Motivational interviewing and self-management support in early stroke rehabilitation: A feasibility randomized controlled study

Research Objectives: To evaluate the feasibility of a trial testing the efficacy of motivational interviewing and a telehealth self-management program in early stroke rehabilitation.

Design: An exploratory randomized controlled trial

Setting: Hospitalized care (inpatient rehabilitation) and community setting

Participants: Using convenience sampling, first-time stroke patients with a mild stroke were recruited at a Level 1 Stroke Center inpatient rehabilitation unit and randomized into an intervention or treatment-as-usual group. Out of 24 eligible patients, 15 enrolled, and 10 completed the study (90% male; age=56 (14.5); intervention group n=6).

Interventions: The intervention group participated in five, 30-minute motivational interviewing sessions delivered in person and over phone by a rehabilitation psychologist and a weekly, 6-session, group-based self-management program, called Improving Participation After Stroke Self-management program-TeleRehab (IPASS-TR), delivered by an occupational therapist and stroke survivor via Zoom. Motivational interviewing focused on discussing post-stroke concerns identified by participants. IPASS-TR focused on building self-management skills to improve post-stroke life participation with an emphasis on understanding and navigating the impact of the environment.

Main Outcome Measures: Feasibility (recruitment rate, attrition, resources used, acceptability, fidelity) data through observation, focus groups, and interviews. PROMIS Global Health, Stroke Impact Scale Perceived Recovery Scale, Patient Activation Measure, NeuroQoL Satisfaction with Social Roles, and Participation Strategies Self-Efficacy Scale.

Results: Demographic and baseline outcome measures were similar between the groups. All outcome measures were feasible to use. Intervention attendance rate was 100%, and fidelity remained strong. Telehealth delivery required supports such as reminders and flexibility in scheduling. Participants were satisfied with the timing, structure, and content and reported emotional benefits and gain of new insights and knowledge. Perceived recovery showed moderate effect favoring the intervention group (r=0.54).

Conclusions: The feasibility of the trial and delivery supports the design of a larger scale trial. While preliminary, participant satisfaction and positive effects support the importance of integrating self-management focused interventions early on in stroke rehabilitation to support patients’ transition into their life with a long-term disability.

Author(s) Disclosures: No conflict to report