Can Addition of Motivational Interviewing to Conventional Therapy and Task Oriented Training Improve Outcome After Stroke? A Randomized Controlled Trial

Background: Stroke can result in loss of self-efficacy in the use of upper limb for functional activities.
Thus, many techniques such as conventional therapy (CT) and task oriented training (TOT) are used for
the rehabilitation of upper limb function. Recently, studies included motivational interviewing (MI); a talk based therapy that improves self-efficacy. When patients have high self-efficacy, this can make them achieve functional independence. The aim of this study is to find out the whether addition of MI to CT and TOT will improve self-efficacy in the use of upper limb.
Methods: The study was a randomized controlled trial approved by the ethical committees of AKTH and
KHMB. The subjects were randomly assigned into 4 groups (CT, TOT and CT+MI and TOT+MI) with 7
subjects each. CT received weight bearing exercises on the affected limb, passive and active movements and therapeutic positioning. TOT performed 8 functional tasks of their convenience. CT+MI received similar tasks in CT and received MI. TOT+MI performed similar tasks in TOT and received MI. All groups received treatments for 3 hours per day, 5 times a week for 4 weeks. However, CT+MI and TOT+MI groups received MI in addition for 10 minutes per session during weekly visit.
Results: TOT, CT+MI and TOT+MI showed significant improvement in self-efficacy post-intervention (p<0.05). However, there was no significant difference in the use of CT+MI and TOT+MI (p>0.05).
Discussion: Addition of motivational interviewing to CT and TOT improves self-efficacy in the use of
upper limb following a stroke and patients who may benefit fromthis protocol are those with no significant motor and cognitive impairments. However, the study is limited as no power calculation was conducted to determine number of subjects required for generalizing the study findings, and therapists and the assessors were not blinded.