The effects of introducing psychoeducational programs in patients with stroke in post-acute care

Česká verzia

Authors: E. Prušová ¹; D. Školoudík ²; K. Langová ¹; K. Procházková ³; H. Kisvetrová ¹
Authors place of work: Centrum vědy a výzkumu, Fakulta zdravotnických věd, UP, Olomouc ¹; Centrum zdravotnického výzkumu, LF OU, Ostrava ²; Oddělení klinické psychologie, Neurochirurgická klinika FN Brno ³
Published in the journal: Cesk Slov Neurol N 2023; 86(6): 383-390
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2023383

Summary

Background: Stroke is not only a very common cause of death, but also the most common cause of disability and long-term health problems with a significant impact on patients‘ quality of life. The present study aimed to assess the effects of a psychoeducational program delivered simultaneously with standard rehabilitation care to patients in the post-acute phase of stroke on their health-related quality of life (HRQoL), dignity, levels of depression, levels of self-sufficiency in activities of daily life, and also pain. Methods: The randomized study involved adult patients after their first stroke occurrence who were admitted to post-acute inpatient rehabilitation care due to persistent neurological deficits. At the same time, they were partially self-sufficient and did not present with dementia or a phatic disorder or severe visual or hearing impairment. In addition to standard care, the intervention group was provided with multi-component psychoeducation. Data collection took place at patient enrollment and 3 months later using standardized questionnaires for health-related quality of life (EQ-5D-5L), depression (Beck‘s Depression Inventory [BDI-II]), dignity (The Patient Dignity Inventory [PDI]), coping with activities of daily living (Barthel index [BI]) and pain (Visual Analogue Scale [VAS]). Statistical evaluation was performed using univariate and multivariate analyses. Results: Of the 221 randomized patients, 201 (91%) completed the study; 102 in the intervention group (65 men, age 60 ± 13.6 years) and 99 in the control group (58 men, age 63 ± 13.4 years). After 3 months, there was a statistically significant difference in the change in EQ-5D-5L/domains (2.77 ± 2.08 vs. 0.93 ± 1,81), EQ-VAS (13.77 ± 12.06 vs. 4.23 ± 15.51), PDI (9.50 ± 8.33 vs. 2.47 ± 8.18), BI (14.94 ± 11.02 vs. 8.96 ± 9.16) and BDI (3.15 ± 3.61 vs. 0.40 ± 4.19) in the intervention group compared to the control group (for all P < 0.0001). Post-hoc analysis showed that the independent predictors of higher HRQoL were, apart from applied psychoeducation, greater degrees of self-sufficiency, less severe depression levels and lower intensity of pain. Conclusion: Psychoeducation is a suitable supplement to post-acute rehabilitation care for post-stroke patients leading to improvements in HRQoL, greater independence in activities of daily life, reduction of depression load and increased sense of dignity.

Keywords:

stroke – depression – health-related quality of life – dignity – psychoeducation – self-suffi ciency

Zdroje

1. Yeoh YS, Koh GC-H, Tan CS et al. Health-related quality of life loss associated with first-time stroke. PLoS One 2019; 14 (1): e0211493. doi: 10.1371/journal.pone.0211493.

2. Hinrichs T, Rössler R, Infanger D et al. Self-reported life- -space mobility in the first year after ischemic stroke: longitudinal findings from the MOBITEC-Stroke project. J Neurol 2023; 270 (8): 3992–4003. doi: 10.1007/s00415-023-11748-5.

3. Nemani K, Gurin L. Neuropsychiatric complications after stroke. Semin Neurol 2021; 41 (1): 85–100. doi: 10.1055/s-0040-1722723.

4. Langhammer B, Sunnerhagen KS, Stanghelle JK et al. Life satisfaction in persons with severe stroke – a longitudinal report from the Sunnaas International Network (SIN) stroke study. Eur Stroke J 2017; 2 (2): 154–162. doi: 10.1177/2396987317695140.

5. Kisvetrová H, Herzig R, Bretšnajdrová M et al. Predictors of quality of life and attitude to ageing in older adults with and without dementia. Aging Ment Health 2021; 25 (3): 535–542. doi: 10.1080/13607863.2019.1705758.

6. Camicia M, Lutz B, Summers D et al. Nursing’s role in successful stroke care transitions across the continuum: from acute care into the community. Stroke 2021; 52 (12): e794–e805. doi: 10.1161/STROKEAHA.121.033938.

7. Forster A, Hartley S, Barnard L et al. An intervention to support stroke survivors and their carers in the longer term (LoTS2Care): study protocol for a cluster randomised controlled feasibility trial. Trials 2018; 19 (1): 317. doi: 10.1186/s13063-018-2669-5.

