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Neuroscience: Motivational Interviewing After Stroke Reduces Mortality, Improves Mood

Talk-based counseling technique effective after just four sessions

Early motivational interviewing improves patient mood and survival after stroke, according to a study published recently in Stroke.

Motivational interviewing (MI) is a talk-based therapy that has been applied to various health problems in the past. Because psychological issues are common post-stroke—and are correlated with worse recovery—the authors of the current study sought to investigate the effects of MI. They tested mood, using the well-validated GHQ-28 questionnaire, and mortality, both at 12 months. Participants were admitted to an urban hospital for acute stroke between July 2002 and January 2005. All were older than 18 years. Those who had severe cognitive or communication problems, were known to be moving out of the area after discharge, and those already receiving psychiatric or clinical psychological intervention were excluded from analysis.

Patients in the control group received usual medical, nursing, and therapeutic input including inpatient care, discharge planning, and post-stroke appointments at one, three, and six months. MI patients received up to four 30- to 60-minute sessions starting two to four weeks after stroke. Therapists facilitated discussions about patients' goals for recovery and perceived barriers. By reinforcing optimism and self-efficacy, they guided patients to identify their own solutions.

The authors found that MI resulted in significant benefit to patients at 12 months (the authors reported significant benefit at three months previously), both in terms of mood and mortality. No other study had examined talk-based interventions this early after stroke; no other study of a talk-based post-stroke intervention had yielded positive effect. The authors conclude that more research is needed but that MI is a relatively straightforward technique for healthcare professionals to learn and that it is effective.

Source: Watkins CL, Wathan JV, Leathley MJ, et al. 2011. The 12-month effects of early motivational interviewing after acute stroke: a randomized controlled trial. Stroke 42:1956-1961.