Effectiveness of the Perceive, Recall, Plan and Perform intervention for persons with brain injury in community-based rehabilitation: protocol for a single-case experimental design with multiple baselines

Marte Ørud Lindstad, Aud Uhlen Obstfelder, Unni Sveen, Linda Stigen, Marte Ørud Lindstad, Aud Uhlen Obstfelder, Unni Sveen, Linda Stigen

Abstract

Introduction: There is a need for standardised interventions in community-based rehabilitation to improve everyday performance for older adults with cognitive challenges due to acquired brain injury (ABI). The Perceive, Recall, Plan and Perform System (PRPP) of intervention has a growing research base. The intervention is suitable for any client with decreased performance in everyday tasks due to ineffective cognitive strategy application to enhance mastery in performance of needed or desired activities. There is no current evidence on the effectiveness of the PRPP intervention for this population.

Purpose: To describe a protocol for a clinical trial that investigates the effectiveness of the PRPP intervention in the context of community-based rehabilitation for persons (65+ years) with difficulties in task performance due to cognitive challenges after ABI.

Methods and analysis: A non-concurrent multiple baseline design across participants with systematic replications (n=6) will be used. Nine sessions of PRPP intervention will be applied by trained occupational therapists in two community-based rehabilitation units. The participants will complete five repeated measurements of everyday tasks as target behaviours. PRPP Assessment stages 1 and 2 serve as outcome measures at baseline, in the intervention period, in the postintervention period and in the follow-up phase. Mastery percentage of the tasks and the participants' application of cognitive strategies at baseline acts as a control and will be compared with the following phases within the participant. Delayed intervention phases act as a control between participants. Goal Attainment Scaling and the Barthel Index will serve as generalisation measures. Data will be analysed using systematic visual inspection of graphical data, descriptions of clinical significance and descriptive statistical analysis.

Ethics and dissemination: This trial, including the data management plan, is approved by The Norwegian Regional Ethics Committee (215391). Results will be published in congresses and scientific journals.

Trial registration number: NCT05148247.

Keywords: PRIMARY CARE; REHABILITATION MEDICINE; Stroke.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The Perceive, Recall, Plan and Perform System of Task Analysis, the 4 quadrants Perceive, Recall, Plan and Perform, the 12 subquadrants, and the outer circle with observable descriptors.

