An investigation of different interventions designed to maintain the benefits following a group-based memory rehabilitation program in stroke patients.

Prior to commencing in the trial, participants will have completed a six-week memory skills group program. The group program comprises one two-hour session each week (including breaks) in groups of 3-8 people who report memory difficulties after experiencing an acquired brain injury (ABI). Sessions are facilitated in-person by qualified clinicians. Program content includes psychoeducation regarding memory functioning, practical training in internal and external compensatory memory strategies, and information about relevant impacts to memory functioning from lifestyle factors such as diet, sleep, and exercise. Interactive in-session exercises and between-session homework tasks are included to encourage practice and application of trained skills and strategies in everyday contexts. All memory skills group sessions will be video recorded throughout the study period, for treatment fidelity checks of a random selection of sessions by an independent expert. Treatment fidelity monitoring will include measures of adherence (using a session content checklist) and competence (using the eNACT Group Facilitation Competency Checklist). At the conclusion of the memory group program, interested participants will be contacted by study staff to be formally enrolled in the Memory-SuSTAIN study and randomised into one of the following two study arms (or a control condition, consisting of usual care involving no active follow-up maintenance): Arm 1: Telehealth booster sessions Participants in the Booster Sessions condition will receive three fortnightly sessions of one-hour duration each, with a trained clinician. Sessions will comprise: • Checking the progress of rehabilitation goals (previously negotiated with memory group clinicians); • Reviewing and consolidating key compensatory and lifestyle strategies covered during the memory group program; • Expanding the number and range of everyday situations to which these memory strategies could be applied; and • Addressing any barriers to ongoing implementation of strategies. Booster sessions will occur remotely via videoconferencing using Zoom, a freely available software program facilitating Internet-enabled videoconferencing. Booster sessions will also be video recorded and treatment fidelity checks conducted by an independent expert. Arm 2: SMS/Email Reminders Participants in the SMS/Email Reminder condition will receive one strategy message per week for six weeks, sent either to their mobile phone as a text message or to a nominated email address, depending on each participant’s preference. Reminder messages will prompt participants to use their three most relevant strategies learned during the memory group program. Following group allocation, participants in the SMS/Email Reminders condition will be asked to nominate their three most useful personally salient strategies from a list of all strategies taught in the memory skills group. These strategies will inform the range of reminder prompts that they receive. Strategies will be identified from a list covering the following areas: Internal Strategies: o Using repetition to enhance encoding (mental rehearsal, asking others to repeat, re-reading text); o Using association to enhance retrieval; o Route-finding strategies: Paying attention to key features to enhance encoding; o Using context to assist recall; o Word-finding and conversations: focusing on meaning, using association, and descriptions; o Learning and recalling names: using alphabet search, association, and elaboration; External Strategies: o Optimising the home environment: decreasing distractions, reducing clutter; o Using note-taking, diaries, calendars, physical reminders, and alarms; o Using smartphones and electronic devices; o Using checklists for complex tasks. Messages will be delivered using the iVERVE platform, an electronic automated messaging system designed and developed by Cadilhac et al. (2018) for message-based e-health interventions. iVERVE will store a bank of strategy reminder messages and securely extract de-identified participant data (selected strategies matched with each relevant participant’s nominated phone number or email address) from a secure web-based database management system (REDCap; Harris et al., 2009). Study data will be collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted and managed by Helix (Monash University; Harris et al., 2009). REDCap is a secure, web-based application designed to support data capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources. Automated messages will be sent to participants at designated times, once per week for six weeks.