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The purpose of this study is to test the relevance, satisfaction and ease-of-use of an online mindfulness intervention among stroke survivors and their caregivers. Quality of life, depression, anxiety, stress and sleep quality will be assessed before, after and at 1 month after the intervention. After the intervention, participants' feedback about the usability and the satisfaction with the intervention and the online program will be gathered. Based on participants' feedback, changes to the intervention will be made to obtain a final version.
The incidence of depression and anxiety is much higher in stroke survivors and their caregivers compared to age-matched peers. Previous work suggests that mindfulness delivered in an online format is promising for both individuals with neurological disorders and caregivers to improve quality of life and psychological well-being.
The overall objective of this project is to develop and refine an online mindfulness program that is perceived as relevant and user-friendly for stroke survivors and their caregivers. This project also aims to determine the potential impact of the mindfulness program on psychological well-being for stroke survivors and caregivers to guide the development of a future intervention study.
The process of development of the online mindfulness program will be iterative and will involve three phases: one development phase, one usability testing phase with end-users and one refinement phase.
Phase 1) The 3-week online mindfulness program will be adapted from the program developed for individuals with amyotrophic lateral sclerosis by mindfulness and stroke experts to ensure suitability and relevance for individuals with stroke.
Phase 2) A testing phase will be conducted remotely for both technical and clinical verification with 5-10 stroke survivors and 5-10 caregivers. Self-reported questionnaires about psychological well-being will be administered prior to and after the participation to the program and at a 1-month follow-up. After the program, a usability questionnaire and a semi-structured interview will be conducted to assess the usability of the mindfulness program and gather participants' feedback. For each group, differences prior to and after the mindfulness program will be assessed using a repeated measure analysis of variance. The transcribed verbatim of the semi-structured interview will be analyzed independently using thematic content analysis by 2 members of the research team.
Phase 3) Based on the results from Phase 2, modifications will be made to the online mindfulness program. If warranted, the testing phase will be replicated with a second cohort of participants.
This project will lead to the development of an online mindfulness program suitable for stroke survivors and their caregivers to improve quality of life and psychological well-being. This project will help guide the development of a planned intervention study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Stroke survivors | Participants who have had a stroke |
| |
| Caregivers | Participants who are caring for someone who have had a stroke |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mindfulness online intervention | Behavioral | A 3-week mindfulness intervention will be offered entirely online. The purpose of the intervention is: 1) to increase participants' mindfulness, and 2) to encourage participants to change their beliefs about the disability associated with stroke to improve their psychological state. Mindfulness refers to the act of being aware: aware of thoughts, aware of emotions, aware of physical sensations, aware of others. The intervention consists of educational texts, daily exercises, audio recordings and videos. Five different topics related to mindfulness will be introduced throughout the intervention. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Stroke Impact Scale | Quality of life and impact of stroke after the intervention. The Stroke Impact Scale is a 59-item measure and is divided in 8 domains. Scores range from 0-100 (with higher score showing better quality of life and lower stroke impact). | from baseline to 3 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Hospital Anxiety and Depression Scale | The Hospital Anxiety and Depression Scale (HADS) is a 14-item scale with 7 items each for anxiety and depression subscales. Each item is scored from 0 to 3, with higher scores indicating higher anxiety or depressive symptoms. Anxiety and depression with scores ranging from 0 (no depression/anxiety) to 21 (severe depressive/anxious symptoms). | from baseline to 3 weeks |
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Inclusion Criteria:
Exclusion Criteria:
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A convenience sample of 5-10 people with stroke and their caregivers will be recruited.
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| Name | Affiliation | Role |
|---|---|---|
| Carolee Winstein, PhD | University of Southern California | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Southern California | Los Angeles | California | 90089 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Stroke Survivors | Participants who have had a stroke |
| FG001 | Caregivers | Participants caring for someone who have had a stroke |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Stroke Survivors | Participants who have had a stroke |
| BG001 | Caregivers | Participants who care for someone who have had a stroke |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | One participant in the caregiver group did not receive the intervention, but participated to the qualitative interview to provide feedback about the program. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in Stroke Impact Scale | Quality of life and impact of stroke after the intervention. The Stroke Impact Scale is a 59-item measure and is divided in 8 domains. Scores range from 0-100 (with higher score showing better quality of life and lower stroke impact). | The Stroke Impact Scale is a measure of stroke severity. It was not administered to caregivers. Two stroke survivors did not complete the post-intervention measurement. | Posted | Mean | Standard Deviation | score on a scale | from baseline to 3 weeks |
|
Adverse events were collected for the duration of the study period (up to 1 month post-intervention).
