This study addresses the growing burden of stroke in Singapore and highlights the lack of rehabilitation services for return to work after stroke. Despite functional physical recovery, many stroke survivors experience persistent impairments that hinder return-to-work. To bridge this gap, the study will implement a community-based brain health programme targeting cognitive and vocational outcomes in stroke survivors. Caregivers will also be included due to their critical support role. The study will assess the intervention's feasibility, acceptability, and its impact on cognitive function, return-to-work, neuroplasticity, psychosocial health, fatigue, and self-care.
Stroke is the fourth leading cause of death and the leading cause of adult disability in Singapore. Statistics indicate a concerning rise in young stroke cases. The burden of stroke care is expected to increase exponentially, posing significant challenges to the healthcare system and society. Cognitive impairment after stroke has been documented in up to one-third of stroke survivors. These impairments may be subtle but persistent and progressive even after the stroke survivor appears to have made functional recovery in other areas. Existing services in Singapore for stroke survivors typically target physical and daily functioning outcomes with little focus on cognitive functioning. Moreover, there is a lack of services for stroke survivors who face difficulties in returning to work due to cognitive impairment even when they have achieved optimal physical recovery. An important assessment of a rehabilitation intervention programme is in examining whether it drives positive neuroplasticity, which leads to improved cognitive and functional outcomes. There is presently a dearth of literature in brain mechanisms underlying the impact of cognitive rehabilitation. A community-based brain health intervention, the Train-Your-Brain Stroke Recovery Programme, will be delivered by registered clinical neuropsychologists. Designed to enhance cognitive function and return-to-work outcomes in stroke survivors with mild cognitive impairment, the intervention will be evaluated using a mixed-methods randomized controlled trial. Stroke survivors will be randomized 1:1 into either the intervention or control arm. Caregivers, given their critical support role, will also be recruited to participate in the study. Outcome measures include feasibility of intervention, acceptability of intervention, cognitive function, return-to-work outcomes, changes in biomarkers, neuroimaging findings, psychosocial health, fatigue, and self-care. Outcome measures will be conducted pre-intervention, post-intervention, and 6-month follow-up.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
TRIPLE
Enrollment
100
The intervention involves a structured brain health programme delivered by clinical neuropsychologists in three phases: an initial needs assessment, a multi-session intervention, and follow-up support. Participants will receive assessments, attend group sessions covering topics such as lifestyle, mood, cognition, and return-to-work strategies, and be supported with workbooks and referrals to community services. The programme combines in-person and online formats.
National University of Singapore
Singapore, Singapore
RECRUITINGNumber of eligible/ineligible participants
Percentage of eligible/ineligible participants and reasons for ineligibility
Time frame: Through study completion, an average of 6 months
Recruitment and attrition rates
Percentage of recruited participants and drop-outs
Time frame: Through study completion, an average of 6 months
VasCog Screen Test
Test is comprised of a short-Montreal Cognitive Assessment (total score out of 12) and modified Symbol Digit Modalities Test (score calculated based on correct responses)
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Vascular Dementia Battery
Participants will meet criteria for Mild Cognitive Impairment if there is 1 or more domain(s) with failure in at least 50% of tasks in domain
Time frame: Baseline (pre-intervention)
National Institute of Neurological Disorders and Stroke - Canadian Stroke Network (NINDS-CSN) Stroke Protocol
A test battery comprised of cognitive tests that are measured against their respective normative scores
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Return-to-work Questionnaire (National Institute of Neurological Disorders and Stroke - Common Data Elements)
Survey questions of participants' work status before and after stroke with check-box responses
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Intervention fidelity
Intervention Fidelity Checklist (eNACT Group Facilitation Competency Checklist) * "Observed - Done well" and "Observed - Done adequately" is equivalent to a score of 2; "Observed - Not done well" is equivalent to a score of 1; "Not observed - despite opportunity" is equivalent to a score of 0 * An overall score of 2 reflects adequate competence in group facilitation
Time frame: During the intervention and immediately after the intervention
Qualitative interviews
Semi-structured interviews will be conducted with stroke survivors and family members to obtain feedback about their experiences of the intervention
Time frame: Immediately after the intervention
Participants' acceptability of the intervention
Feedback forms provided after each intervention session rated on a 5-point response scale from Strongly Disagree to Strongly Agree
Time frame: During the intervention
Patient-Reported Outcomes Measurement Information System (PROMIS) - 10
5-point response scale from Excellent (5) to Poor (1)
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
EuroQol 5-Dimension 5-Level (EQ-5D-5L)
Survey questions of participants' Mobility, Self-care, Usual activities, Pain/discomfort, and Anxiety/depression with check-box responses across five levels of severity, ranging from no problems to extreme problems.
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Fatigue Assessment Scale
5-point response scale from Always (5) to Never (1)
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Depression, Anxiety, Stress Scale
3-point response scale from Did not apply to me at all (0) to Applied to me very much, or most of the time (3)
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Zarit Burden Interview
4-point response scale from Nearly Always (4) to Never (0)
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Voils Domains Of Subjective Extent of Nonadherence
Survey questions on participants' extent and reasons for nonadherence with check-box responses (None of the time, A little of the time, Some of the time, Most of the time, Every time)
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Blood Pressure Measurement
Measurement of participants' blood pressure reading
Time frame: Baseline (pre-intervention), immediately after the intervention, 6-months follow-up
Blood-Derived Neurotrophic Factor
Blood biomarker derived from participants' blood samples
Time frame: Immediately after the intervention, 6-months follow-up
Functional near-infrared spectroscopy measurement
Measurement of oxyhaemoglobin (HbO2), deoxyheemoglobin (HbR), and regional oxygen saturation (rSO2) while participants undergo various cognitive tests (e.g. N-back Task, verbal fluency test, Stroop Task)
Time frame: Immediately after the intervention, 6-months follow-up
Cost Effectiveness Analysis Questionnaire
Time frame: Immediately after the intervention, 6-months follow-up
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