8. Miler KK, Lin SH, Neville M. From hospital to home to participation: a position paper on transition planning poststroke. Arch Phys Med Rehabil 2019; 100 (6): 1162–1175. doi: 10.1016/j.apmr.2018.10.017.

9. Norrving B, Barrick J, Davalos A et al. Action plan for stroke in Europe 2018–2030. Eur Stroke J 2018; 3 (4): 309–336. doi: 10.1177/2396987318808719.

10. Mou H, Lam SKK, Chien WT. The effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: a randomised controlled trial. Int J Nur Stud 2023; 143: 104504. doi: 10.1016/j.ijnurstu.2023.104504.

11. Chen T, Zhang B, Deng Y. Long-term unmet needs after stroke: systematic review of evidence from survey studies. BMJ Open 2019; 9 (5): e028137. doi: 10.1136/bmjopen-2018-028137.

12. Kontou E, Kettlewell J, Condon L et al. A scoping review of psychoeducational interventions for people after transient ischemic attack and minor stroke. Top Stroke Rehabil 2021; 28 (5): 390–400. doi: 10.1080/1074 9357.2020.1818473.

13. EuroQol Research Foundation. EQ-5D-5L | About. [online]. Dostupné z URL: https: //euroqol.org/eq-5d-instruments/eq-5d-5l-about.

14. Pickard AS, Johnson JA, Feeny DH. Responsiveness of generic health-related quality of life measures in stroke. Qual Life Res 2005; 14 (1): 207–219. doi: 10.1007/s11136-004-3928-3.

15. Chen G, Olsen JA. Extending the EQ-5D: the case for a complementary set of 4 psycho-social dimensions. Qual Life Res 2023; 32 (2): 495–505. doi: 10.1007/s11136-022-03243-7.

16. Chochinov HM, Johnston W, McClement SE et al. Dignity and distress towards the end of life across four non-cancer populations. PLOS ONE 2016; 11 (1): e0147607. doi: 10.1371/journal.pone.0147607.

17. Kisvetrová H, Školoudík D, Danielová L et al. Czech version of the Patient Dignity Inventory: translation and validation in incurable patients. J Pain Symptom Manage 2018; 55 (2): 444–450. doi: 10.1016/j.jpainsymman.2017.10.008.

18. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J J 1965; 14: 61–65.

19. Duffy L, Gajree S, Langhorne P et al. Reliability (inter-rater agreement) of the Barthel Index for assessment of stroke survivors: systematic review and meta-analysis. Stroke 2013; 44 (2): 462–468. doi: 10.1161/STROKE AHA.112.678615.

20. Gallagher EJ, Bijur PE, Latimer C et al. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med 2002; 20 (4): 287–290. doi: 10.1053/ajem.2002.33778.

21. Qassim H, Zhao Y, Ströbe A et al. Deep Brain stimulation for chronic facial pain: an Individual Participant Data (IPD) meta-analysis. Brain Sci 2023; 13 (3): 492. doi: 10.3390/brainsci13030492.

22. Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation 1996.

23. Ptáček R, Raboch J, Vňuková M et al. Beckova škála deprese BDI-II – standardizace a využití v praxi. Česk a slov Psychiat 2016; 112 (6): 270–274.

24. Chiu EC, Chen YJ, Wu WC et al. Psychometric comparisons of three depression measures for patients with stroke. Am J Occup Ther 2022; 76 (4): 7604205140. doi: 10.5014/ajot.2022.049347.

25. Tielemans NS, Visser-Meily JM, Schepers VP et al. Effectiveness of the Restore4Stroke self-management intervention „Plan ahead!“: a randomized controlled trial in stroke patients and partners. J Rehabil Med 2015; 47 (10): 901–909. doi: 10.2340/16501977-2020.

26. van Mierlo M, van Heugten C, Post MWM et al. Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study. Disabil Rehabil 2018; 40 (9): 997–1006. doi: 10.1080/09638288.2017.129 2320.

27. Minshall C, Castle DJ, Thompson DR et al. A psychosocial intervention for stroke survivors and carers: 12-month outcomes of a randomized controlled trial. Top Stroke Rehabil 2020; 27 (8): 563–576. doi: 10.1080/10749357.2020.1738677.

28. Markle-Reid M, Orridge C, Weir R et al. Interprofessional stroke rehabilitation for stroke survivors using home care. Can J Neurol Sci 2011; 38 (2): 317–334. doi: 10.1017/s0317167100011537.

