Neal S. Parikh, MD 

Visser MM, Heijenbrok-Kal MH, van‘t Spijker A, Lannoo E, Busschbach JJV, and Ribbers GM. ProblemSolving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life: Randomized Controlled Trial. Stroke. 2016   

Marieke Visser and colleagues sought to assess the utility of group-based problem solving therapy (PST) after stroke for improving coping strategies and health-related quality of life (HRQoL). 

The authors begin by summarizing the body of evidence regarding reduced HRQoL after stroke. One possible mediator of HRQoL is coping strategy. Problem-solving refers to an active process by which the stroke survivor finds specific solutions to specific problems, as opposed to the less active process of coping, by which the survivor simply learns to accept obstacles. The authors cite evidence suggesting that PST may be helpful for reducing depression. 

166 patients undergoing out-patient rehabilitation after stroke (including subarachnoid hemorrhage) who were deemed able to participate in group therapy were randomized to standard rehabilitation or standard rehabilitation plus PST. The PST module consisted of 8 weekly group sessions lasting 1.5 hours each during which participants were coached in positive problem solving techniques. Participants randomized to PST attended an average of 6.5 sessions.

Patients were assessed within 3 weeks prior to intervention, 10 days post-intervention, and 6 and 12 months post-intervention. The outcome measures were: 1. Coping Inventory for Stressful Situations, 2. Social Problem Solving Inventory-Revised and 3. Psychological, stroke-specific HRQoL scales. A secondary outcome was depression as measured by the Center for Epidemiologic Studies Depression Scale. Approximately 10% of subjects dropped out, roughly equally between the two groups.

At the 6 month post-intervention evaluation, PST was associated with increases in coping strategies deemed positive by the authors in addition to increases in general measures of HRQoL. These benefits were not apparent at 12 months post-intervention. There were no measurable, durable differences in problem-solving skills, psychological HRQoL, or depression between the two groups.

The results of the study are challenging to interpret. Unfortunately, the study did not utilize an active control group. Therefore, it is unclear whether the transient benefits of PST seen at the 6 month post-intervention evaluation were due to PST itself or simply the additional attention received by participants as compared to the control group.

This study demonstrates the feasibility of rigorous assessment of rehabilitative methods. Targeting specific cognitive rehabilitative approaches to patients with specific anatomically-based deficits may yield more convincing data. Advances in rehabilitation science may eventually allow clinicians to recommend individualized, high-yield programs for their patients.