Video Narratives Intervention Among Stroke Survivors: Feasibility and Acceptability Study of a Randomized Controlled Trial

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>A large number of stroke survivors worldwide suffer from moderate to severe disability. In Malaysia, long-term uncontrolled stroke risk factors lead to unforeseen rates of recurrent stroke and a growing incidence of stroke occurrence across ages, predominantly among the elderly population. This situation has motivated research efforts focused on tapping into patient education, especially related to patient self-efficacy of understanding and taking medication appropriately. Video narratives integrated with health belief model constructs have demonstrated potential impacts as an aide to patient education efforts.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The aim of this study was to investigate the feasibility and acceptability of study procedures based on a randomized controlled trial protocol of a video narratives intervention among poststroke patients. We also aimed to obtain preliminary findings of video narratives related to medication understanding and use self-efficacy (MUSE) and blood pressure control.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A parallel group randomized controlled trial including a control group (without video viewing) and an intervention group (with video viewing) was conducted by researchers at a neurology outpatient clinic on poststroke patients (N=54). Baseline data included patients’ sociodemographic characteristics, medical information, and all outcome measures. Measurements of MUSE and blood pressure following the trial were taken during a 3-month follow-up period. Feasibility of the trial was assessed based on recruitment and study completion rates along with patients’ feedback on the burden of the study procedures and outcome measures. Acceptability of the trial was analyzed qualitatively. Statistical analysis was applied to ascertain the preliminary results of video narratives.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The recruitment rate was 60 out of 117 patients (51.3%). Nevertheless, the dropout rate of 10% was within the acceptable range. Patients were aged between 21 and 74 years. Nearly 50 of the patients (&gt;85%) had adequate health literacy and exposure to stroke education. Most of the patients (&gt;80%) were diagnosed with ischemic stroke, whereby the majority had primary hypertension. The technicalities of randomization and patient approach were carried out with minimal challenge and adequate patient satisfaction. The video contents received good responses with respect to comprehension and simplicity. Moreover, an in-depth phone interview with 8 patients indicated that the video narratives were considered to be useful and inspiring. These findings paralleled the preliminary findings of significant improvement within groups in MUSE (P=.001) and systolic blood pressure control (P=.04).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The queries and feedback from each phase in this study have been acknowledged and will be taken forward in the full trial.</jats:p> </jats:sec> <jats:sec> <jats:title>Trial Registration</jats:title> <jats:p>Australian New Zealand Clinical Trials Registry ACTRN 12618000174280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373554</jats:p> </jats:sec>

An Integrative Review Considering the Impact of Storytelling and Sharing Interventions in Stroke

“…Fourteen studies were included in the integrated synthesis. This included six qualitative studies [ 29 , 30 , 31 , 32 , 33 , 34 ], two RCTs [ 35 , 36 ] and six mixed-method studies [ 37 , 38 , 39 , 40 , 41 , 42 ]. Figure 1 gives a full breakdown of the process of searching and identifying studies.…”

“…Time since stroke onset ranged from two weeks post stroke to 174 months post stroke. Participants in the studies with the largest populations [ 32 , 35 , 36 , 38 , 40 ] had ischemic stroke. The type of stroke in the remaining studies [ 29 , 30 , 31 , 33 , 34 , 37 , 39 ] was unknown.…”

“…Kessler et al [ 32 ] included stroke survivors who had moderate dependence when performing basic activities of daily living. Appalasamy et al [ 36 , 40 ] included participants with several stroke risk factors and most had primary hypertension. The remaining studies did not provide information regarding their participants’ health or characteristics [ 30 , 37 , 38 , 39 ].…”

“…Half of the studies used subjects who lived in their own homes and the majority lived with a spouse or other family members [ 29 , 32 , 33 , 35 , 38 ], while the remaining studies did not disclose details of participants’ living environment [ 30 , 31 , 34 , 35 , 37 , 39 , 40 , 41 , 42 ]. Among the 727 participants, 164 were married, 51 had significant others, seven were single, five divorced and one widowed, while the marital status of the other 499 was not disclosed.…”

“…In accordance with the definition of classes of evidence [ 21 ], three studies [ 35 , 36 , 40 ] were assessed as moderate at low risk, rated II, one [ 38 ] as at moderate high risk, rated III, and four [ 37 , 39 , 41 , 42 ] were evaluated as at high risk of bias, rated IV.…”