Acceptance and Commitment Therapy to support psychological adjustment after stroke: Investigating acceptability, fidelity and measurement

Abstract

Stroke is a leading cause of disability in the UK and stroke survivors often require rehabilitation and support in the long-term. Mental health issues are a common long-term impact of stroke, and research into psychological support post-stroke has been identified as the number one research priority for Life after Stroke. There is a lack of interventions available to support wellbeing and adjustment post-stroke, and an insufficient workforce to deliver psychological interventions to stroke survivors. The Wellbeing After Stroke (WAterS) feasibility study developed and evaluated an Acceptance and Commitment Therapy (ACT) informed intervention for community-dwelling stroke survivors with mild-to-moderate cognitive and communication difficulties and/or distress in adjusting to stroke, to be delivered online in groups by trained frontline practitioners from the Stroke Association. This PhD used multiple methods and aimed to explore potential measurement tools for use in the WAterS study, to examine the fidelity of the delivery of the intervention, and to investigate acceptability by exploring the views of the deliverers and recipients of the intervention. A scoping review (Study One) was conducted to identify the processes and outcomes targeted, and measurement tools used, in previous ACT interventions for acquired neurological conditions. This study found numerous measures in use, which hampers the ability to strengthen the evidence base through the pooling of data. This study produced a comprehensive list of the processes, outcomes and tools that have been used previously, which informed the measures used in the WAterS study, and is a first step towards the future development of a standardised set of measures to use in ACT interventions with this population. Studies Two, Three and Four took place alongside the WAterS study. Practitioners were recruited and trained in the delivery of the WAterS intervention, and were then interviewed about the acceptability of the practitioner training and potential acceptability of the WAterS intervention delivery (Study Two). Following recruitment of stroke survivors, the WAterS intervention was delivered to groups of stroke survivors and the fidelity of delivery of the intervention was measured (Study Three). On intervention completion, stroke survivors were interviewed as to the acceptability of the groups (Study Four). Study Two found that the practitioner training was perceived to be acceptable, understandable and beneficial. Practitioners were motivated to deliver the WAterS intervention, but felt that additional preparation time would be required. Study Three investigated fidelity of delivery of the intervention to the protocol and the ACT model, and found that the practitioners delivered the intervention with high fidelity to the clinical protocol, but not always consistently with the ACT model. Study Four found that the WAterS intervention was broadly acceptable to the stroke survivors who received it. The intervention was reported to be supportive and accessible, with strategies that were applicable to the stroke survivors’ lives. The time-limited nature of the intervention was challenging to some participants. Taken as a whole, the promising findings from these four studies demonstrate that the WAterS intervention is appropriate for further investigation, and suggest that it is possible for practitioners to deliver psychological support online to stroke survivors, so increasing the reach and accessibility of this support.

Date of Award	6 Jan 2025
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Audrey Bowen (Supervisor), Emma Patchwood (Supervisor) & Sarah Cotterill (Supervisor)