- Faculty of Health and Wellbeing, University of Central Lancashire
Liz Lightbody is Professor in Stroke Care and Improvement in the School of Nursing at the University of Central Lancashire. She is a nurse by professional background and is the chair of the National Stroke Nursing Forum (NSNF). Her research interests include acute stroke care (e.g. telemedicine, neurological monitoring, nurse education, oral care, and positioning) and psychological adjustment post-stroke (e.g. screening tools, training for stroke service staff and interventions that address the needs of stroke survivors adjusting to life after stroke). She is the project coordinator for the Accelerating Delivery of Psychological Therapies after Stroke (ADOPTS) project, which is one of the projects within the Collaboration for Leadership in Applied Health Research and Care North West Coast. ADOPTS explored the implementation of a stepped-care approach to psychological support and intervention for people following a stroke.
She was one of the counsellors in the first Motivational Interviewing study post-stroke, which was the first study to show a positive impact of a talk-based psychological intervention following stroke. She is now Chief Investigator on a multicentre randomised controlled trial of Motivational interviewing funded by NIHR CLAHRC - North West Coast (COMMITS trial). This study aims to recruit 1200 participants across 15 sites in the UK.
She is the Deputy Director for the UK of the NIHR Global Health Research Group for Improving Stroke Care in India (IMPROVISE), University of Central Lancashire, Preston, UK
Brief outline of projects
ADOPTS: Accelerating the Delivery of Psychological Therapies after Stroke
Stroke can have huge emotional impacts on stroke survivors and their carers. However, psychological services and support for these difficulties have been shown to be insufficient. Evidence and guidance to enable service providers to provide appropriate support is lacking.
The Accelerating the Delivery of Psychological Therapies after Stroke study (ADOPTS), was committed to improving psychological support, by exploring the feasibility of implementing and researching a collaborative psychological care pathway. We have developed an evidence-based pathway to enhance access to psychological support. Our research project aimed to see if we could use services that already exist for general psychological support (e.g. Increasing Access to Psychological Therapies (IAPT) services) and adapt them to be useful for stroke survivors. Stroke specific staff have received training to identify psychological distress and increase their confidence, to deliver low level psychological support. We also wanted to foster collaboration between stroke and psychology services (including acute, rehabilitation, community, voluntary stroke services and mental health services) by identifying champions in each of these services, who would act as a point of contact.
The patient pathway was successfully implemented in four sites across CLAHRC North West Coast. Staff liked the practical tips and suggestions of what to say and what not to say. They reported not being so worried about trying to address some of the issues around psychological distress and IAPT staff felt more able to adapt therapy materials to assist in communication with stroke survivors.
COMMITS - COnfirming the Mechanism of Motivational Interviewing Therapy after Stroke
Depression affects one in three people post-stroke, and can negatively affect stroke survivors’ recovery and quality of life. Post-stroke depression remains inadequately treated. Our motivational interviewing-based intervention (MIBI) is a talking therapy that supports personal adjustment post-stroke and aims to prevent and treat depression. Our single-centre study showed MIBI to substantially prevent, and potentially treat, post-stroke depression. Our subsequent single-centre feasibility study showed it was achievable for clinical staff to deliver MIBI.
The aim of this study is to determine the effectiveness of MIBI on depression post-stroke; relative to usual care (UC), and to an attention control (AC) (ensuring control for non-specific elements of treatment).
COMMITS is a multi-centre, individual patient-randomised, three-arm randomised controlled trial: MIBI plus UC vs. AC plus UC vs. UC. We will recruit a total of 1200 patients to the study, across 15 hospitals, over an 18-month period. Participants randomised to MIBI+UC will receive four 45-minute weekly individual sessions in hospital/community, with the same MIBI-trained therapist (clinical staff). Participants randomised to AC+UC will receive four 45-minute weekly individual social attention sessions (e.g. listening to music, conversation), with the same AC-trained visitor. Participants randomised to UC will receive the standard care in that centre. Data collection at baseline, and postal at 6-weeks and 3-months post-randomisation.
Primary outcome will be depression at 3-months post-randomisation, measured with PHQ-9.
Secondary outcomes (3-months only): Status (Alive/Dead); anxiety (GAD-7); Yale; Self-reported depression, antidepressant use, psychological input; Further stroke; Quality of life: Stroke Impact Scale, Function: modified Rankin, Barthel. Explore impact of health inequalities by comparing differential outcomes by deprivation indices.