Problem Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health Related Quality of Life: Randomized Controlled Trial
Background and Purpose This study investigated whether problem solving therapy (PST) is an effective group intervention for improving coping strategy and health related quality of life (HRQoL) in patients with stroke. Methods In this multicenter randomized controlled trial, the intervention group received PST as add on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear mixed models. Primary outcomes were task oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ 5D 5L utility score, emotion oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem solving skills as measured by the Social Problem Solving Inventory Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale. Results Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19) 53% men, median time poststroke 7.29 months (interquartile range, 4.90 10.61 months) Six months post intervention, the PST group showed significant improvement when compared with the control group in task oriented coping (P=0.008) but not stroke specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months. Conclusions PST seems to improve task oriented coping but not disease specific psychosocial HRQoL after stroke >6 month follow up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping. Clinical Trial Registration URL: http:/www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509.
Stroke