Motivational interviewing improves patients' mood and reduces mortality 12 months poststroke
- Correspondence to David R Thompson
Cardiovascular Research Centre, Australian Catholic University, VECCI Building Level 4, 486 Albert Street, Melbourne, VIC 3002, Australia;
Implications for nursing practice and research
■ The study findings that motivational interviewing improves mood and reduces mortality a year after acute stroke should inform clinical practice guidelines.
■ More trial data are needed to examine factors such as whether frequency of motivational interviewing sessions is more important than time frame, whether there are differences in therapist effects and whether there are differences using a training and supervision manual when applying motivational interviewing.
■ More research is needed to explore the mechanisms by which motivational interviewing is effective and how it influences mood and survival.
Depression is common after a stroke, and, if it occurs early, it can inhibit recovery as depressed patients often lack motivation to participate in rehabilitation and leisure and social activities. Psychological treatments, if initiated early poststroke, are more likely to prevent and/or treat depression.
Motivational interviewing is a specific talk-based therapy designed to engage ambivalent or resistant patients/clients in the process of health behaviour change.1 It was originally developed to help people with addictions, but it is being used successfully with a wide range of health problems, including cardiovascular disease2 and stroke.3
Watkins and colleagues3 previously reported using motivational interviewing in a randomised controlled trial early after acute stroke and found improved mood at 3 months poststroke. The current study reports the results at 12-month follow-up.
An open, randomised controlled trial was conducted at a hospital with a stroke unit. Four hundred and eleven patients on the stroke register aged above 18 without cognitive or communication problems and not receiving psychiatric or psychological intervention were studied. All patients received usual stroke care, but those in the intervention group (n=204) also received up to four 30–60 min individual, weekly sessions of motivational interviewing. The primary outcome was the proportion of patients with normal mood measured by the 28-item General Health Questionnaire (GHQ-28) mailed at 12-month poststroke. Secondary outcomes were mortality, depression screen, activities of daily living, and beliefs and expectations of recovery.
Data were analysed on an intention-to-treat basis. Where data were missing, imputations were performed.
At 12-month follow-up, 37.7% of patients in the control group and 48% in the intervention group had normal mood (GHQ-28 score <5), and 12.8% in the control group and 6.5% in the intervention group had died. A significant benefit of motivational interviewing over usual stroke care was found for mood (OR 1.66, 95% CI 1.08 to 2.55) and mortality (OR 2.14 95% CI 1.06 to 4.38). There were no significant differences between groups on the other secondary outcomes.
The authors concluded that motivational interviewing improves patients' mood and reduces mortality 12 months poststroke. They noted that this supports their earlier study of motivational interviewing having a beneficial effect on patient mood at 3 months poststroke. They also noted that other poststroke studies have neither examined talk-based interventions so early (beginning within 4 weeks poststroke) nor found such beneficial effects. The protective effect of motivational interviewing on survival is striking and, as the authors point out, suggests that improving mood could increase survival poststroke.
As the authors allude, further research is warranted to examine factors such as whether the frequency of motivational interviewing sessions is more important than the timeframe, whether there are differences in therapist effect and whether there are differences using a training and supervision manual when applying motivational interviewing. Finally, as the authors suggest, more research is needed to explore the mechanisms by which motivational interviewing is effective and how it influences mood and survival.