Date Presented 4/21/2018
This pilot study tested a novel positive psychology intervention for couples coping with stroke. There is a need for interventions targeting both survivors and care partners after stroke to improve depression, occupational participation, and quality of life.
Primary Author and Speaker: Alexandra Terrill
Contributing Authors: Beth Cardell, Jackie Einerson, Justin J. MacKenzie, Jennifer J. Majersik, Lorie Richards
PURPOSE: Depressive symptoms poststroke occur in 30%–50% of people with stroke and their care partners and adversely affect participation and quality of life (QOL). Emotional well-being is interdependent in couples; depression in one partner increases depression risk in the other. Sustaining well-being in both partners is important for occupational engagement and community reintegration. Yet interventions to support couples after stroke are lacking and often overlooked during standard rehabilitation services. We pilot tested a positive psychology–based intervention (PPI) in couples affected by stroke to improve depressive symptoms, participation in meaningful activities, and QOL.
METHOD: This study was a pretest–posttest clinical intervention pilot trial. Participants were recruited through university-affiliated outpatient neurology and rehabilitation clinics. Twelve community-dwelling cohabiting couples enrolled; one partner had had a stroke >6 mo previously and one or both reported depressive symptoms. The sample was primarily White and well educated, included 60% female survivors and male care partners, and had a mean age of 56 (range = 27–84). Participants, independently and in separate rooms to reduce potential reporting bias, completed baseline testing with the eight-item PROMIS Depression Short Form and the Stroke Impact Scale (SIS; Version 3.0). On the SIS, participants with stroke rated poststroke function in eight domains: strength, hand function, mobility, activities of daily living, emotion, memory, communication, and social participation. An additional item was perceived percentage recovery from stroke (0% = no recovery, 100% = full recovery). Care partners rated their partner’s function on an adapted SIS.
After a short training, participants engaged in an 8-wk self-administered PPI at home, completing two activities alone and two together each week (e.g., expressing gratitude, working toward a goal, savoring). We provided activity booklets, tracking calendars, and weekly check-in calls. Participants then completed postintervention testing. Outcomes were analyzed via paired samples t tests.
RESULTS: After the PPI, depressive symptoms decreased significantly in survivors and care partners (p = .01); nearly 70% of participants reported less depression. Participants with stroke reported significant improvement in the SIS meaningful activities domain (p = .009); 70% reported less participation limitation. There was a trend for improvement in communication (p = .17); half of participants with stroke noted less communication difficulty. Although more than half of care partners saw advances in their partner’s engagement in these domains, their ratings were not statistically significant. All other SIS domains (except hand function) improved after the intervention, but changes did not reach significance in this small sample. Care partner–reported changes were not always consistent with changes reported by their partners with stroke. Of note, on the SIS percentage recovery item, couples agreed on the presence of improvement in recovery after the intervention, yet care partners estimated a greater improvement in recovery.
CONCLUSION: This study is the first to use a dyadic PPI to target and examine impact on both stroke survivors and their care partners. Preliminary results suggest the PPI may be effective in improving depressive symptoms in couples affected by stroke and occupational participation for stroke survivors. Although generalizability is limited by the small sample, these findings represent a promising first step in a novel dyadic approach easily incorporated into standard occupational therapy rehabilitation to address the needs of this population.
References
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Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health, 13, 119. https://doi.org/10.1186/1471-2458-13-119
Towfighi, A., Ovbiagele, B., El Husseini, N., Hackett, M. L., Jorge, R. E., Kissela, B. M., . . . Williams, L. S. (2017). Poststroke depression: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 48(2), e30-e43. https://doi.org/10.1161/str.0000000000000113
