Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Non-pharmacological Interventions to Treat Mood Disturbances Post Stroke: a systematic review (106858)

Vibha Balram 1 , Rhianna Ingleton 2 , Dave Parsons 3 , Stacey George 1 , Maayken van den Berg 1
  1. Flinders University, Bedford, SA
  2. St John of God Public Hospital, Midland, WA
  3. Curtin University, Perth, WA

Introduction: Stroke survivors face high rates of depression, anxiety, and pseudobulbar affect. Clinicians report lack clarity on effective non-pharmacological interventions due to uncertainty about treatment options (Fang, 2020) as barriers to evidence-based treatment. No systematic review has investigated the effectiveness of non-pharmacological interventions on the conditions of depression, anxiety and pseudo-bulbar affect.

Methods: Following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines we searched databases Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO for randomised controlled trials in English, within 2012 to 2023, evaluating the effect of a non-pharmacological intervention on depression, anxiety and / or pseudobulbar affect. Two researchers screened titles, abstracts and full texts. One researcher extracted data and assessed risk of bias. Data was synthesised narratively.

Results: Forty-three studies were included. Intervention types included education (n=9), psychological therapy (n=8), and physical exercise (n=8). Intervention types reporting positive outcomes for depression were psychological therapy (n=6), physical exercise (n=3) and robot-assisted therapy (n=3). Intervention types effective in improving anxiety were physical exercise (n=3), psychological therapy (n=3) and multi-modal therapy approaches (n=2). No studies explored the impact on pseudobulbar affect.

Conclusion: Non-pharmacological interventions may be effective in improving mood in stroke survivors. Robot-assisted therapy and physical exercise was seen to improve multiple outcome measures. Patient education should be delivered alongside rehabilitation and directed to both stroke-survivor and caregiver.

Relevance to clinical practice or patient experience: Clinically, mood disorders are an overlooked area in stroke and psychological care has been identified as one of the greatest areas of unmet need in community-dwelling stroke survivors (Kim, 2016). This research paper highlights therapy modalities and methods that can improve depression and anxiety in this population. This paper also highlights the lack of clarity in treating pseudobulbar affect and identifies areas for further investigation.