29. Ribeiro Lima R, Rose ML, Lima HN et al. Socio-demographic factors associated with quality of life after a multicomponent aphasia group therapy in people with sub-acute and chronic post-stroke aphasia. Aphasiology 2021; 35 (5): 1–16. doi: 10.1080/02687038.2020.1727710.

30. Rejnö ÅCU, Berg LK. Communication, the key in creating dignified encounters in unexpected sudden death – with stroke as example. Indian J Palliat Care 2019; 25 (1): 9–17. doi: 10.4103/IJPC.IJPC_117_18.

31. Ahmed T, Tamanna, Kumar R et al. Factors affecting quality of life among post-stroke patients in the Sub-Himalayan region. J Neurosci Rural Pract 2020; 11 (4): 616–622. doi: 10.1055/s-0040-1716927.

32. Fang Y, Mpofu E, Athanasou J. Reducing depressive or anxiety symptoms in post-stroke patients: pilot trial of a constructive integrative psychosocial intervention. Int J Health Sci 2017; 11 (4): 53–58.

33. Bakas T, Clark PC, Kelly-Hayes M et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke 2014; 45 (9): 2836–2852. doi: 10.1161/STR.0000000000000033.

34. Ostwald SK, Godwin KM, Cron SG et al. Home- -based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial. Disabil Rehabil 2014; 36 (1): 55–62. doi: 10.3109/09638288.2013.777806.

35. Visser MM, Heijenbrok-Kal MH, Spijker AV et al. Problem-solving therapy during outpatient stroke rehabilitation improves coping and health-related quality of life. Stroke 2016; 47 (1): 135–142. doi: 10.1161/STROKEAHA. 115.010961.

36. Verberne DPJ, Kroese MEAL, Staals J et al. Nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual. Disabil Rehabil 2022; 44 (12): 2849–2857. doi: 10.1080/09638288.2020.1849417.

37. Olukolade O, Osinowo HO. Efficacy of cognitive rehabilitation therapy on poststroke depression among survivors of first stroke attack in Ibadan, Nigeria. Behav Neurol 2017; 2017: 4058124. doi: 10.1155/2017/4058124.

38. Plecash AR, Chebini A, Ip A et al. Updates in the treatment of post-stroke pain. Curr Neurol Neurosci Rep 2019; 19 (11): 86. doi: 10.1007/s11910-019-1003-2.

39. Dydyk AM, Munakomi S. Thalamic pain syndrome. Treasure Island: StatPearls Publishing 2023.

40. Xiong F, Shen P, Li Z et al. Bibliometric analysis of post-stroke pain research published from 2012 to 2021. J Pain Res 2023; 16: 1–20. doi: 10.2147/JPR.S375063.

41. Valenta S, Miaskowski C, Spirig R et al. Randomized clinical trial to evaluate a cancer pain self-management intervention for outpatients. Asia Pac J Oncol Nurs 2022; 9 (1): 39–47. doi: 10.1016/j.apjon.2021.12.003.

42. Paolucci S, Iosa M, Toni D. Prevalence and time course of post-stroke pain: a multicenter prospective hospital-based study. Pain Med 2016; 15 (5): 924–930. doi: 10.1093/pm/pnv019.

43. Wróblewska I, Dziechciaż M, Wróblewska Z. The level of independence among seniors with a history of ischemic stroke. J Neurol Neurosurgl Nurs 2019; 8 (3): 112–118. doi: 10.15225/PNN.2019.8.3.3.

44. Chen HY, Chair SY, Chau JPC. Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: a randomised controlled trial. Int J Nurs Stud 2018; 87: 84–93. doi: 10.1016/j.ijnurstu. 2018.07.005.

45. Mou H, Wong MS, Chien WT. Effectiveness of dyadic psychoeducational intervention for stroke survivors and family caregivers on functional and psychosocial health: a systematic review and meta-analysis. Int J Nurs Stud 2021; 120: 103969. doi: 10.1016/j.ijnurstu.2021.103969.

46. Lee EY, Sohn MK, Lee JM et al. Changes in long-term functional independence in patients with moderate and severe ischemic stroke: comparison of the responsiveness of the modified Barthel index and the functional independence measure. Int J Environ Res Public Health 2022; 19 (15): 9612. doi: 10.3390/ijerph19159612.

47. de Wit L, Theuns P, Dejaeger E et al. Long-term impact of stroke on patients’ health-related quality of life. Disabil Rehabil 2017; 39 (14): 1435–1440. doi: 10.1080/09638288.2016.1200676.

48. Horne J, Lincoln NB, Preston J et al. What does confidence mean to people who have had a stroke? A qualitative interview study. Clin Rehabil 2014; 28 (11): 1125–1135. doi: 10.1177/026921551453408.