garvey, Robert A Dineen, Paul Ince, Jane Horne, Rebecca J Fisher, Jenny L Taylor
Clinical Rehabilitation 2012, 26 (8): 675-85
22180445

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.

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