Journal of Rehabilitation Medicine 51-8 | Page 21

J Rehabil Med 2019; 51: 557–565 ORIGINAL REPORT EFFECT OF A DIALOGUE-BASED INTERVENTION ON PSYCHOSOCIAL WELL- BEING 6 MONTHS AFTER STROKE IN NORWAY: A RANDOMIZED CONTROLLED TRIAL Ellen G. HJELLE, OT, MHSc 1 , Line K. BRAGSTAD, OT, PhD 1,2 , Marit KIRKEVOLD, RN, EdD 1 , Manuela ZUCKNICK, STAT, PhD 3 , Berit A. BRONKEN, RN, PhD 4 , Randi MARTINSEN, RN, PhD 4 , Kari J. KVIGNE, RN, PhD 4 , Gabriele KITZMÜLLER, RN, PhD 5 , Margrete MANGSET, RN, PhD 6 , Bente THOMMESSEN, MD, PhD 7 and Unni SVEEN, OT, PhD 8 From the 1 Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Faculty of Medicine, University of Oslo, 2 Department of Geriatric Medicine, Oslo University Hospital, 3 Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Faculty of Medicine, University of Oslo, 4 Department of Nursing and Health Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 5 Department of Health and Care Sciences, Faculty of Health Sciences, UIT, The Arctic University of Norway, 6 Department of Geriatric Medicine, Oslo University Hospital, 7 Department of Neurology, Akershus University Hospital and 8 Department of Geriatric Medicine and Physical Medicine and Rehabilitation, Oslo University Hospital, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway Objective: To evaluate the effect of a dialogue-based intervention on psychosocial well-being 6 months after stroke. Design: Multicentre, prospective, randomized con- trolled trial. Subjects: Adults (aged ≥ 18 years) who had their first or recurrent stroke within the last month, were medically stable, had sufficient cognitive functioning to participate and understood and spoke Norwegian. Methods: A total of 322 participants were randomly as- signed to the intervention (n  = 166) or control (n  = 156) group. Participants in the intervention group received up to 8 individual sessions aimed at supporting the co- ping and life skills of stroke survivors in addition to usual care. The primary outcome was the proportion of participants with normal mood measured by the General Health Questionnaire-28 (GHQ-28). The se- condary outcomes included health-related quality of life (Stroke and Aphasia Quality of Life Scale; SAQOL- 39g), depression (Yale-Brown single-item questionn- aire; Yale) and sense of coherence (SOC-13). Results: After controlling for the baseline values, no significant benefit was found in the intervention gro- up over the control group (odds ratio (OR): 0.898: 95% confidence interval (95% CI): 0.54-1.50, p = 0.680) 6 months post-stroke. Conclusion: Psychosocial well-being improved during the first 6 months after stroke in both arms of the trial, but no statistically significant benefit of the di- alogue-based intervention was found compared with usual care. Key words: psychosocial rehabilitation; stroke; intervention study; mood; psychosocial factor. Accepted Jul 8, 2019; Epub ahead of print Aug 14, 2019 J Rehabil Med 2019; 51: 557–565 Correspondence address: Ellen Gabrielsen Hjelle, Department of Nur- sing Science, Faculty of Medicine, University of Oslo, Pb 1130 Blindern, NO-0318 Oslo, Norway. E-mail: [email protected] S troke is a major cause of death and disability glo- bally and imposes social and economic burdens LAY ABSTRACT The aim of this study was to evaluate the effect of a dialogue-based intervention on psychosocial well-be- ing 6 months after stroke. A total of 322 participants were assigned to an intervention (n  = 166) or control (n  = 156) group. Participants in the intervention group received up to 8 individual sessions aimed at supporting the coping and life skills of stroke survivors in addition to usual care. Psychosocial well-being improved during the first 6 months after the stroke in both arms of the trial. However, no benefit of the dialogue-based inter- vention was found compared with usual care. on individuals, families and communities (1). Every year, approximately 12,000 people suffer from stroke in Norway (2). Psychosocial challenges and emotional symptoms are frequent sequelae after stroke. Approx- imately one-third of patients report depressive symp- toms (3) or anxiety (4) the first year post-stroke. Other common challenges include general psychological distress and social isolation (5). Psychosocial problems affect long-term functioning and health-related quality of life as well as motivation to participate in rehabilita- tion, but follow-up targeting psychosocial adjustment may improve psychosocial well-being, independent of functional impairment after stroke (6). To promote well-being, prevent additional negative consequences after stroke, and maximize the effect of rehabilitation, psychosocial well-being should be a focus during post-stroke care. Systematic reviews have explored psychosocial interventions after stroke (3, 7–10). Although moti- vational interviewing is the only intervention with a documented effect (7), providing information (10), counselling (9) and liaisons with services (8) may contribute to psychosocial well-being. A study on mo- tivational interviewing found a statistically significant benefit over usual stroke care. The results suggested that motivational interviewing led to improvements in the patients’ mood 3 months after stroke, and the benefit was confirmed at 12 months (11). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2585