Background: Addressing memory problems post-stroke is a priority because of considerable unmet needs. Compensatory memory skills programs can result in short-term benefits, but difficulties establishing new strategies into everyday routines can reduce longer-term effectiveness.
Aims: To evaluate the acceptability, feasibility, costs, and potential effectiveness of two eHealth maintenance interventions to sustain the effects of a memory skills group program compared to usual care.
Methods: An observer-blinded pilot randomised controlled trial was conducted with community-dwelling stroke survivors experiencing everyday memory problems. Following a 6-week memory skills group program, participants were randomly allocated into one of the three maintenance conditions: i) booster sessions delivered via telehealth, ii) electronic (SMS/email) reminders prompting strategy use, or iii) no active maintenance (usual care). Outcome measures included participant acceptability ratings, participant retention, costs (intervention delivery and health services used), Goal Attainment Scaling (GAS) and Everyday Memory Questionnaire-Revised (EMQ-R). GAS and EMQ-R were assessed post-memory group (baseline), post-waiting-period-1 (6 weeks), post-maintenance intervention (12 weeks), and post-waiting-period-2 (18 weeks). Within-group and between-group changes were modelled using generalised linear mixed effects regressions.
Results: 38 participants were randomised (56% female, median age 53 years, median time-since-stroke 13 months). Acceptability ratings were equally high for the three maintenance conditions (7.7-9.2/10); 92% of participants retained post-randomisation. Intervention delivery costs were greatest for booster sessions, but total costs were greatest for electronic reminders due to more health service utilisation. GAS t-scores improved and EMQ-R memory complaints decreased between baseline and 18 weeks for all conditions (p<.01), with no between-group differences. Within-group differences indicated the highest effect size for booster sessions for both GAS (d=2.86) and EMQ-R (d=2.02).
Conclusion: Maintenance interventions appear acceptable and feasible. Booster sessions may have the greatest effect without increasing total costs. Participants receiving usual care also unexpectedly sustained gains, possibly due to regular monitoring. A definitive trial is justified.