Motivational interviewing for low mood and adjustment early after stroke : A feasibility randomised trial

Journal article


Patel, Kulsum, Watkins, Caroline L., Sutton, Chris J., Holland, Emma-Joy, Benedetto, Valerio, Auton, Malcolm F., Barer, David, Chatterjee, Kausik and Lightbody, Catherine E.. (2018). Motivational interviewing for low mood and adjustment early after stroke : A feasibility randomised trial. Pilot and Feasibility Studies. 4(1), p. 152. https://doi.org/10.1186/s40814-018-0343-z
AuthorsPatel, Kulsum, Watkins, Caroline L., Sutton, Chris J., Holland, Emma-Joy, Benedetto, Valerio, Auton, Malcolm F., Barer, David, Chatterjee, Kausik and Lightbody, Catherine E.
Abstract

Background
Management of psychological adjustment and low mood after stroke can result in positive health outcomes. We have adapted a talk-based therapy, motivational interviewing (MI), and shown it to be potentially effective for managing low mood and supporting psychological adjustment post-stroke in a single-centre trial. In the current study, we aimed to explore the feasibility of delivering MI using clinical stroke team members, and using an attention control (AC), to inform the protocol for a future definitive trial.

Methods
This parallel two-arm feasibility trial took place in north-west England. Recruitment occurred between December 2012 and November 2013. Participants were stroke patients aged 18 years or over, who were medically stable, had no severe communication problems, and were residents of the hospital catchment. Randomisation was to MI or AC, and was conducted by a researcher not involved in recruitment using opaque sealed envelopes. The main outcome measures were descriptions of study feasibility (recruitment/retention rates, MI delivery by clinical staff, use of AC) and acceptability (through qualitative interviews and completion of study measures), and fidelity to MI and AC (through review of session audio-recordings). Information was also collected on participants’ mood, quality of life, adjustment, and resource-use.

Results
Over 12 months, 461 patients were screened, 124 were screened eligible, and 49 were randomised: 23 to MI, 26 to AC. At 3 months, 13 MI and 18 AC participants completed the follow-up assessment (63% retention). This was less than expected based on our original trial. An AC was successfully implemented. Alternative approaches would be required to ensure the feasibility of clinical staff delivering MI. The study measures, MI, and AC interventions were considered acceptable, and there was good fidelity to the interventions. There were no adverse events related to study participation.

Conclusions
It was possible to recruit and retain participants, train clinical staff to deliver MI, and implement an appropriate AC. Changes would be necessary to conduct a future multi-centre trial, including: assuming a recruitment rate lower than that in the current study; implementing more strategies to increase participant retention; and considering alternative clinical staff groups to undertake the delivery of MI and AC.

