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

Latham, N. K., Jette, D. U., Coster, W., Richards, L., Smout, R. J., James, R. A., Gassaway, J., & Horn, S. D. (2006). Occupational therapy activities and intervention techniques for clients with stroke in six rehabilitation hospitals. The American Journal of Occupational Therapy, 60(4), 369–378. https://doi.org/10.5014/ajot.60.4.369

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