The clinicaltrials.gov definition was used.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Stroke Survivors | Participants who have had a stroke | 0 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Moderate Adverse Event (Shoulder pain) | Musculoskeletal and connective tissue disorders | Non-systematic Assessment | Polymyalgia rheumatica diagnosed during the participation to the study |
Our sample was small and heterogenous. This study was not powered to detect changes in the self-reported measures, but it provided guidance on the selection of outcome measures for a larger intervention study. The possibility of a social desirability bias is not excluded since participants may have wanted to please the researchers.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Marika Demers, PhD, OT, post-doctoral research fellow | University of Southern California | 13234421196 | demers@pt.usc.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jun 25, 2020 | Aug 18, 2021 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Aug 13, 2021 | Aug 16, 2021 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D000084802 | Caregiver Burden |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| Change in National Institute of Health Perceived Stress Survey | 10-item self-reported measure assessing perceived stress. Scores range from 10 to 50, with higher scores indicating greater levels of perceived stress. | from baseline to 3 weeks |
| Change in Single-Item Sleep Quality Scale | 1-item sleep quality scale ranging from 1 to 10. Higher scores indicate better sleep quality. | from baseline to 3 weeks |
| Change in World Health Organization Quality of Life-bref | The World Health Organization Quality of Life-BREF (WHOQOL-BREF) comprises 26 questions from 4 domains about health and well-being: 1) Physical health (e.g., Activities of daily living, Mobility, Fatigue, etc.), 2) Psychological (e.g., Negative/positive feelings, Self-esteem, Spirituality, etc.), 3) Social relationships (e.g., Personal relationships, Social support, Sexual activity), 4) Environment (e.g., financial resources, home environment, opportunities for leisures, etc.). The scores are transformed on a scale from 0-100. Higher scores indicate better perceived health and well-being. Outcome measure only administered to caregivers. | from baseline to 3 weeks |
| Adapted Post-Study System Usability Questionnaire | The adapted Post-Study System Usability Questionnaire (PSSUQ) consists of 5 questions on perceived satisfaction with the online platform used to host the program. Each question is scored on a 7-point Likert scale from 1 (Strongly Agree) to 7 (Strongly Disagree) for a total score of 35. Higher scores indicate lower usability. | 3 weeks |
| Change in Zarit Burden Interview | The Zarit Burden Interview includes 22 questions about caregiver burden rated from 0 (never) to 4 (nearly always). Scores range from 0-88 with higher scores indicating greater burden. Measure administered only to participants in the caregiver group. | from baseline to 3 weeks |
| BG002 | Total | Total of all reporting groups |
| Mean |
| Standard Deviation |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Count of Participants | Participants |
|
|
|
| Secondary | Change in Hospital Anxiety and Depression Scale | The Hospital Anxiety and Depression Scale (HADS) is a 14-item scale with 7 items each for anxiety and depression subscales. Each item is scored from 0 to 3, with higher scores indicating higher anxiety or depressive symptoms. Anxiety and depression with scores ranging from 0 (no depression/anxiety) to 21 (severe depressive/anxious symptoms). | Two stroke survivors did not complete the post-intervention measurement. One caregiver group did not receive the intervention (only did the qualitative portion of the study). | Posted | Mean | Standard Deviation | score on a scale | from baseline to 3 weeks |
|
|
|
| Secondary | Change in National Institute of Health Perceived Stress Survey | 10-item self-reported measure assessing perceived stress. Scores range from 10 to 50, with higher scores indicating greater levels of perceived stress. | Two stroke survivors did not complete the post-intervention measurement. One caregiver group did not receive the intervention (only did the qualitative portion of the study). | Posted | Mean | Standard Deviation | score on a scale | from baseline to 3 weeks |
|
|
|
| Secondary | Change in Single-Item Sleep Quality Scale | 1-item sleep quality scale ranging from 1 to 10. Higher scores indicate better sleep quality. | Two stroke survivors did not complete the post-intervention measurement. One caregiver group did not receive the intervention (only did the qualitative portion of the study). | Posted | Mean | Standard Deviation | units on a scale | from baseline to 3 weeks |
|
|
|
| Secondary | Change in World Health Organization Quality of Life-bref | The World Health Organization Quality of Life-BREF (WHOQOL-BREF) comprises 26 questions from 4 domains about health and well-being: 1) Physical health (e.g., Activities of daily living, Mobility, Fatigue, etc.), 2) Psychological (e.g., Negative/positive feelings, Self-esteem, Spirituality, etc.), 3) Social relationships (e.g., Personal relationships, Social support, Sexual activity), 4) Environment (e.g., financial resources, home environment, opportunities for leisures, etc.). The scores are transformed on a scale from 0-100. Higher scores indicate better perceived health and well-being. Outcome measure only administered to caregivers. | One caregiver group did not receive the intervention (only did the qualitative portion of the study). | Posted | Mean | Standard Deviation | score on a scale | from baseline to 3 weeks |
|
|
|
| Secondary | Adapted Post-Study System Usability Questionnaire | The adapted Post-Study System Usability Questionnaire (PSSUQ) consists of 5 questions on perceived satisfaction with the online platform used to host the program. Each question is scored on a 7-point Likert scale from 1 (Strongly Agree) to 7 (Strongly Disagree) for a total score of 35. Higher scores indicate lower usability. | Two stroke survivors did not complete the post-intervention measurement. One caregiver group did not receive the intervention (only did the qualitative portion of the study). | Posted | Mean | Standard Deviation | score on a scale | 3 weeks |
|
|
|
| Secondary | Change in Zarit Burden Interview | The Zarit Burden Interview includes 22 questions about caregiver burden rated from 0 (never) to 4 (nearly always). Scores range from 0-88 with higher scores indicating greater burden. Measure administered only to participants in the caregiver group. | One caregiver group did not receive the intervention (only did the qualitative portion of the study). | Posted | Mean | Standard Deviation | score on a scale | from baseline to 3 weeks |
|
|
|
| 13 |
| 0 |
| 13 |
| 0 |
| 13 |
| EG001 | Caregivers | Participants caring for someone who have had a stroke | 0 | 3 | 0 | 3 | 1 | 3 |
|
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| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D013315 | Stress, Psychological |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |