A systematic review of anxiety interventions in stroke and acquired brain injury: Efficacy and trial design

https://doi.org/10.1016/j.jpsychores.2017.11.010Get rights and content
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Highlights

  • A systematic review of trials of anxiety interventions for stroke and acquired brain injury.

  • Some evidence to suggest efficacy of psycho- and pharmacotherapy interventions.

  • Key aspects of trial design and sources of bias are summarized and discussed.

Abstract

Objective

There is little randomized controlled trial (RCT) evidence to guide treatment for anxiety after stroke. We systematically reviewed RCTs of anxiety interventions in acquired brain injury (ABI) conditions including stroke and traumatic brain injury (TBI) in order to summarize efficacy and key aspects of trial design to help guide future RCTs.

Methods

We searched the Cochrane trial register, Medline, Embase, PsychInfo and CINAHL systematically up to August 2017. Two independent reviewers systematically selected studies and extracted data. We summarized the effect size, key study characteristics and sources of potential bias in trial design.

Results

14 studies (12 stroke; one stroke & TBI; one TBI) with 928 participants were included. Meta-analysis of five psychotherapy comparisons favoured intervention over control (standardized mean difference (SMD): − 0.41 [− 0.79, − 0.03], I2 = 28%); Overall effect size of pharmacotherapy comparisons favoured intervention over control (SMD: − 2.12 [− 3.05, − 1.18], I2 = 89%). One comparison of mixed pharmacotherapy and psychotherapy favoured intervention over usual care (SMD: − 4.79 [− 5.87, − 3.71]). One comparison favoured forest therapy versus urban control (SMD: − 2.00 [− 2.59, − 1.41]). All positive studies carried high or unclear risk of bias. Sample sizes were small in all included studies.

Conclusions

There is low quality evidence to suggest that psychotherapy and pharmacotherapy may be effective interventions in the treatment of anxiety after stroke based on underpowered studies that carried high risk of bias. Large-scale well-designed definitive trials are needed to establish whether pharmacological or psychotherapy works. Our review highlighted key considerations for investigators wishing to design high quality trials to evaluate treatments for anxiety after stroke.

Keywords

Anxiety
Stroke
Neuropsychiatric
Intervention
Rehabilitation
Clinical trial

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