Problem-solving therapy may improve coping skills after stroke

Offering stroke patients problem-solving therapy in addition to traditional rehabilitation treatment may help them do a better job of coping with complex tasks than standard care alone, a recent study suggests.

Problem-solving therapy is an approach that focuses on helping patients identify specific problems and goals, generate multiple solutions, choose the best option, then assess how well this choice turns out.

"Problem-solving therapy is aimed at structuring all kinds of practical problems patients encounter in their daily life," said study co-author Majanka Heijenbrok-Kal of Erasmus University Medical Center in Rotterdam.

Researchers tested the effectiveness of this approach in a group of 166 stroke patients, half of whom received problem-solving therapy in addition to traditional rehab services such as occupational or speech therapy, physiotherapy, psychological counseling and help from social workers.

The group that received problem-solving therapy during their last eight weeks of outpatient rehabilitation had significantly more improvements in quality of life and task-oriented coping skills after six months. They also improved more in avoidance-coping, which is steering clear of sources of stress.

But problem-solving therapy wasn't linked to better outcomes for psychosocial problems specific to quality of life in stroke patients, such as challenges with personal relationships or interactions in social settings.

This was surprising, because the research team only expected the intervention to help with psychosocial problems, Heijenbrok-Kal said by email.

It's possible that the treatment may have had a broader effect on overall quality of life that masked the improvements in psychosocial problems, and it's also possible that the study may have failed to detect a small but relevant improvement, Heijenbrok-Kal said.

To test the effectiveness of this therapy, researchers offered half of the study participants eight weekly group treatment sessions, each lasting 1.5 hours.

At the start of the study, participants were 53 years old, on average, and had experienced their strokes five to 10 months earlier.

About 40 percent of them had left-side strokes, which may lead to personality changes, communication problems and paralysis on the right side of the body.

Three fourths of the participants had ischemic strokes, which are the most common form and are caused by obstructions inside blood vessels supplying the brain.

After six months, the problem-solving therapy group had significant improvements in task-oriented coping, while the control group of people receiving standard rehab care got slightly worse in this area. After one year, the problem-solving therapy group was still doing better in this area, but the difference was too small to rule out the role of chance.

Emotional coping declined in both groups, regardless of whether the participants received problem-solving therapy, researchers reported in the journal Stroke.

Over time, the therapy wasn't linked to improvements or differences between groups in problem-solving skills. This was surprising, and might be due to a broader improvement in other coping skills that made this specific outcome harder to detect, the researchers conclude.

It's also possible that the questionnaires used to measure problem-solving skills weren't sensitive enough to detect differences between the two groups, the study team concedes.

Because problem-solving therapy has been shown by previous research to improve depression, it may still be a useful intervention for stroke patients, noted Dr. Mary Hildebrand, a researcher at the Massachusetts General Hospital Institute of Health Professions in Boston.

"Depression after stroke has a negative effect on the person's ability to participate in rehabilitation, causing functional outcomes to be much worse," Hildebrand, who wasn't involved in the study, said by email.

Because not all stroke patients may experience the same impairments or degree of difficulty in the same areas, it can be possible for people to experience improvements in one aspect of quality of life without having a significant overall improvement in quality of life scores on surveys, noted Dimitris Kiosses, a psychiatry researcher at Weill Cornell Medicine in New York who wasn't involved in the study.

"The findings of the study are encouraging that problem-solving therapy may be beneficial as add on to outpatient rehabilitation," Kiosses said by email. "Nevertheless, additional research is needed to better understand the discrepancies of the results."