A new study has found that stroke patients who, in addition to receiving standard stroke care, met with therapists to discuss recovery, life expectations, and potential obstacles, within one month after stroke experienced a 50% lower death rate, and showed fewer signs of depression than patients who received standard stroke care only.
The new study, led by Caroline L. Watkins, PhD, Professor of Stroke and Older People’s Care at the Clinical Practice Research Unit, School of Health, University of Central Lancashire, England, and her colleagues, was published in the June 23, 2011 issue of Stroke: Journal of the American Heart Association.
Motivational interviewing is generally a talk-based therapy for patients with health problems that require behavior change, but in this study it was used to support adjustment to life after stroke. Depression is a common problem after stroke that interferes with recovery, survival and return to normal participation in life.
The study involved 411 patients in a hospital’s stroke unit. The patients were on average 70 years old and slightly more than half were men. They weren’t moving out of the area after discharge, and did not have severe cognitive or communication problems that would have prevented participation in interviews.
All patients received usual stroke care and half were assigned randomly to one therapist for up to four 30- to 60-minute sessions of the talk-based therapy within two to four weeks after suffering a stroke.
Therapists asked the patients their thoughts about the future, what hurdles they expected to face in recovery and how confident they felt about approaching these hurdles. Therapists encouraged patients to identify their own solutions to problems they anticipated.
The therapists weren’t trained clinical psychologists — two were nurses and two had psychology degrees. But all were trained and supervised by a clinical psychologist, suggesting that the program could be replicated easily in a variety of healthcare settings with proper supervision.
The researchers assessed patients’ mood, beliefs and expectations for recovery and activities of daily living using standard questionnaires. These assessments were made at the beginning of the study, and again at 12 months via mailed questionnaires.
After one year, 48 percent of patients who met with a therapist to discuss recovery and life expectations within one month after stroke had normal mood, compared to 37.7 percent of patients who did not have the therapy. Thus, the patients who received the early, talk-based therapy were 66% more likely to have a normal mood at 12 months than those who received usual care without the talk therapy.
The death rate among the group who received the talk therapy was 6.5 percent, compared to 12.8 percent in the control group. Those who received the talk therapy were thus approximately 50% less likely to die within 12 months after stroke than the patients who received standard stroke care only.
Unlike previous post-stroke talk and drug therapy studies, researchers began the talk therapy in this study within one month after patients suffering a stroke, as previously noted.
“Prior studies targeting depressed stroke patients have had limited success, but the depression may have already interfered with rehabilitation and recovery,” said Caroline Watkins, Ph.D., lead author of the study. “We found that early intervention helped people set realistic expectations for recovery, avoid some of the misery associated with life after stroke, and may even help them live longer.”
“While a higher percentage of patients in the control group had died after 12 months, we did not study the cause of death of every patient,” Watkins said. “These results imply a strong association between mood following a stroke and mortality within one year, but we believe it should be examined in a much larger study.”
The study also did not include patients with severe communication problems because it would have been difficult for them to participate in talk-based therapy.
Furthermore, researchers conducted the study in one hospital, where the training and supervision of therapists was tightly controlled. It’s unclear if the same effects would be seen in less controlled settings, researchers said.
“The simplicity and brevity of this intervention makes it inexpensive to deliver, and yet it has the potential to give huge benefits to its recipients,” Watkins said. “It’s imperative that further research is supported to ensure effective methods of implementation are developed.”
For more information about stroke, see our resource pages on Heart Disease & Stroke.
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