Approximately 30% of people with stroke experience symptoms of depression. Many may benefit from access to mental health services that target unhelpful thoughts, such as cognitive behaviour therapy (CBT), but go untreated due to lack of access to specialized care, costs, remote location, or stigma related to seeking care. Internet Cognitive Behavioural Therapy (ICBT) may overcome these barriers. The stroke ICBT program teaches skills such as challenging unhelpful thoughts, memory and attention, managing related physical symptoms, and pacing through a mix of online learning and weekly contact with a trained Guide. While the program's content was found to be acceptable among individuals after stroke, the program's effectiveness still needs to be evaluated. Thus, the primary purpose of this study is to evaluate if the stroke ICBT program will improve symptoms of depression compared to an attention control group. Individuals in both groups will answer questions about themselves and their injury and describe symptoms of depression, quality of life, and health service use to evaluate its impact on people's wellbeing. The study results will be useful in determining if the ICBT program is effective and whether it should be part of routine clinical practice.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
100
A 10-week internet-delivered cognitive behavioural therapy (ICBT) will be delivered to participants who have sustained a stroke. In addition to the online program, a Guide with experience delivering ICBT will provide support by email or phone call once a week. The Guide will spend approximately 15 minutes per week/per client.
A 10-week stroke-specific rehabilitation education program for stroke patients in usual care at specialized stroke rehabilitation units. The lessons will include information on spinal cord injury rehabilitation: 1)stroke basics, 2)mental health after stroke, 3)pain after stroke, 4)understanding rehabilitation 5)summary of lessons through an online platform. A Guide will check in with participants once a week to answer any content-related questions. The Guide will spend approximately 15 minutes per week/per client.
Change in depression
Measured by Patient Health Questionnaire - 9 Item (PHQ-9), higher scores indicate worse outcomes
Time frame: baseline, 10 weeks, 3 months
Change in anxiety
Measured by Generalize Anxiety Disorder - 7 Item (GAD7)higher scores indicate worse outcomes
Time frame: baseline, 10 weeks, 3 months
Change in quality of life symptoms
Measured by VAS on the EuroQol-5D (EQ5D), higher scores indicate better outcomes
Time frame: baseline, 10 weeks, 3 months
Self-efficacy
Measured by Self-Efficacy for managing Chronic Disease-6 (SEMCD), higher scores indicate better outcomes
Time frame: baseline, 10 weeks, 3 months
Change in perceived disability
Measured by The World Health Organization Disability Assessment Schedule ,(WHODAS), higher scores indicate worse outcomes
Time frame: baseline, 10 weeks, 3 months
Treatment credibility
Measured by Treatment Credibility Questionnaire (TCQ) which contains 4 items. The first three items range from 0-9 with higher scores indicating better outcome, and the fourth item ranges from 0-100%, with higher scores indicating greater improvement in functioning.
Time frame: baseline, 10 weeks
Treatment satisfaction
Measured by Internet-CBT Treatment Satisfaction Measure, higher scores indicate greater satisfaction
Time frame: baseline, 10 weeks
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