Trial registration
ISRCTN study ID: ISRCTN55624892

Trial funding
Northern Stroke Research Fund

Keywordsfeasibility; motivational interviewing; stroke; psychological adjustment
Year2018
JournalPilot and Feasibility Studies
Journal citation4 (1), p. 152
PublisherBiomed Central Ltd
ISSN2055-5784
Digital Object Identifier (DOI)https://doi.org/10.1186/s40814-018-0343-z
Scopus EID2-s2.0-85064409478
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-13
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online25 Sep 2018
Publication process dates
Accepted17 Sep 2018
Deposited17 May 2021
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Watkins, Caroline, Wathan, J, Leathley, M, Auton, M, Deans, Carol, Dickinson, H, Jack, Cathy, Sutton, C, Van Den Broek, M and Lightbody, C. (2011). The 12-month effects of early motivational interviewing after acute stroke :A randomized controlled trial. Stroke: a journal of cerebral circulation. 42(7), pp. 1956 - 1961. https://doi.org/10.1161/STROKEAHA.110.602227
Combined conservative interventions for urge, stress or mixed incontinence in adults (protocol)
French, Beverley, Thomas, Lois H., Sutton, Christopher J., Booth, J., Brittain, Katie, Burton, Christopher R., Cheater, Francine, Roe, Brenda, Hay-Smith, E. Jean C., McAdam, J. J. and Watkins, Caroline. (2010). Combined conservative interventions for urge, stress or mixed incontinence in adults (protocol). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD008910
Changing stroke mortality trends in middle-aged people : An age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England
Sutton, C, Marsden, J, Watkins, Caroline, Leathley, M and Dey, P. (2010). Changing stroke mortality trends in middle-aged people : An age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England. Journal of Epidemiology and Community Health. 64(6), pp. 523 - 529. https://doi.org/10.1136/jech.2008.086785
Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis
French, Beverley, Thomas, Lois, Leathley, Michael, Sutton, Christopher, McAdam, Joanna, Forster, Anne, Langhorne, Peter, Price, Chris, Walker, Annette and Watkins, Caroline. (2010). Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine. 42(1), pp. 9 - 15. https://doi.org/10.2340/16501977-0473
Very early rehabilitation or intensive telemetry after stroke : A pilot randomised trial
Langhorne, P, Stott, D, Knight, A, Bernhardt, Julie, Barer, D and Watkins, Caroline. (2010). Very early rehabilitation or intensive telemetry after stroke : A pilot randomised trial. Cerebrovascular Diseases. 29(4), pp. 352 - 360. https://doi.org/10.1159/000278931
Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis
French, Beverley, Thomas, Lois, Leathley, Michael, Sutton, Christopher, McAdam, Joanna, Forster, Anne, Langhorne, Peter, Price, Chris, Walker, Annette and Watkins, Caroline. (2010). Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine. 42(1), pp. 9 - 15. https://doi.org/10.2340/16501977-0473
Stroke knowledge and awareness : An integrative review of the evidence
Jones, Susanne, Jenkinson, A, Leathley, M and Watkins, Caroline. (2010). Stroke knowledge and awareness : An integrative review of the evidence. Age and Ageing. 39(1), pp. 11 - 22. https://doi.org/10.1093/ageing/afp196;10.1093/ageing/afp196
Nursing patients with neurological problems
Watkins, Caroline Leigh. (2009). Nursing patients with neurological problems. In In G. Castledine and A. Close (Ed.). Oxford handbook of adult nursing pp. 435 - 484 Oxford University Press. https://doi.org/10.1093/med/9780199231355.003.0013
Repetitive task training for improving functional ability after stroke
French, Beverley, Thomas, Lois H., Leathley, Michael John, Sutton, Christopher J., McAdam, Joanna J., Forster, Anne, Langhorne, Peter J., Price, Christopher I.M., Walker, Andrew and Watkins, Caroline L.. (2009). Repetitive task training for improving functional ability after stroke. Stroke: a journal of cerebral circulation. 40(4), pp. 98 - 99. https://doi.org/10.1161/STROKEAHA.108.519553
Psychological intervention poststroke: ready for action?
Watkins, Caroline and French, Beverley. (2009). Psychological intervention poststroke: ready for action? Stroke. 40(9), pp. 2951 - 2952. https://doi.org/10.1161/STROKEAHA.109.562348
Treatment of stroke: Acting on the symptoms
Jones, Stephanie, Leathley, Michael J. and Watkins, Caroline Leigh. (2008). Treatment of stroke: Acting on the symptoms. Asian Hospital and Healthcare Management.
Treatment of urinary incontinence after stroke in adults (review)
Thomas, Lois H., Cross, S., French, B., Leathley, M. J., Sutton, C. J. and Watkins, Caroline Leigh. (2008). Treatment of urinary incontinence after stroke in adults (review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004462.pub3
Engaging service users in the development of stroke services: An action research study
Jones, Stephanie P., Auton, Malcolm F., Burton, Christopher R. and Watkins, Caroline L.. (2008). Engaging service users in the development of stroke services: An action research study. Journal of Clinical Nursing. 17(10), pp. 1270 - 1279. https://doi.org/10.1111/j.1365-2702.2007.02259.x
Acute stroke management: An online course
Jones, Stephanie, McLoughlin, A. and Watkins, Caroline. (2008). Acute stroke management: An online course. Journal of Paramedic Practice: the clinical monthly for emergency care professionals. 3(6), pp. 322 - 326.
Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence
Marsden, Jenny, Gibson, Lorna Mary, Lightbody, Catherine Elizabeth, Sharma, Anil Kumar, Siddiqi, Mashood and Watkins, Caroline. (2008). Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence. Age and Ageing. 37(2), pp. 142 - 150. https://doi.org/10.1093/ageing/afm198
A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness
French, Beverley, Leathley, Michael John, Sutton, Christopher J., McAdam, Joanna J., Thomas, Lois H., Forster, A., Langhorne, Peter J., Price, Christopher I.M., Walker, Annette and Watkins, Caroline. (2008). A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness. Health Technology Assessment. 12(30), pp. 1 - 140. https://doi.org/10.3310/hta12300