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 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.
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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.”
SOURCE: http://bit.ly/1Y2C1eJ Stroke, online November 19, 2015.
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