References

    1. Béjot Y, Bailly H, Durier J, et al. . Epidemiology of stroke in Europe and trends for the 21st century. Presse Med 2016;45:e391–8. 10.1016/j.lpm.2016.10.003
    1. Brazinova A, Rehorcikova V, Taylor MS, et al. . Epidemiology of traumatic brain injury in Europe: a living systematic review. J Neurotrauma 2021;38:1–30. 10.1089/neu.2015.4126
    1. Norrving B, Barrick J, Davalos A, et al. . Action plan for stroke in Europe 2018-2030. Eur Stroke J 2018;3:309–36. 10.1177/2396987318808719
    1. Andelic N, Røe C, Tenovuo O, et al. . Unmet rehabilitation needs after traumatic brain injury across Europe: results from the CENTER-TBI study. J Clin Med 2021;10:1035–18. 10.3390/jcm10051035
    1. Munthe-Kaas R, Aam S, Ihle-Hansen H, et al. . Impact of different methods defining post-stroke neurocognitive disorder: the Nor-COAST study. Alzheimers Dement 2020;6:e12000. 10.1002/trc2.12000
    1. Chen R-L, Balami JS, Esiri MM, et al. . Ischemic stroke in the elderly: an overview of evidence. Nat Rev Neurol 2010;6:256–65. 10.1038/nrneurol.2010.36
    1. Gardner RC, Dams-O'Connor K, Morrissey MR, et al. . Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma 2018;35:889–906. 10.1089/neu.2017.5371
    1. Norwegian Ministry of Health and Care Services . Health and care [HelseOmsorg21]. Oslo: Norwegian Ministry of Health and Care Services; 2021. [Accessed 19 Nov 2021].
    1. Meld. St. 15 (2017–2018) . Leve hele livet — En kvalitetsreform for eldre [A full life - all your life. A quality reform for older persons]. Oslo: Norwegian Ministry of Health and Care Services; 2018.
    1. McKevitt C, Fudge N, Redfern J, et al. . Self-reported long-term needs after stroke. Stroke 2011;42:1398–403. 10.1161/STROKEAHA.110.598839
    1. Andelic N, Soberg HL, Berntsen S, et al. . Self-perceived health care needs and delivery of health care services 5 years after moderate-to-severe traumatic brain injury. PM R 2014;6:1013–21. 10.1016/j.pmrj.2014.05.005
    1. Arntzen C, Hamran T. Rehabiliteringsforløp etter hjerneslag [Recovery trajectory after stroke]. Geriatrisk sykepleie 2015;3:24–34.
    1. Cicerone KD, Goldin Y, Ganci K, et al. . Evidence-based cognitive rehabilitation: systematic review of the literature from 2009 through 2014. Arch Phys Med Rehabil 2019;100:1515–33. 10.1016/j.apmr.2019.02.011
    1. Stigen L, Bjørk E, Lund A. Occupational therapy interventions for persons with cognitive impairments living in the community. Occup Ther Health Care 2022:1–20. 10.1080/07380577.2022.2056777
    1. Gramstad A, Nilsen R. Prioriterte områder for forskning blant kommuneergoterapeuter i Norge. [Prioritized topics for research amongst Norwegian occupational thrapists]. Ergoterapeuten 2017;3:36–45.
    1. Stigen L, Bjørk E, Lund A. The conflicted practice: municipal occupational therapists' experiences with assessment of clients with cognitive impairments. Scand J Occup Ther 2019;26:261–72. 10.1080/11038128.2018.1445778
    1. Downing M, Bragge P, Ponsford J. Cognitive rehabilitation following traumatic brain injury: a survey of current practice in Australia. Brain Impairment 2019;20:24–36. 10.1017/BrImp.2018.12
    1. Koh C-L, Hoffmann T, Bennett S, et al. . Management of patients with cognitive impairment after stroke: a survey of Australian occupational therapists. Aust Occup Ther J 2009;56:324–31. 10.1111/j.1440-1630.2008.00764.x
    1. Korner-Bitensky N, Barrett-Bernstein S, Bibas G, et al. . National survey of Canadian occupational therapists' assessment and treatment of cognitive impairment post-stroke. Aust Occup Ther J 2011;58:241–50. 10.1111/j.1440-1630.2011.00943.x
    1. Holmqvist K, Ivarsson A-B, Holmefur M. Occupational therapist practice patterns in relation to clients with cognitive impairment following acquired brain injury. Brain Inj 2014;28:1365–73. 10.3109/02699052.2014.919529
    1. Chapparo C, Ranka JL. The perceive: recall: plan: perform (PRPP) system of task analysis, 2013. Available: [Accessed 26 May 2020].
    1. Toglia JP, Rodger SA, Polatajko HJ. Anatomy of cognitive strategies: a therapist's primer for enabling occupational performance. Can J Occup Ther 2012;79:225–36. 10.2182/cjot.2012.79.4.4
    1. Nott MT, Chapparo C. Cognitive strategy use in adults with acquired brain injury. Brain Inj 2020;34:508–14. 10.1080/02699052.2020.1725837
    1. Chapparo C, Ranka J. The PRPP intervention course manual; 2018.
    1. Chapparo C, Ranka JL, Nott MT. Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis and Intervention. In: Curtin M, Egan M, Adams J, eds. Occupational therapy for people experiencing illness, injury or impairment: promoting occupation and participation. 7rd ed. Edinburgh: Elsevier, 2017: 243–57.
    1. Nott MT, Chapparo C, Heard R. Effective occupational therapy intervention with adults demonstrating agitation during post-traumatic amnesia. Brain Inj 2008;22:669–83. 10.1080/02699050802227170
