Effects of a nurse-led peer support intervention on psychosocial outcomes of stroke survivors: A randomised controlled trial

Background: Living with stroke poses many psychosocial challenges. Interventions for improving stroke survivors' psychosocial outcomes are lacking. Peer support interventions may contribute to recovery after stroke. However, current evidence is insufficient to suggest their application in enhancing stroke survivors' psychosocial well-being.

Objective: This study aimed to evaluate the effectiveness of a nurse-led peer support intervention for improving the psychosocial outcomes of stroke survivors.

Design: An assessor-blinded two-arm randomised controlled trial with an attention control group.

Settings: A community health centre and a rehabilitation unit in Yangzhou, China.

Participants: First-ever or recurrent ischaemic or haemorrhagic stroke survivors.

Methods: A convenience sample of 120 stroke survivors was recruited with 60 participants randomly assigned to each of the intervention and control groups. Intervention group participants received the nurse-led peer support intervention. Control group participants received attention care. The primary outcomes were social participation and participation self-efficacy. The secondary outcomes were psychological distress, perceived social support, stigma towards diseases, and quality of life. Data were collected at baseline (T0), immediately post-intervention (T1) and three months post-intervention (T2). Generalised estimating equations models were used to determine the effects of the intervention on the outcomes.

Results: The intervention significantly improved social participation (T1: adjusted mean difference = -18.45, 95 % CI: -22.89 to -14.01, p < 0.001; T2: adjusted mean difference = -14.71, 95 % CI: -22.36 to -7.05, p < 0.001), participation self-efficacy (T1: adjusted mean difference = 47.92, 95 % CI: 37.56 to 58.27, p < 0.001; T2: adjusted mean difference = 39.58, 95 % CI: 17.88 to 61.28, p < 0.001) and perceived social support (T1: adjusted mean difference = 7.56, 95 % CI: 4.93 to 10.19, p < 0.001; T2: adjusted mean difference = 7.41, 95 % CI: 4.01 to 10.80, p < 0.001), and reduced psychological distress (T1: adjusted mean difference = -4.97, 95 % CI: -6.25 to -3.69, p < 0.001; T2: adjusted mean difference = -4.67, 95 % CI: -6.24 to -3.11, p < 0.001) and stigma towards diseases (T1: adjusted mean difference = -3.83, 95 % CI: -5.14 to -2.51, p < 0.001; T2: adjusted mean difference = -3.19, 95 % CI: -5.20 to -1.19, p < 0.001) at both T1 and T2. The intervention significantly improved quality of life at T1 only (adjusted mean difference = 0.12, 95 % CI: 0.06 to 0.19, p = 0.02).

Conclusions: The results provide empirical support for the effectiveness of the nurse-led peer support intervention in improving the psychosocial outcomes of stroke survivors and provide additional evidence to support their inclusion in stroke rehabilitation.

Registration: ChiCTR.org.cn (ChiCTR2100050853), Start of recruitment: October 2021.