Stroke Clinical Trial
Official title:
A Feasibility Study of a Brief Psychological Intervention for Post-stroke Fatigue
Stroke is a leading cause of adult disability in the community. Fatigue affects about a third
of stroke survivors. It results in difficulty taking part in everyday activities, and
increases risk of hospitalization and death after stroke. Despite of its high prevalence and
distressing consequences, there is no effective treatment.
Psychological interventions have improved fatigue in patients with other conditions such as
multiple sclerosis. These interventions primarily target patients' beliefs about overcoming
fatigue and their physical activities in daily life. Also studies indicated that post-stroke
fatigue is associated with mood. Based on this knowledge, the investigator has designed a
brief psychological intervention for post-stroke fatigue.
The current study is a feasibility study to test the adequacy of intervention manuals and the
feasibility of trial processes. This study will need 12 stroke survivors who have post-stroke
fatigue and are over three months but within two years after their stroke. Stroke survivors
with severe depression or having insufficient capability in cognition or communication will
not be included. The investigator will check their eligibility by questionnaires and
interviews and then invite eligible people to take part in the study.
This intervention will be delivered by a therapist (a clinical psychologist) to each
participant through six face-to-face therapy sessions. Each session will be about one hour
and be two weeks' apart. During the sessions, participants will discuss with the therapist
their fatigue problems, and, with the support from the therapist, work out ways to solve
their problems. One month after the last face-to-face session, each participant will receive
a feedback session by telephone from the therapist. Each participant will be followed up to
three months after the last face-to-face session.
After all participants complete their feedback sessions, the investigator will invite them to
a group meeting to share their experiences of taking part in this trial and makes suggestions
as how their experiences of this intervention, and also of this trial, could be improved.
This is a feasibility study to test a brief psychological intervention for post-stroke
fatigue. 12 stroke survivors with post-stroke fatigue will be recruited for this study. This
intervention has been adapted from similar interventions that have improved fatigue in other
conditions, such as multiple sclerosis, cancer and chronic fatigue syndrome. Like in other
conditions, fatigue in stroke survivors is associated with low mood, people's beliefs about
overcoming fatigue, and reduced physical activity. This intervention will target patients'
mood, their beliefs about their ability to overcome fatigue, and the scheduling of daily
activities, with an aim to increase physical activities in daily life and finally reduce the
level of fatigue.
Following the relevant guideline of the United Kingdom (UK) Medical Research Council, the
investigators will perform a sequence of trials to test the feasibility, safety and
effectiveness of this intervention. Current study is an initial stage to test the feasibility
of the intervention, i.e. whether this brief psychological intervention could be adequately
delivered to people with post-stroke fatigue on an individual basis. To standardize the
therapeutic components of this psychological intervention, this intervention will be
delivered by a clinical psychologist in the current study. In subsequent trials, the
intervention will then be adapted to be delivered by stroke nurses, which is a more practical
situation within the National Health Service of the United Kingdom.
Check for eligibility and consent for participation: the investigator will send mails to
stroke survivors who had a stroke between the past three to 24 months to invite them to take
part in a survey for post-stroke fatigue and depression. For those who have post-stroke
fatigue and do not have severe depression, they will be invited to a face-to-face meeting
with the investigator. At this meeting, the investigator will further check the eligibility
of each potential participant and answer his/her questions about this study. If the potential
participant is willing to take part in the trial, him/her will be asked to sign a consent
form for participation.
Baseline assessment of clinical outcomes: after signing the consent, the participant will be
asked to complete four questionnaires for baseline assessment:
1. Fatigue Assessment Scale
2. Case definition of post-stroke fatigue
3. Nottingham Extended Activities of Daily Living
4. Stroke Impact Scale
Therapy sessions: each participant will be attending six face-to-face sessions over a period
of eleven weeks in the hospital. Each session will last for about one hour, where the
participant will meet a therapist (a clinical psychologist) of this intervention. With the
support from the therapist, the participant will work through an intervention manual to learn
skills to overcome their problems related to fatigue, especially for physical activity, mood
and sleep. There will be intervals of two weeks between sessions. During the intervals, the
participant will be asked to keep a diary to record their daily activities and sleep, to put
into action things they have agreed with the therapist (including doing more activity), or to
read sections of the intervention manual.
Post-treatment assessment of clinical outcomes: participants will three assessments of
clinical outcomes, i.e. immediately after completing all six treatment sessions, one month
after treatment, and three-month after treatment.
1. Fatigue (Fatigue Assessment Scale and a case definition of post-stroke fatigue)
2. Depression (Patient Health Questionnaire-9)
3. Independence in daily life (Nottingham Extended Activities of Daily Living)
4. Health-related quality of life (Stroke Impact Scale)
An interim analysis will be performed after one-month assessment and the final analysis will
be performed after the three-month assessment. Before- and after- treatment assessments will
show whether the intervention is beneficial for the above aspects and whether these benefits
could be maintained. The investigator will then write to each participant to inform them of
the individual results of both analyses.
Feedback session: at the time of one-month assessment, the participant will be asked to fill
a feedback form for their experience of this intervention and the trial. The investigator
will analyze the results of this feedback form as well as the results of one-month
assessment, and then inform both the participant and the therapist of the individual results.
Then the therapist will carry out a feedback session with each participant by telephone
(about one hour). During this session, they will discuss the results of assessments and any
difficulties that the participant may have experienced in the past month. They will also
agree a plan to make further improvement.
Fatigue is a chronic symptom which would require a long term for recovery. Thus this
intervention with six treatment sessions is expected to be an intensive initial program for
the recovery of post-stroke fatigue, from which participants will learn skills to overcome
fatigue-related problems that they can use in daily life. Thus the therapist will encourage
participants to continue using these skills in their daily life even after completing the
therapy sessions.
Feedback meeting: after all participants have completed their feedback sessions, the
investigator will invite them to a feedback meeting. This meeting will be facilitated by the
Chief Investigator of this study. At this meeting, participants will share their experience
in taking part in this trial, discuss any difficulties they have experienced, and make
suggestions to improve this intervention and the trial processes.
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