The Effect of Motivational Interviewing on Rehabilitation Outcomes After Stroke: A Meta-Analysis

Objective(s): To efficiently consolidate existing evidence for the benefits of using MI in PT treatment of stroke and to suggest cohesive alternatives to reporting outcomes.

Data Sources: Databases searched were CINAHL, Cochrane, EMbase, Medline, and Pubmed. The following MeSH terms and text words were used: “physical therapy” OR “rehabilitation” AND “stroke” OR “CVA” AND “motivational interviewing” OR “cognitive behavioral therapy” OR “health coaching.” Researchers pooled outcome measures from RCTs that included patients who received PT after stroke.

Study Selection: Inclusion criteria: Adults 18 and older; males and females; acute, subacute, and chronic stroke; interventions of cognitive therapy and/or MI; patients with co-morbidities; comparison group of traditional therapy; outcome measures for function, adherence/compliance, activity, and/or participation.

Data Extraction: Data extraction and study quality assessment were performed by two reviewers. Disagreements were resolved by consensus and review by a third reviewer.

Data Synthesis:Due to high variability, outcome measures were analyzed together using Comprehensive Meta-Analysis software. A meta-analysis using standardized mean difference was performed. Completing a meta regression would not be appropriate due to the lack of a continuous variable. The pooling of outcome measures resulted in a small, yet statistically significant effect favoring MI in PT for stroke treatment: SDM=0.301 (SEM=0.077), p=0.000. Q=22.491 and I2=42.199, indicating moderate heterogeneity. This may be explained by the inclusion of two outlier studies with small samples, yielding higher effect sizes. A second meta-analysis excluding these two outliers confirmed this theory. The heterogeneity was virtually eliminated (Q=7.917, I2=0.000) and the inclusion of MI maintained a small, statistically significant effect overall with SDM=0.220 (SEM=0.053), p=0.000.

Conclusions: In conclusion, there are small, yet statistically meaningful improvements in outcome measures for patients after stroke with the inclusion of MI in their PT. This shows cognitive interventions have a positive effect on outcomes in this population and will guide research in the use of MI by PTs to collaborate with patients to improve outcomes in mobility, quality of life, satisfaction with care, and ultimately adherence to treatment.

Author(s) Disclosures: n/a