Date Presented 04/21/2023
Findings from the feasibility randomized controlled trial testing the efficacy of motivational interviewing and self-management in stroke rehabilitation support the study design and the potential of integrating chronic care supports early on.
Primary Author and Speaker: Danbi Lee
Additional Authors and Speakers: Melody Yang
Contributing Authors: Heidi Fischer, Jamie L. Tingey, Ralph Woods, McKenzie Miller, Charles Bombardier
PURPOSE: Stroke rehabilitation focuses on functional recovery, however, often does not include preparing patients for long-term self-management and community engagement. This study evaluated the feasibility of a trial testing the efficacy of motivational interviewing (MI) and self-management (SM) support in early stroke rehabilitation.
METHOD: An exploratory randomized controlled trial was conducted in which first-time stroke patients with a mild stroke (91% male, age=56±14.5), recruited at a Level 1 Stroke Center inpatient rehabilitation unit, were randomized into an intervention (n=6) or treatment-as-usual group (n=5). The intervention group received 5 MI sessions and a 6-session virtual group-based stroke specific SM program. Feasibility was evaluated by observation, focus groups, and interviews. Health, perceived recovery, patient activation, and self-efficacy outcomes were collected at baseline, discharge, and post-intervention by blinded assessors. Preliminary effects were analyzed using non-parametric effect sizes (r). Qualitative data were analyzed using thematic analysis.
RESULTS: Out of 24 eligible patients, 15 were enrolled and 11 completed the study. All outcome measures were feasible to use. Intervention attendance rate (n=11) was 100%, and fidelity remained strong. Perceived recovery and patient activation outcomes showed moderate effects (r>0.3). Participants were satisfied with the timing, structure, and content of the intervention and reported emotional benefits and gain of new insights, confidence, and knowledge.
CONCLUSION: The results of this feasibility trial indicate the need for a larger scale trial. While preliminary, participant satisfaction and positive effects support the potential of integrating MI and SM early on in stroke rehabilitation to support patients’ transition into life with a long-term disability. Occupational therapists can play a vital role in supporting this transition by integrating chronic care supports in practice.
References
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Lee, D., Fischer, H., Zera, S., Robertson, R., & Hammel, J. (2017). Examining a participation-focused stroke self-management intervention in a day rehabilitation setting: A quasi-experimental pilot study. Topics in Stroke Rehabilitation, 24(8), 601–607. https://doi.org/10.1080/10749357.2017.1375222
Watkins, C. L., Wathan, J. V., Leathley, M. J., Auton, M. F., Deans, C. F., Dickinson, H. A., … Lightbody, C. E. (2011). The 12-month effects of early motivational interviewing after acute stroke: A randomized controlled trial. Stroke, 42(7), 1956–1961. https://doi.org/10.1161/STROKEAHA.110.602227
