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Its just one study, but its an interesting one. Here's a news report:
July 1, 2011 — A type of talk therapy called motivational interviewing (MI) that has been shown to improve mood and reduce mortality 3 months after a stroke continues to be beneficial at 1 year, a new study suggests.
"Not only did this intervention reduce depression and mortality in the short term, but the effects were still apparent 12 months after the stroke," said lead study author Caroline Watkins, PhD, professor of stroke and older people's care, University of Central Lancashire, Preston, United Kingdom. "That's important because it's a brief psychological intervention delivered in the first few weeks after the stroke."
The study was published online June 23 in Stroke.
After motivational interviewing, trained therapists encourage patients to talk about their adjustment to stroke and to be more realistic about the future. "It may adjust patients' expectations of what can be achieved and help them to feel comfortable with that," said Dr. Watkins.
The single-center trial included patients who were admitted to a hospital with a stroke unit between July 2002 and January 2005 with an acute stroke. They were randomized to receive usual care (n = 207) or usual care and up to four 30- to 60-minute sessions of MI that began within 4 weeks after the stroke (n = 207).
Researchers used questionnaires to monitor improvement, including the 28-Item General Health Questionnaire (GHQ-28), a widely used questionnaire related to mood, and others that assess activities of daily living and beliefs and expectations of recovery (Stroke Expectations Questionnaire [SEQ]).
In the MI group, the odds ratio (OR) at 12 months of having normal mood (or GHQ-28 score <5) compared with the control group was 1.66 (95% confidence interval [CI], 1.08 – 2.55; P = .02). There was also a protective effect of MI on death (OR [alive relative to dead], 2.15; 95% CI, 1.06 – 4.38; P = .03).
However, because data on cause of death were not obtained for the study, the protective effect of MI on death may be a chance finding, commented the study authors.
Beliefs and Expectations
There were no significant differences between groups on mean SEQ beliefs score (adjusted difference in mean [intervention relative to control], 0.5; 95% CI, −1.4 to 2.4; P = .61) or mean SEQ expectations score (−1.0; 95% CI, −3.2 to 1.2; P = .37). This, said the study authors, may be due to the SEQ's inability to detect change.
The difference between SEQ beliefs and expectations reduced over time in the MI group, suggesting that those who received this therapy might be, on average, more realistic about recovery than those receiving only usual care, commented the study authors.
There was no demonstrable effect of MI on activities of daily living, which is surprising given that the intervention influenced mood and mood is related to poststroke function. "We only measured fairly basic activities, which may reflect severity of stroke, and those things may not be able to be changed dramatically," explained Dr. Watkins.
The study did not measure participation rates in social and leisure activities, which may better reflect improved mood. These, said Dr. Watkins, will be measured in future studies.
It's possible that those assigned to only usual care didn't do as well as the MI group simply because they were aware that they didn't get the intervention or that those receiving talk therapy got better because they knew they were getting extra attention.
Helping to Adjust
Dr. Watkins pointed out that MI works not just because it's based on talk therapy. Studies of cognitive behavior therapy, which also incorporates "talk" to change behaviors, suggest that this therapy doesn't seem to work to improve mood in stroke patients. "So there is something about this particular talk-based therapy [MI] that is helping people to adjust and not to feel so depressed about the future."
That "something" may be that MI doesn't just change behaviors but also expectations and encourages patients to come up with their own solutions. "It's about allowing people to set the agenda, to talk about the things they want to talk about, and giving them room to actually talk through things," said Dr. Watkins.
MI has been used to change behaviors in people who depend on alcohol, food, and cigarettes, she said.
The timing and frequency of the MI sessions may have contributed to the benefit of this therapy, and additional sessions may be even more effective. "Some people may benefit from having a longer intervention period, but we don't know that just now," said Dr. Watkins.
MI is relatively easy to learn, and various healthcare professionals can be trained to practice it. In this study, none of the therapists had experience in psychological therapy, although they were trained by neuropsychologists. They included 2 nurses and 2 psychology graduates.
The study had patients with some speech and language problems so the therapy does not have to be restricted to stroke patients with unaffected communication skills. In fact, said Dr. Watkins, “some preliminary analysis seems to show that not only have those people benefited, but it may be that they actually benefited more than the people who had normal communications.”
It's not clear why this would be, but it may have something to do with patients knowing they're being heard. “We wondered whether it had to do with having somebody who is prepared to sit down and actually listen to what you're saying and try to show by using reinforcement that they've heard what you've said and then allowing you to talk more about it.”
The mechanism by which MI was effective and how it influenced mood and survival require further exploration, said Dr. Watkins.
The next step for her research team is to see if the therapy works outside their center. She wants to perform a multicenter study possibly including centers in Australia.
Striking Benefit
Asked to comment, Howard S. Kirshnerm MD, professor and vice chair, Department of Neurology, Vanderbilt Medical Center North, Nashville, Tennessee, and a member of the American Academy of Neurology, said he found the "most striking benefit" of MI was reduced mortality at 1 year.
"Depression scales showed less benefit, and activity of daily living measures did not show a difference at 1 year," he wrote in an email to Medscape Medical News.
His greatest criticism is that the investigators only used measures of attitudes or optimism and didn't include a quality-of-life measure because improved quality of life may be the ultimate aim of the therapy.
The study authors have disclosed no relevant financial relationships.
Stroke. Published online June 23, 2011.
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