title: Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life: Randomized Controlled Trial.
abstract: OBJECTIVE
  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-5D-5L 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.
  
  
  BACKGROUND
  URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509.
authors.affiliation: From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.). mheijenbrok@rijndam.nl.
authors.forename: Marieke M
authors.initials: MM
authors.lastname: Visser
authors.affiliation: From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.).
authors.forename: Majanka H
authors.initials: MH
authors.lastname: Heijenbrok-Kal
authors.affiliation: From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.).
authors.forename: Adriaan
authors.initials: A
authors.lastname: Van't Spijker
authors.affiliation: From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.).
authors.forename: Engelien
authors.initials: E
authors.lastname: Lannoo
authors.affiliation: From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.).
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.affiliation: From the Department of Rehabilitation Medicine (M.M.V., M.H.H.-K., G.M.R.) and Department of Psychiatry, Section Medical Psychology and Psychotherapy (A.v.S., J.J.V.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research Department (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands (M.M.V., M.H.H.-K., G.M.R.); and Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium (E.L.).
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Ribbers
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D011340:Problem Solving; D011788:Quality of Life / Q000523:psychology*; D012047:Rehabilitation Centers; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation
keywords: adaptation, psychological; problem solving; quality of life; randomized controlled trial; stroke