Regaining confidence after stroke: a feasibility study

Hooban, Kate Elizabeth (2016) Regaining confidence after stroke: a feasibility study. MPhil thesis, University of Nottingham.

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Abstract

Background:

Stroke is a common health condition with an incidence rate of 152,000 new strokes every year in the UK. Stroke survivors frequently experience mood disorders and reduced confidence post stroke, which have a significant impact on quality of life. There is limited research providing evidence for the effectiveness of group psychological support interventions, such as the Regaining Confidence after Stroke (RCAS) programme, which aims to address low mood and confidence post stroke. This study was designed to assess the feasibility of delivering the RCAS intervention to stroke survivors (and their carers) and of completing a randomised controlled trial (RCT) to evaluate its effectiveness.

Method:

A feasibility randomised controlled trial was conducted which aimed to recruit 60 participants. Methods of recruitment, screening, and gaining consent were explored. Participants were recruited from two different recruitment sources either through postal invitation letter or by face to face invitation and provided with study information. A screening tool was used to exclude participants who did not meet the study criteria. All eligible participants provided written consent to participate in the study. Carers of participants were also invited to participate in the study.

Randomisation was completed using a computer programme for random number generation and allocation. Participants were allocated to two groups; intervention and control. The intervention participants and their carers were invited to attend the 11 week RCAS group intervention which was delivered in a community venue by a trained rehabilitation support worker and assistant psychologist. The control participants and their carers were not invited to the RCAS group. All study participants continued to receive ‘usual care’. Attendance and fidelity of the intervention were measured through RCAS records, patient interviews and video recordings of the intervention. Semi structured interviews were completed with intervention group participants three months after randomisation to measure acceptability of the RCAS intervention.

Baseline and follow up questionnaires measuring mood, confidence and functional ability were completed at three and six months after randomisation with all willing study participants. Carer mood and strain were also assessed through questionnaires. Interviews were transcribed, coded and analysed using framework analysis. RCAS session video recordings were analysed against a checklist of criteria devised from the RCAS manual. Participant and carer questionnaire outcomes were analysed to describe the sample and to examine for evidence of effectiveness of the intervention.

Results:

Forty seven out of six hundred and forty (7%) people with stroke contacted were recruited into the study. Of the 47 participants, 22 were allocated to the intervention group and 25 to the control group. As 47 out of the proposed 60 participants were recruited, 78.3% of the target sample size was achieved.

The intervention was delivered to four separate groups of participants. A median of 8.1 out of the possible eleven sessions were attended by the participants. At the three month follow up 35 (77.8%) of the participants returned the questionnaires, and 30 (66.7%) were returned at the six months follow up. Of all the questionnaires sent, 38 (42.2%) were returned fully completed. The General Health Questionnaire for mood was the most fully completed by participants, with 78.5% of participants fully completing the measure. The COPE questionnaire for coping was the least fully completed with 63.1% of participants fully completing this measure.

Interviews were completed with eight of the intervention group participants. The interviews highlighted that participants enjoyed attending the intervention, and found support from sharing experiences, however there was mixed opinion on the preferred number of people attending the intervention sessions. The interviews highlighted that the majority of participants felt that the intervention had improved their mood and that the skills of the intervention leader had a key role in participant’s experience of the group.

Conclusion:

The results from this study provide evidence that a definitive RCT to evaluate the RCAS intervention can be completed. People with stroke can be recruited into a study to evaluate the RCAS intervention but the return rate to postal invitations was low. They engaged with the intervention, enjoyed attending the sessions and felt that the skills of the instructor were important to the success of the intervention. The participants returned the follow up questionnaires at a high enough rate to suggest that outcome data could be collected by post. However the amount of missing data on the individual outcome measures is a concern and needs to be explored more fully.

Item Type: Thesis (University of Nottingham only) (MPhil)
Supervisors: Logan, P.A.
Lincoln, N.B.
Keywords: Stroke rehabilitation, Group psychological support interventions
Subjects: W Medicine and related subjects (NLM Classification) > WL Nervous system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 38848
Depositing User: Hooban, Kate
Date Deposited: 10 Feb 2017 11:28
Last Modified: 19 Oct 2017 17:30
URI: http://eprints.nottingham.ac.uk/id/eprint/38848

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