Cognitive strategies for improving activity-level outcomes post stroke: an integrative review.

PURPOSE: This integrative review aimed to identify cognitive strategy interventions supporting rehabilitation engagement and activity-level outcomes for individuals with post-stroke cognitive impairments. MATERIALS AND METHODS: Following Joanna Briggs Institute (JBI) methodology and PRISMA-ScR checklist, comprehensive searches were conducted in Embase, CINAHL, Scopus, MEDLINE, and PsycINFO. Two reviewers independently performed study selection and data extraction, using the TIDieR checklist and QuADS for quality assessment. RESULTS: From 35,250 articles screened, 40 studies met the inclusion criteria, half (n = 20) were randomised controlled trials. Interventions were delivered between 6 days and 9.5 years post-stroke. Cognitive strategies included 20 domain-specific, 12 mental practice, and 8 global approaches. Global approaches were most consistent, though applicability across cognitive impairment type remains unclear. Domain-specific strategies target impairment directly and aim for transfer to functional outcomes, while mental practice approaches may only be suitable for mildly impaired cognition. Across studies, 47 different primary outcome measures were reported, with the Functional Independence Measure and Barthel Index used the most, across 10 studies each. CONCLUSIONS: Three cognitive strategy categories were identified. Outcome measures lacked consistency and there was a notable lack of stakeholder involvement. Future research should standardise interventions and outcome measures to enable systematic evidence synthesis and inform clinical guidelines.