Abstract
Background: Psychological difficulties such as anxiety and depression are common post-stroke. Mindfulness-based interventions (MBIs), such as Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) have demonstrated effectiveness in alleviating such difficulties in other clinical health populations and show promise in stroke-related psychological difficulties. Objective and Outcomes: The study aimed to assess the feasibility of recruiting and retaining stroke survivors into a randomised waitlist control trial with an 8-week waitlist period and 3-month follow-up. We also aimed to assess the acceptability of an online mindfulness-based intervention for this population and the use of outcome measures relating to anxiety, depression, perceived stress, health status, quality of life and perseverative thinking. Methods: Stroke survivors were recruited at 6-month post-stroke in an NHS clinical setting. No criteria were set regarding minimum pre-existing psychological difficulties. Intervention: 10-session online mindfulness course, comprising elements of both MBSR and MBCT. Results: Fifty-four people were screened. Eighteen were deemed ineligible. Of the thirty-six assessed for eligibility, ten declined to participate. Twenty-four others considered participation but ultimately decided not to participate for reasons such as low confidence with computers. Two participants were successfully recruited and randomised (one to waitlist control). The intervention could be delivered as planned. The 8-week waitlist period was tolerated. No adverse effects were reported. Follow-up at 1 and 3-months was feasible. Reliable and clinically significant improvements were demonstrated in depression for one participant, certain mindfulness domains and quality of life scores. Where reliable deterioration was indicated to perseverative thinking and anxiety measures, low baseline scores prevent us from drawing any substantial inferences. Thematic analysis of interview data conducted with both participants and the recruiter indicated overall acceptability of the intervention and outcome measures used whilst highlighting difficulties in recruitment such as fears about safety online and the priority of physical rehabilitation. Conclusion: Despite the promise of MBIs for stroke-survivors, our poor recruitment rate indicates a larger trial of the proposed design is not currently feasible as planned.