Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life

After stroke ≈75% of surviving patients will have problems in mobility, fatigue, emotion, and cognition, measured ≤5 years post stroke. Many patients with stroke will also experience reduced health-related quality of life (HRQoL). Known predictors of HRQoL are functional constraints, age, sex, socioeconomic status, depression, and coping strategy. Patients with stroke use insufficient active, problem-oriented coping strategies, whereas active coping strategies are associated with better HRQoL. During postacute rehabilitation, HRQoL will increase, along with recovery of bodily functions and activities. After discharge from rehabilitation, a decrease in HRQoL has been observed, with a further decline in the long term. The current study was set up to evaluate whether an add-on module on problem-solving skills in postacute stroke rehabilitation would result in better coping strategies and better HRQoL. Problem-solving and coping are different concepts. Coping is defined as the cognitive and behavioral efforts to deal with stressful situations and the emotions they generate, whereas problem-solving refers to the “process of finding solutions to specific problems”. Problem-solving therapy (PST) is an intervention in which patients are taught to increase structure in solving problems and flexibility by using different coping strategies in various situations. In patients with stroke, PST has been shown successful in reducing symptoms of depression Background and Purpose—This study investigated whether problem-solving therapy (PST) is an effective group intervention for improving coping strategy and health-related quality of life (HRQoL) in patients with stroke. Methods—In this multicenter randomized controlled trial, the intervention group received PST as add-on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear-mixed models. Primary outcomes were task-oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke-Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ-5D5L utility score, emotion-oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem-solving skills as measured by the Social Problem Solving Inventory-Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale. Results—Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19), 53% men, median time poststroke 7.29 months (interquartile range, 4.90–10.61 months). Six months post intervention, the PST group showed significant improvement when compared with the control group in task-oriented coping (P=0.008), but not stroke-specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months. Conclusions—PST seems to improve task-oriented coping but not disease-specific psychosocial HRQoL after stroke >6-month follow-up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping. Clinical Trial Registration—URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509. (Stroke. 2016;47:135-142. DOI: 10.1161/STROKEAHA.115.010961.)