Background and aim 
Psychosocial challenges are common after stroke and can affect motivation, long-term functioning, quality of life and reduce the effect of rehabilitation. This study aimed to evaluate the effect of a dialogue-based intervention to promote psychosocial well-being after stroke.

Materials and methods  
Adults with first or recurrent acute stroke, medically stable, with sufficient cognitive functioning and able to understand and speak Norwegian were included within one-month post-stroke. All participants received usual care that included treatment at acute stroke units followed by further treatment and therapy in rehabilitation centres or in the municipality according to needs and availability. 

The participants in the intervention group received a dialogue-based intervention in addition to usual care. The intervention consisted of 8 individual 1-1 ½ hour sessions between the stroke survivor and a trained health care professional (registered nurse, occupational therapist) during the period between 1 and 6 months post-stroke. 

The intervention targeted feelings, thoughts and experiences related to the life after the stroke. In the sessions, work sheets developed to support the dialogues were used. The work sheets consisted of drawings, figures, unfinished sentences, and key words that pointed to the topic that the participants were invited to address. Each meeting had a guiding topical outline, addressing significant issues described in the research literature like bodily changes, emotional challenges, personal relations, daily life issues, meaningful activities, existential issues and important values.

The primary outcome was mood at 6 months measured by the General Health Questionnaire-28 (GHQ-28). Secondary outcomes included health-related quality of life (Stroke and Aphasia Quality of Life Scale (SAQOL-39g)), depression (Yale-Brown single-item questionnaire) and Sense of Coherence (SOC-13). 
To explore the effect of the intervention, logistic regression, general linear modelling, independent sample t-tests and paired sample t-tests were applied. 

Results 
Three hundred and twenty-two participants were randomly assigned to the intervention group (n=166) or the control group (n=156). From baseline to 6 months, the proportion of participants with normal mood increased by 28.9% in the intervention group and 31.8% in the control group. After controlling for the baseline values, no significant benefit was found in the intervention group compared to the control group 6 months after the stroke (OR: 0.882: 95% CI: 0.53-1.45, P=0.621). The secondary outcomes did not show any between-group difference in well-being.

Conclusions
Psychosocial well-being improved during the first six months after stroke in both arms of the trial, but no statistically significant benefit of the dialogue-based intervention compared to usual care was found.

The effect of a psychosocial intervention on well-being 6 months after stroke