Date Presented 04/21/2023

Findings from the feasibility randomized controlled trial testing the efficacy of motivational interviewing and self-management in stroke rehabilitation support the study design and the potential of integrating chronic care supports early on.

Primary Author and Speaker: Danbi Lee

Additional Authors and Speakers: Melody Yang

Contributing Authors: Heidi Fischer, Jamie L. Tingey, Ralph Woods, McKenzie Miller, Charles Bombardier

Keywords:
motivational interviewing, self-management, stroke rehabilitation

PURPOSE: Stroke rehabilitation focuses on functional recovery, however, often does not include preparing patients for long-term self-management and community engagement. This study evaluated the feasibility of a trial testing the efficacy of motivational interviewing (MI) and self-management (SM) support in early stroke rehabilitation.

METHOD: An exploratory randomized controlled trial was conducted in which first-time stroke patients with a mild stroke (91% male, age=56±14.5), recruited at a Level 1 Stroke Center inpatient rehabilitation unit, were randomized into an intervention (n=6) or treatment-as-usual group (n=5). The intervention group received 5 MI sessions and a 6-session virtual group-based stroke specific SM program. Feasibility was evaluated by observation, focus groups, and interviews. Health, perceived recovery, patient activation, and self-efficacy outcomes were collected at baseline, discharge, and post-intervention by blinded assessors. Preliminary effects were analyzed using non-parametric effect sizes (r). Qualitative data were analyzed using thematic analysis.

RESULTS: Out of 24 eligible patients, 15 were enrolled and 11 completed the study. All outcome measures were feasible to use. Intervention attendance rate (n=11) was 100%, and fidelity remained strong. Perceived recovery and patient activation outcomes showed moderate effects (r>0.3). Participants were satisfied with the timing, structure, and content of the intervention and reported emotional benefits and gain of new insights, confidence, and knowledge.

CONCLUSION: The results of this feasibility trial indicate the need for a larger scale trial. While preliminary, participant satisfaction and positive effects support the potential of integrating MI and SM early on in stroke rehabilitation to support patients’ transition into life with a long-term disability. Occupational therapists can play a vital role in supporting this transition by integrating chronic care supports in practice.