Motivational Interviewing Early After Acute Stroke

Abstract

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...

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

“…This technique refers to client-centered counseling, in which the interventionist expresses empathy, rolls with resistance, develops discrepancy and builds self-efficacy [24][25][26][27][28]. An individualized action plan and wallet card with the main intervention messages was given to each participant to take home.…”

“…Patient's expressions of intention to change during motivational interviewing sessions have been associated with improved outcomes [27,28]. The involvement of participants and a focus on their unique experience contributed to the expression of empathy.…”

The 12-Month Effects of Early Motivational Interviewing After Acute Stroke

“…19 The same nurse then assigned intervention group patients to 1 of 4 therapists using an opaque sealed envelope in a pseudorandomized blocked design. The therapists were not involved in the initial assessment of patients, randomization, or assignment of patients to therapists.…”

“…Details of therapist training, supervision, and quality assessment of application of MI techniques are in the original report. 19 …”

“…23 We applied MI in a randomized controlled trial early poststroke. 19 Further details of this intervention are given in our article reporting results to 3-month follow-up, 19 which suggested MI improved mood 3 months poststroke. Here we report our results at 12-month follow-up.…”