Non-pharmacological interventions for post-stroke emotionalism (PSE) within inpatient stroke settings: a theory of planned behavior survey

ABSTRACT

Background: Post-stroke emotionalism (PSE) is common. Trials of antidepressants for PSE suggest only modest clinical benefit and risk of side effects. There have been no trials of non-pharmacological treatments for PSE; in fact, little is known about the non-pharmacological treatments actually provided to PSE sufferers in clinical practice.

Objectives: To determine the non-pharmacological interventions provided by stroke professionals, their perceived effectiveness, and the factors associated with the intention to provide them.

Methods: Focus groups and published sources of information were used to construct a comprehensive list of non-pharmacological approaches for PSE. This was followed by a national (online) survey of 220 UK stroke clinicians from nursing, medicine, and the allied health professions to investigate the approaches used in clinical practice, using Theory of Planned Behavior components to determine the factors associated with intention to provide them.

Results: Most respondents reported high intention to provide non-pharmacological interventions from the list that was constructed. Offering reassurance and talking to patients about goals were the commonest interventions, and distraction and tensing facial muscles least common. Respondents who perceived others to hold them professionally responsible for carrying out non-pharmacological approaches were more likely to use them, as were respondents who held more positive attitudes.

Conclusions: Our survey data reveal that stroke clinicians report regular use of non-pharmacological interventions for PSE. There is a pressing need for well-conducted clinical trials to evaluate the effectiveness of these approaches.

KEYWORDS:

• Emotionalism
• stroke
• rehabilitation
• interventions
• survey
• behavior
• questionnaire

Acknowledgments

We wish to acknowledge the work of our late colleague Dr Marion Murray in the early stages of this research.

Background details

Q1. Location of stroke service: Acute □; Post-acute □; Combined acute/post-acute □

Q2. Gender: Male □; Female □

Q3. Staff group: Medicine □; Nursing □; Occupational Therapy □; Physiotherapy □; Psychology □; Speech Therapy □; Other □ (please state)

Q4. The length of time you have worked in stroke care: 0-2 yrs □; 3-5 yrs □; 6-10 yrs □; 11+ yrs □

Each question in this survey refers to OFFERING A NON-DRUG TREATMENT APPROACH to inpatients with post-stroke emotionalism (PSE). PSE refers to “a lessening of control over emotions leading to a greater tendency to cry or laugh” (SIGN 118 Guideline, 2010).

Q5. Please estimate: (a) how often over the past 12 months you have provided the following non-drug treatment approaches for PSE; and (b) where you gave a rating of 2 or more on the first scale (i.e. you have provided the approach in question), please rate how effective you have personally found each approach in treating PSE.

Q6. On average, how many patients do you see each month with PSE? □

Q7. To distinguish between PSE and post-stroke depression is:

Easy 1 2 3 4 5 6 7 Difficult

Q8. How likely is it that you will provide a non-drug treatment approach for PSE over the next three months?

Unlikely 1 2 3 4 5 6 7 Likely

Q9. Non-drug treatment approaches for PSE are:

Useful 1 2 3 4 5 6 7 Useless

Harmful 1 2 3 4 5 6 7 Beneficial

Good practice 1 2 3 4 5 6 7 Bad practice

Unhelpful 1 2 3 4 5 6 7 Helpful

The right thing to do 1 2 3 4 5 6 7 The wrong thing to do

Inappropriate 1 2 3 4 5 6 7 Appropriate

Q10. Colleagues from other professions think I should provide non-drug treatment approaches for PSE

Strongly disagree 1 2 3 4 5 6 7 Strongly agree

Q11. Colleagues from my profession think I should provide non-drug treatment approaches for PSE

Strongly disagree 1 2 3 4 5 6 7 Strongly agree

Q12. I am confident that I could provide non-drug treatment approaches for PSE if I wanted to

Strongly disagree 1 2 3 4 5 6 7 Strongly agree

Q13. For me to provide non-drug treatment approaches for PSE is:

Easy 1 2 3 4 5 6 7 Difficult

Q14. The decision to provide non-drug treatment approaches for PSE is beyond my control

Strongly disagree 1 2 3 4 5 6 7 Strongly agree

Q15. Whether I provide non-drug treatment approaches for PSE or not is entirely up to me

Strongly disagree 1 2 3 4 5 6 7 Strongly agree

Additional information

Funding

This work was supported by the Chest, Heart and Stroke Association Scotland [Minor Research Award].