A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression.

BACKGROUND: Our previous studies have demonstrated the treatment benefits of dense cranial electroacupuncture stimulation (DCEAS), a novel brain stimulation therapy in patients with major depression, postpartum depression and obsessive-compulsive disorder. The purpose of the present study was to further evaluate the effectiveness of DCEAS combined with body acupuncture and selective serotonin reuptake inhibitors (SSRIs) in patients with post-stroke depression (PSD). METHODS: In a single-blind, randomized controlled trial, 43 patients with PSD were randomly assigned to 12 sessions of DCEAS plus SSRI plus body electroacupuncture (n = 23), or sham (non-invasive cranial electroacupuncture, n-CEA) plus SSRI plus body electroacupuncture (n = 20) for 3 sessions per week over 4 weeks. Treatment outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), the Clinical Global Impression - Severity scale (CGI-S) and Barthel Index (BI), a measure used to evaluate movement ability associated with daily self-caring activity. RESULTS: DCEAS produced a significantly greater reduction of both HAMD-17 and CGI-S as early as week 1 and CGI-S at endpoint compared to n-CEA, but subjects of n-CEA group exhibited a significantly greater improvement on BI at week 4 than DCEAS. Incidence of adverse events was not different in the two groups. CONCLUSIONS: These results indicate that DCEAS could be effective in reducing stroke patients' depressive symptoms. Superficial electrical stimulation in n-CEA group may be beneficial in improving movement disability of stroke patients. A combination of DCEAS and body acupuncture can be considered a treatment option for neuropsychiatric sequelae of stroke. TRIAL REGISTRATION: http://www.clinicaltrials.gov, NCT01174394.

Long-term effect of motivational interviewing on clinical and psychological outcomes and health-related quality of life in cardiac rehabilitation patients with poor motivation in Hong Kong: a randomized controlled trial.

OBJECTIVE: To investigate the long-term effects of motivational interviewing on clinical outcomes, psychological outcomes, health-related quality of life among cardiac rehabilitation patients with poor motivation. DESIGN: A randomized controlled trial with blind data collectors. SETTING: Cardiac rehabilitation centre. SUBJECTS: A total of 146 cardiac rehabilitation patients with poor motivation. INTERVENTION: All participants received usual care, including exercise and education, while those in the experimental group also received 10 sessions of motivational interviewing, each lasting 30-45 minutes. MAIN MEASURES: Clinical and psychological outcomes and health-related quality of life were assessed at baseline and at six, nine and 12 months for both groups. RESULT: There was no significant difference between the two groups at baseline on demographic and clinical outcomes except for monthly family income (p = 0.034). Patients in the experimental group had higher increases in health-related quality of life (SF-36) scores in bodily pain (88.7 SD 16.7 vs. 87.6 SD 18.7 at month 12, p = 0.044) and role limitation owing to emotional problems (86.9 SD 19.2 vs. 78.6 SD 21.8 at month 9, p = 0.019; 85.8 SD 18.9 vs. 76.9 SD 23.9 at month 12, p = 0.022). No statistically significant group difference was found among other outcomes. CONCLUSION: The long-term effect of motivational interviewing on clinical and psychological outcomes and health-related quality of life in studied patients is limited.

Short-term effect of motivational interviewing on clinical and psychological outcomes and health-related quality of life in cardiac rehabilitation patients with poor motivation in Hong Kong: a randomized controlled trial.

BACKGROUND: Motivational interviewing (MI) is effective in promoting behavioural changes in patients with substance abuse and smoking. However, its effectiveness on health outcomes in cardiac rehabilitation patients is unclear. DESIGN: A randomized controlled trial. METHOD: A total of 146 patients assessed as having poor motivation attended a cardiac rehabilitation programme from February 2008 to June 2010. Patients (n = 73) in the control group received usual care while those in the experimental group (n = 73) received usual care plus four sessions of MI, each lasting 30-45 min. Clinical and psychological outcomes and health-related quality of life were measured at baseline and 3 months after entering the programme. Descriptive statistics, independent t-test, Pearson Chi-squared test, and generalized estimating equations models were used to analyse the data. RESULTS: There was no significant difference between the two groups on clinical outcomes (all p-values >0.05). Patients in the experimental group had higher increases in health-related quality of life (SF-36) scores in the aspects of general health (4.74, 95% CI 0.04-9.44; p = 0.048) and role limitation due to emotional problems (8.80, 95% CI 1.16-16.43; p = 0.024). However, they reported significantly higher increases in anxiety levels (Hospital Anxiety and Depression Scale) than those in the control group (0.96, 95% CI 0.09-1.83; p = 0.030). CONCLUSION: The short-term effectiveness of MI on clinical outcomes and health-related quality of life in poorly motivated cardiac rehabilitation patients is limited. MI, however, was shown to increase anxiety levels of patients during the study period (3 months). More evidence is needed to better understand this phenomenon in the future studies.