Joyce A Kootker1, Sascha M C Rasquin2, Frederik C Lem3, Caroline M van Heugten4, Luciano Fasotti5, Alexander C H Geurts6. 1. Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: joyce.kootker@radboudumc.nl. 2. Adelante Rehabilitation Center, Hoensbroek, The Netherlands; CAPHRI, Department of Rehabilitation Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. 3. Groot Klimmendaal, Rehabilitation Center, Arnhem, The Netherlands. 4. School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands. 5. Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Klimmendaal Rehabilitation Center, Arnhem, The Netherlands. 6. Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
Abstract
OBJECTIVE: To evaluate the effectiveness of individually tailored cognitive behavioral therapy (CBT) for reducing depressive symptoms with or without anxiety poststroke. DESIGN: Multicenter, assessor-blinded, randomized controlled trial. SETTING: Ambulatory rehabilitation setting. PARTICIPANTS: Patients who had a Hospital Anxiety and Depression Scale-depression subscale (HADS-D) score >7 at least 3 months poststroke (N=61). INTERVENTIONS: Participants were randomly allocated to either augmented CBT or computerized cognitive training (CCT). The CBT intervention was based on the principles of recognizing, registering, and altering negative thoughts and cognitions. CBT was augmented with goal-directed real-life activity training given by an occupational or movement therapist. MAIN OUTCOME MEASURES: HADS-D was the primary outcome, and measures of participation and quality of life were secondary outcomes. Outcome measurements were performed at baseline, immediately posttreatment, and at 4- and 8-month follow-up. Analysis was performed with linear mixed models using group (CBT vs CCT) as the between-subjects factor and time (4 assessments) as the within-subjects factor. RESULTS: Mixed model analyses showed a significant and persistent time effect for HADS-D (mean difference, -4.6; 95% confidence interval, -5.7 to -3.6; P<.001) and for participation and quality of life in both groups. There was no significant group × time effect for any of the outcome measures. CONCLUSIONS: Our augmented CBT intervention was not superior to CCT for the treatment of mood disorders after stroke. Future studies should determine whether both interventions are better than natural history.
RCT Entities:
OBJECTIVE: To evaluate the effectiveness of individually tailored cognitive behavioral therapy (CBT) for reducing depressive symptoms with or without anxiety poststroke. DESIGN: Multicenter, assessor-blinded, randomized controlled trial. SETTING: Ambulatory rehabilitation setting. PARTICIPANTS: Patients who had a Hospital Anxiety and Depression Scale-depression subscale (HADS-D) score >7 at least 3 months poststroke (N=61). INTERVENTIONS:Participants were randomly allocated to either augmented CBT or computerized cognitive training (CCT). The CBT intervention was based on the principles of recognizing, registering, and altering negative thoughts and cognitions. CBT was augmented with goal-directed real-life activity training given by an occupational or movement therapist. MAIN OUTCOME MEASURES: HADS-D was the primary outcome, and measures of participation and quality of life were secondary outcomes. Outcome measurements were performed at baseline, immediately posttreatment, and at 4- and 8-month follow-up. Analysis was performed with linear mixed models using group (CBT vs CCT) as the between-subjects factor and time (4 assessments) as the within-subjects factor. RESULTS: Mixed model analyses showed a significant and persistent time effect for HADS-D (mean difference, -4.6; 95% confidence interval, -5.7 to -3.6; P<.001) and for participation and quality of life in both groups. There was no significant group × time effect for any of the outcome measures. CONCLUSIONS: Our augmented CBT intervention was not superior to CCT for the treatment of mood disorders after stroke. Future studies should determine whether both interventions are better than natural history.
Authors: Evelien van Valen; Ellie Wekking; Moniek van Hout; Gert van der Laan; Gerard Hageman; Frank van Dijk; Angela de Boer; Mirjam Sprangers Journal: Int Arch Occup Environ Health Date: 2018-06-25 Impact factor: 3.015
Authors: Yejin Lee; Brian Chen; Mandy W M Fong; Jin-Moo Lee; Ginger E Nicol; Eric J Lenze; Lisa T Connor; Carolyn Baum; Alex W K Wong Journal: Top Stroke Rehabil Date: 2020-08-12 Impact factor: 2.119