Social Participation & psychological flexibility in chronic stroke survivors

Stroke survivors value return to social participation after rehabilitation. Social participation comprises meaningful activities that involve interpersonal interactions with family, friends, peers, and community members. Restrictions in social participation begin when stroke survivors re-enter the community after hospital discharge and persist for several years. Failure to return to social participation has significant long-term health consequences including social isolation, depression, sedentary behavior, and subsequent chronic illness. Strategy training (ST) uses iterative practice of meaningful activities with structured instruction and feedback. While strategy training shows promise for optimizing social participation outcomes in stroke survivors, there is a need to further examine whether strategy training addresses psychological processes that impact social participation, such as fear of embarrassment. Acceptance and Commitment Therapy (ACT) provides additional tools to address these psychological processes and improves psychological flexibility (acceptance, reduced avoidance) and shows promise for improving social participation among stroke survivors. By combining ACT with structured practice, as is possible when combining ACT with ST, rehabilitation providers may help stroke survivors resume social participation. We will examine the feasibility of a randomized controlled trial that compares the synergistic effects of ST+ACT to ST alone for social participation, psychological flexibility, and well-being outcomes for community-dwelling chronic stroke survivors. Participants will be randomized to receive either 10 sessions (2 times per week for 5 weeks) of a manualized ST+ACT or a manualized ST intervention. We will compare participant retention (percent who complete all procedures) and engagement (mean Pittsburgh Rehabilitation Participation Score), as well as intervention dose (total intervention minutes), fidelity (percent of sessions with fidelity ≥80%) and satisfaction (mean Client Satisfaction Questionnaire score) between groups. We also hypothesize that ST+ACT will be associated with significantly greater improvements in social participation (primary outcomes: PROMIS Ability to Participate in Social Roles and Activities and PROMIS Satisfaction with Participation in Social Roles), psychological flexibility (secondary outcome: Multidimensional Psychological Flexibility Inventory), and wellbeing (secondary outcome: RAND 12- item Health Survey), compared to ST alone, after intervention and 1 month later. Our study directly addresses priorities specified within the NIH Research Plan on Rehabilitation focused on optimizing rehabilitation to promote social participation and wellbeing for people with disabilities. Furthermore, our study provides critical pilot data to inform future large scale clinical studies seeking to optimize social participation, wellbeing, and health after stroke. Project Number: 1R03HD114635-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Minmei Shih | Institution: UNIVERSITY OF PITTSBURGH AT PITTSBURGH, PITTSBURGH, PA | Award Amount: $159,000 | Activity Code: R03 | Study Section: Function, Integration, and Rehabilitation Sciences Study Section[CHHD-K] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R03HD11463501A1