Background and Purpose-The purpose of this study was to determine whether motivational interviewing, a patientcentered counseling technique, can benefit patients' mood 3 months after stroke. Methods-A single-center, open, randomized, controlled trial was conducted at a single hospital with a stroke unit.Subjects consisted of 411 consecutive patients on the stroke register who were over 18 years of age and who did not have severe cognitive and communication problems that would prevent them from taking part in an interview; were not known to be moving out of the area after discharge; and were not already receiving psychiatric or clinical psychology intervention. All patients received usual stroke care. Patients in the intervention group received 4 individual, weekly sessions of motivational interviewing with a trained therapist in addition to usual stroke care. The primary outcome was the proportion of patients with normal mood at 3 months poststroke measured by the 28-item General Health Questionnaire (normal, Ͻ5; low Ն5) using a mailed questionnaire. here is a strong relationship between early psychologic problems and the rate and extent of recovery after stroke. Depressed patients with stroke lack the motivation to participate in rehabilitation, making less progress, 1 staying in the hospital longer, 2 failing to engage in leisure pursuits and social activities, 3 and surviving for less time. 4 These negative outcomes could be related to a failure to adjust or adapt to the effects of the stroke.Several studies have attempted to address psychologic problems directly using either pharmacological 5 or conventional cognitive-behavioral therapies. 6 -9 However, the results thus far have failed to give a clear message 10 as have studies aiming to reduce psychologic problems indirectly, for example, by improving social support. 11 Alternative approaches to addressing psychologic issues after stroke need to be explored.Motivational interviewing is a specific talk-based therapy originally developed to help people with addictions. 12 More recently, it has been used successfully with a wide range of health problems characterized by poor motivation and the necessity to make some form of health behavior change. 13 Our aim is to intervene at an early stage after stroke using motivational interviewing to support and build patients' motivation to adjust and adapt to having had a stroke. Through the use of motivational interviewing techniques, patients will be helped to recognize the importance of making psychologic adjustments and practical adaptations. Subsequently, they will be able to develop confidence in their ability to adjust and adapt and to identify realistic personal goals for their recovery. This will address low expectations 14 and provide the psychologic impetus to engage in rehabilitation and improve recovery. 15 Methods Study DesignThis was a single-center, open, randomized, controlled trial. Ethical approval was obtained from the local research ethics committee. This study is registered as an International Stan...

BACKGROUNDThe role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion. METHODSIn a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death). RESULTSThe median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P<0.001). In a proportional-odds model, there was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the lying-flat group and patients in the sitting-up group (unadjusted odds ratio for a difference in the distribution of scores on the modified Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P = 0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among the patients in the sitting-up group (P = 0.83). There were no significant betweengroup differences in the rates of serious adverse events, including pneumonia. CONCLUSIONSDisability outcomes after acute stroke did not differ significantly between patients assigned to a lying-flat position for 24 hours and patients assigned to a sitting-up position with the head elevated to at least 30 degrees for 24 hours. (Funded by the

Background and Purpose-The purpose of this study was to determine whether motivational interviewing (MI), a patient-centered counseling technique, can benefit patients' mood and mortality poststroke. Methods-This was a single-center, open, randomized, controlled trial. The setting was a hospital with a stroke unit. Four hundred eleven consecutive patients on the stroke register were Ͼ18 years old, not known to be moving out-of-area postdischarge, not receiving psychiatric or clinical psychology intervention, and were without severe cognitive or communication problems preventing participation in interviews. All patients received usual stroke care. Patients in the intervention group also received 4 individual, weekly sessions of MI. The primary outcome was the proportion of patients with normal mood measured by the 28-item General Health Questionnaire (normal Ͻ5; low Ն5) using a mailed questionnaire at 12 months poststroke. Results-At 12-month follow-up (including imputed data), 37.7% patients in the control group and 48.0% patients in the intervention group had normal mood. Twenty-five (12.8%) of 195 patients in the control group and 13 (6.5%) of 199 patients in the intervention group had died. A significant benefit of motivational interviewing over usual stroke care was found for mood (Pϭ0.020; OR, 1.66; 95% CI, 1.08 to 2.55) and mortality (Pϭ0.035; OR, 2.14; 95% CI, 1.06 to 4.38). Conclusions-Results

The results suggest that the introduction of team co-ordinated approaches (team notes and care pathways) do not improve attitudes to team working, teams appear to take a long time to establish cohesion and develop shared values.

One study found that participants were less anxious three months after using a relaxation CD when compared with those who were given no therapy. One study reported that participants were less anxious when treated with an antidepressant medicine (paroxetine), or with paroxetine and psychotherapy, than with standard care. This study reported that half of the participants receiving paroxetine 2 Interventions for treating anxiety after stroke (Review)