Wellbeing After Stroke (WAterS): Feasibility Testing of a Co-developed Acceptance and Commitment Therapy Intervention to Support Psychological Adjustment After Stroke

Emma Patchwood; Hannah Foote; Andy Vail; Sarah Cotterill; Geoff Hill; WAterS PCPI Group; Audrey Bowen

doi:10.1177/02692155241239879

Wellbeing After Stroke (WAterS): Feasibility Testing of a Co-developed Acceptance and Commitment Therapy Intervention to Support Psychological Adjustment After Stroke

Clin Rehabil. 2024 Mar 20:2692155241239879. doi: 10.1177/02692155241239879. Online ahead of print.

Authors

Emma Patchwood^{1

2}, Hannah Foote^{1

2}, Andy Vail³, Sarah Cotterill³, Geoff Hill⁴; WAterS PCPI Group; Audrey Bowen^{1

2}

Affiliations

¹ Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance and University of Manchester, Manchester, UK.
² Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
³ Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
⁴ Neuropsychology Service, South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, UK.

PMID: 38505946
DOI: 10.1177/02692155241239879

Abstract

Objective: Feasibility test a co-developed intervention based on Acceptance and Commitment Therapy to support psychological adjustment post-stroke, delivered by a workforce with community in-reach.

Design: Observational feasibility study utilising patient, carer, public involvement.

Setting: Online. UK.

Participants: Stroke survivors with self-reported psychological distress 4 + months post-stroke.

Interventions: The co-developed Wellbeing After Stroke (WAterS) intervention includes: 9-weekly, structured, online, group sessions for stroke survivors, delivered via a training programme to upskill staff without Acceptance and Commitment Therapy experience, under Clinical Psychology supervision.

Main measures: Feasibility of recruitment and retention; data quality from candidate measures; safety. Clinical and demographic information at baseline; patient-reported outcome measures (PROMs) via online surveys (baseline, pre- and post-intervention, 3 and 6 months after intervention end) including Mood (hospital anxiety and depression scale (HADS)), Wellbeing (ONS4), Health-Related Quality of Life (EQ5D5L), Psychological Flexibility (AAQ-ABI) and Values-Based Living (VQ).

Results: We trained eight staff and recruited 17 stroke survivors with mild-to-moderate cognitive and communication difficulties. 12/17 (71%) joined three intervention groups with 98% attendance and no related adverse events. PROMS data were well-completed. The HADS is a possible future primary outcome (self-reported depression lower on average by 1.3 points: 8.5 pre-group to 7.1 at 3-month follow-up; 95% CI 0.4 to 3.2).

Conclusion: The WAterS intervention warrants further research evaluation. Staff can be trained and upskilled to deliver. It appears safe and feasible to deliver online to groups, and study recruitment and data collection are feasible. Funding has been secured to further develop the intervention, considering implementation and health equality.

Keywords: acceptance and commitment therapy; feasibility; psychological adjustment; rehabilitation; stroke.