A systematic review of anxiety interventions in stroke and acquired brain injury: Efficacy and trial design

Abstract

ObjectiveThere is little randomized controlled trial (RCT) evidence to guide treatment for anxiety after stroke. We systematically reviewed RCTs of anxiety interventions in acquired brain injury (ABI) conditions including stroke and traumatic brain injury (TBI) in order to summarize efficacy and key aspects of trial design to help guide future RCTs.MethodsWe searched the Cochrane trial register, Medline, Embase, PsychInfo and CINAHL systematically up to August 2017. Two independent reviewers systematically selected studies and extracted data. We summarized the effect size, key study characteristics and sources of potential bias in trial design.Results14 studies (12 stroke; one stroke & TBI; one TBI) with 928 participants were included. Meta-analysis of five psychotherapy comparisons favoured intervention over control (standardized mean difference (SMD): − 0.41 [− 0.79, − 0.03], I2 = 28%); Overall effect size of pharmacotherapy comparisons favoured intervention over control (SMD: − 2.12 [− 3.05, − 1.18], I2 = 89%). One comparison of mixed pharmacotherapy and psychotherapy favoured intervention over usual care (SMD: − 4.79 [− 5.87, − 3.71]). One comparison favoured forest therapy versus urban control (SMD: − 2.00 [− 2.59, − 1.41]). All positive studies carried high or unclear risk of bias. Sample sizes were small in all included studies.ConclusionsThere is low quality evidence to suggest that psychotherapy and pharmacotherapy may be effective interventions in the treatment of anxiety after stroke based on underpowered studies that carried high risk of bias. Large-scale well-designed definitive trials are needed to establish whether pharmacological or psychotherapy works. Our review highlighted key considerations for investigators wishing to design high quality trials to evaluate treatments for anxiety after stroke.

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

“…In a study by Chun et al[ 62 , 64 , 65 ], meta-analysis including four pharmacotherapy comparisons studies (three studies published in Chinese journals) using paroxetine, imipramine, and buspirone, as well as eight psychotherapy comparisons studies showed an overall favorable pharmacotherapy and psychotherapy effect compared with control; however, the heterogeneity of the included studies of this meta-analysis was high and the quality of literature was relatively low. The positive conclusion may be driven by risk of bias[ 65 ]. In line with the study by Chun et al[ 64 ], a Cochrane review suggested that there was no high-quality clinical evidence to guide PSA management.…”

Forest and Wellbeing: Bridging Medical and Forest Research for Effective Forest-Based Initiatives

“…Among this body of research, an experience in forest is considered one method to positively influence mental, physical and social wellbeing [17,18]. Indeed, there is increasing evidence suggesting that forests, including both natural and urban woodlands, offer effective opportunities for enhancing people's quality of life [19,20], reducing public health care costs [21][22][23] and potentially providing alternative and innovative income sources for the forest sector. Accordingly, the number and variety of forest-based initiatives for health and wellbeing have increased [24] worldwide: from Shinrin-Yoku and forest bathing (FB) in Japan to healing forests in Korea, from social forestry to art exhibitions, from burial forests to forest kindergartens, examples are thriving [25,26].…”

A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population

“…One review found that, for stroke patients specifically, psychosocial counselling, problem‐solving interventions, motivational interviewing and psychoeducation about the possible effects of the injury are effective in reducing post‐stroke depressive symptoms (Kim, 2017). However, for reducing anxiety symptoms, the evidence for CBT (Knapp et al., 2017; Zhang et al., 2020) or other psychotherapies, such as acceptance and commitment therapy, was insufficient (Chun et al., 2018; Soo et al., 2011). In addition, two systematic reviews and meta‐analyses and a nationwide population‐based study found small‐ to medium‐positive effects of physical exercise in reducing post‐ABI depressive symptoms (Liu et al., 2019; Perry et al., 2020; Yeh et al., 2020).…”