Title: A feasibility study of a randomised controlled trial of an Arts for Health group intervention to support self-confidence and psychological wellbeing following a stroke.
Funder: Department of Health (England)

Abstract: Background Stroke is one of the leading causes of morbidity in the UK and its impact can be overwhelming; with individuals facing not only reduced physical functioning and disability but also hidden psychological challenges, which if unresolved can lead to mood disturbance. If untreated, this is associated with higher mortality rates, long-term disability, hospital admissions, suicide, and higher utilisation of outpatient services. Arts for Health (AfH) interventions allow those with physical or emotional communication barriers to express themselves non-verbally and thus offer opportunities to explore psychological challenges. Aim To investigate the feasibility of conducting a multicentre randomised controlled trial (RCT) to assess the effectiveness and cost effectiveness of a group-based Arts for Health (AfH) intervention for stroke survivors. Research question How can we best conduct a RCT in which stroke survivors are allocated to an AfH intervention plus standard care or standard care alone? Plan of investigation 32 patients will be recruited from a secondary care stroke service (Bournemouth Hospital) and 32 patients from a primary care setting (Cambridge Community Services NHS Trust). Recruitment and randomisation Adult stroke survivors up to nine months post-stroke will be given information about the study by a health professional and asked if they would be happy to be contacted by the research team. If they agree, they will be contacted (by telephone/email) and have an opportunity to discuss the study in detail. If they still wish to take part, the researcher will visit them at home to gain written informed consent and complete baseline outcome measures. Those who agree to take part will be randomised to receive either the AfH intervention plus usual care or usual care alone. Exclusions 1) Cognitive impairments (unable to appreciate others’ needs in a group setting/to complete assessments with support). 2) Insufficient language ability to comprehend consent process or intervention. 3) Already receiving psychiatric or clinical psychology intervention. Arts for Health Intervention A group with 6-8 members meeting for ten 2-hour sessions over 14-weeks held in the community and facilitated by an artist. The group atmosphere will be non-judgemental, creating a safe/supportive space with an emphasis on the person rather than his/her stroke. Members will have access to arts materials and be encouraged to express themselves and explore who they are, changes and continuities in their lives, and support others’ explorations. Early sessions will be facilitator-led with a gradual transition towards self-directed work/shared facilitation. Outcomes (measured at baseline and post-intervention) Encompassing demographic, stroke-related, mood, wellbeing and quality of life domains as well as health service use and process measures. These data will help us to plan the methodology for the full trial. Qualitative component Two (pre/post) interviews with 12 participants (8 intervention, 4 control) will permit an in-depth consideration of participants’ perceptions of the acceptability of study processes including recruitment, the AfH intervention and outcome measures, to inform the main trial. Economic evaluation Methods to collect intervention costs and resource utilisation will be piloted to develop and test a methodology to inform an economic evaluation for the future trial. Potential benefits to patients and the NHS The information collected will help us develop a rigorously designed full-scale RCT to test if AfH is effective and cost-effective following stroke and is suitable for adoption within stroke services. The intervention is novel in stroke care and addresses aspects of psychological support highlighted as a priority by policy and patients alike. It has the potential to provide low-cost preventive psychological support for stroke survivors (the majority of whom experience subthreshold psychological issues)3, reducing the long-term costs to survivors, families and healthcare services.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: STROKE