Feasibility of Problem-Solving Training During Inpatient Rehabilitation in Patients With Stroke

Abstract

Abstract Importance: Stroke survivors report feeling unprepared to manage challenges that arise during the transition from hospital to home. Cultivating problem-solving skills before discharge may better prepare patients for the transition home. Objective: To determine the feasibility of a protocol to deliver Problem-Solving Training (PST) to stroke survivors during inpatient rehabilitation to increase goal achievement. Design: Single-group feasibility study. Setting: Academic and county hospital inpatient rehabilitation units. Participants: Adult patients with stroke and planned discharge home. Intervention: Up to six PST sessions over 2 to 3 wk followed by 3 mo of mobile health boosters. Results: Of 17 eligible participants, 15 consented and 11 completed three or more PST sessions. Six participants used electronic boosters, achieving at least one goal postdischarge. Participants reported high satisfaction with PST (Client Satisfaction Questionnaire–8 M score = 29.3, SD = 4.4; range = 8–32), moderate depression at baseline (eight-item Patient Health Questionnaire [PHQ–8] score, M = 11.0, SD = 6.1; range = 0–27), mild depression at 3 mo postdischarge (PHQ–8 score, M = 8.3, SD = 5.5), moderately high self-efficacy at baseline (General Self-Efficacy Scale [GSE] score, M = 31.1, SD = 7.3; range = 10–40), and a self-efficacy increase at 3 mo postdischarge (GSE score, M = 34.1, SD = 4.2). Conclusions and Relevance: PST among patients with stroke during inpatient rehabilitation was feasible, and participants demonstrated improvements in clinical outcomes and goal attainment. Barriers to participation and adherence should be addressed in future studies. What This Article Adds: Teaching patients problem-solving skills early after a stroke using a metacognitive strategy is feasible and may decrease depression and increase self-efficacy while fostering independent goal setting and problem solving.