    1. Juntorn S, Sriphetcharawut S, Munkhetvit P. Effectiveness of information processing strategy training on academic task performance in children with learning disabilities: a pilot study. Occup Ther Int 2017;2017:1–13.
    1. Mills C, Chapparo C, et al. . Use of perceive, recall, plan, perform stage two cognitive task analysis for students with autism and intellectual disability: the impact of a sensory activity schedule. J Occup Ther Sch Early Interv 2017;10:232–53. 10.1080/19411243.2017.1335262
    1. Krasny-Pacini A, Evans J. Single-case experimental designs to assess intervention effectiveness in rehabilitation: a practical guide. Ann Phys Rehabil Med 2018;61:164–79. 10.1016/j.rehab.2017.12.002
    1. Tate RL, Perdices M, Rosenkoetter U, et al. . Revision of a method quality rating scale for single-case experimental designs and n-of-1 trials: the 15-item risk of bias in n-of-1 trials (RoBiNT) scale. Neuropsychol Rehabil 2013;23:619–38. 10.1080/09602011.2013.824383
    1. Tate RL, Perdices M. Single-case experimental designs for clinical research and neurorehabilitation settings. planning, conduct, analysis and reporting. New York: Routledge, 2019.
    1. Porcino AJ, Shamseer L, Chan A-W, et al. . Spirit extension and elaboration for n-of-1 trials: spent 2019 checklist. BMJ 2020;368:m122. 10.1136/bmj.m122
    1. Craig P, Dieppe P, Macintyre S, et al. . Developing and evaluating complex interventions: the new medical Research Council guidance. BMJ 2008;337:a1655–6. 10.1136/bmj.a1655
    1. Tate RL, Perdices M, Rosenkoetter U, et al. . The single-case reporting guideline in behavioural interventions (SCRIBE) 2016: explanation and elaboration. Arch Sci Psychol 2016;4:10–31. 10.1037/arc0000027
    1. Norwegian Association for Stroke Survivors . Main board, 2021. Available: [Accessed 20 Aug 2021].
    1. Statistics Norway . Grouping of municipalities after population and economic framework 2020 [Gruppering av kommuner etter folkemengde og økonomiske rammebetingelser 2020]. Oslo: Statistics Norway; 2020.
    1. Ranka J. Description of the PRPP intervention: occupational performance model (Asutralia), 2014. Available: [Accessed 10 Jun 2021].
    1. Ranka J, Chapparo C. The PRPP assessment course manual; 2015.
    1. Fry K, O'Brien L. Using the perceive, recall, plan and perform system to assess cognitive deficits in adults with traumatic brain injury: a case study. Aust Occup Ther J 2002;49:182–7. 10.1046/j.1440-1630.2002.00337.x
    1. Nott MT, Chapparo C. Measuring information processing in a client with extreme agitation following traumatic brain injury using the perceive, recall, plan and perform system of task analysis. Aust Occup Ther J 2008;55:188–98. 10.1111/j.1440-1630.2007.00685.x
    1. Nott MT, Chapparo C. Exploring the validity of the perceive, recall, plan and perform system of task analysis: cognitive strategy use in adults with brain injury. British Journal of Occupational Therapy 2012;75:256–63. 10.4276/030802212X13383757345067
    1. Nott MT, Chapparo C, Heard R. Reliability of the perceive, recall, plan and perform system of task analysis: a criterion-referenced assessment. Aust Occup Ther J 2009;56:307–14. 10.1111/j.1440-1630.2008.00763.x
    1. Aubin G, Stip E, Gélinas I, et al. . Daily activities, cognition and community functioning in persons with schizophrenia. Schizophr Res 2009;107:313–8. 10.1016/j.schres.2008.08.002
    1. Steultjens EMJ, Voigt-Radloff S, Leonhart R, et al. . Reliability of the perceive, recall, plan, and perform (PRPP) assessment in community-dwelling dementia patients: test consistency and inter-rater agreement. Int Psychogeriatr 2012;24:659–65. 10.1017/S1041610211002249
    1. Van Keulen-Rouweler BJ, Sturkenboom IHWM, Kottorp A, et al. . The perceive, recall, plan and perform (PRPP) system for persons with Parkinson's disease: a psychometric study. Scand J Occup Ther 2017;24:65–73. 10.1080/11038128.2016.1233291
    1. Kiresuk TJ, Smith A, Cardillo JE. Goal attainment scaling: applications, theory, and measurement. New York: Psychology Press, 1994.
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md State Med J 1965;14:61–5.
    1. Collin C, Wade DT, Davies S, et al. . The Barthel ADL index: a reliability study. Int Disabil Stud 1988;10:61–3. 10.3109/09638288809164103
    1. Lane JD, Gast DL. Visual analysis in single case experimental design studies: brief review and guidelines. Neuropsychol Rehabil 2014;24:445–63. 10.1080/09602011.2013.815636
    1. Kratochwill TR, Hitchcock JH, Horner RH, et al. . Single-case intervention research design standards. Remedial Spec Educ 2013;34:26–38. 10.1177/0741932512452794
    1. Lane JD, Ledford JR, Gast DL. Single-case experimental design: current standards and applications in occupational therapy. Am J Occup Ther 2017;71:7102300010p1–7102300010. 10.5014/ajot.2017.022210
    1. World Medical Association . WMA Declaration of Helsinki – ethical principles for medical research involving human subjects; 2018. [Accessed 02 Jun 2021].

Source: PubMed

3
Sottoscrivi