title: Effectiveness of psychological interventions in chronic stage of stroke: a systematic review.
abstract: OBJECTIVE
  To examine the effectiveness of interventions for psychological issues faced by individuals post stroke when initiated in the chronic stage of stroke.
  
  
  METHODS
  MEDLINE, CINAHL, EMBASE, and Scopus databases were searched from 1980 to July 2012. A study was included if (1) the study was a randomized controlled trial (RCT); (2) at least 50% of individuals in the study were entered into the study at over 6 months post stroke; (3) the study examined the effect of an intervention on psychological functioning; and (4) study participants were ≥ 18 years of age. Similar interventions were grouped and results summarized. Data on the study design, participant characteristics, interventions, outcomes, and adverse events were extracted from each of the selected studies.
  
  
  RESULTS
  Nine RCTs met inclusion criteria. All 9 studies examined effectiveness on mood and 3 on adjustment. Repetitive transcranial magnetic stimulation had the strongest evidence of effectiveness in improving mood followed by pharmacotherapy; whereas exercise appeared to be effective in improving adjustment and coping among individuals in the chronic stage of stroke.
  
  
  CONCLUSIONS
  Overall, interventions provided in the chronic stage of stroke appear to be effective in improving mood and adjustment up to 3 months post intervention. The use of multidisciplinary interventions and acceptance models may be important in the overall adjustment process.
authors.affiliation: Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.forename: Shelialah
authors.initials: S
authors.lastname: Pereira
authors.forename: Shannon
authors.initials: S
authors.lastname: Janzen
authors.forename: Amanda
authors.initials: A
authors.lastname: McIntyre
authors.forename: Andrew
authors.initials: A
authors.lastname: McClure
authors.forename: Robert W
authors.initials: RW
authors.lastname: Teasell
mesh_terms: D000223:Adaptation, Psychological; D000341:Affective Disorders, Psychotic / Q000209:etiology* / Q000628:therapy*; D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000523:psychology