Abstract
BackgroundExtensive studies have documented the complex and comprehensive psychosocial consequences of stroke. Psychosocial difficulties significantly affect long-term functioning and quality of life. Many studies have explored psychosocial interventions to prevent or treat psychosocial problems, but most have found modest effects. This study evaluated, from the perspective of adult stroke survivors, (1) the content, structure and process and (2) experienced usefulness of a dialogue-based psychosocial nursing intervention in primary care aimed at promoting psychosocial health and wellbeing.MethodsThis was part of a feasibility study guided by the UK MRC complex interventions framework. It consisted of dialogue-based encounters with trained health professionals during approximately the first year poststroke. It was tested in two formats; individual or group encounters. Inclusion criteria were: Acute stroke, above 18 y.o., sufficient physical and cognitive functioning to participate. Data were collected immediately before, during and 14 days after the completion of the intervention. Pre- and post-data included medical and demographic data, quality of life, emotional wellbeing, life satisfaction, anxiety and depression. Qualitative interviews focusing on participant experiences were conducted two weeks following the intervention. Log notes taken by the health professionals conducting the intervention and work sheets filled in by participants also comprised data. Data analysis was case-oriented. The structured instruments were analysed regarding completeness of data and indication of changes in outcome variables. The qualitative interviews, log notes and work sheets were analysed using thematic content analysis.ResultsTwenty-five stroke survivors (17 men, 8 women), median age 64 (range 33–89), participated. Physical limitations varied from mild to severe. Seven participants had moderate to severe expressive aphasia. The participants found the content and process of the intervention relevant. Both the individual and group formats were found useful. Patients with aphasia reported that there were too few encounters (eight encounters were originally planned). The participants underscored the benefits of being supported through a difficult time, having a chance to tell and (re)create their story and being supported in their attempts to cope with the situation.ConclusionsThis study provides initial support for the usefulness of the psychosocial intervention and highlights areas requiring further consideration and development.Trial registration numberClinicalTrials.gov Identifier: NCT01912014
Highlights
Extensive studies have documented the complex and comprehensive psychosocial consequences of stroke
Our work builds on the latter theory and aims to reduce the stress associated with adjusting to the consequences of the stroke by providing psychosocial support and facilitating the stroke survivor’s own coping efforts
We report on findings from a feasibility study (Craig et al 2008) of a psychosocial intervention developed to promote psychosocial adjustment and wellbeing
Summary
Extensive studies have documented the complex and comprehensive psychosocial consequences of stroke. Some researchers theorise that poststroke depression may be a direct effect of ischemic brain lesions damaging the nervous circuits regulating mood (Whyte and Mulsant 2002). This theory is controversial (Bhogal et al 2004; Kouwenhoven et al 2011). Other researchers assume that poststroke depression is a response to overwhelming stress, affective overload and inability to cope with the extensive losses following a stroke (Whyte and Mulsant 2002; Kouwenhoven et al 2011). Our work builds on the latter theory and aims to reduce the stress associated with adjusting to the consequences of the stroke by providing psychosocial support and facilitating the stroke survivor’s own coping efforts
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