Effects of MI-Guided Bedside ADL Training on Functional and Emotional Outcomes In Post-Stroke Depression: A Retrospective Cohort Study

Summary

This protocol describes a method integrating motivational interviewing with bedside activities of daily living training to support the rehabilitation of patients with post-stroke depression, with a focus on improving functional independence and psychological engagement.

Abstract

Post-stroke depression (PSD) impedes recovery and is often insufficiently addressed by conventional rehabilitation. This retrospective cohort study presents a structured protocol for integrating motivational interviewing (MI) with bedside activities of daily living (ADL) training, including standardized bedside rehabilitation procedures and repeated functional and psychological assessments in PSD patients. In a retrospective cohort of 174 patients, participants were assigned to either an MI-guided ADL training group or a conventional rehabilitation group. Functional independence, emotional status, and serum monoamine neurotransmitter levels were assessed at multiple time points using standardized scales and biochemical analysis. The results showed that the MI-ADL group was associated with improved functional and emotional outcomes compared with the conventional rehabilitation group, accompanied by increased levels of key monoamine neurotransmitters: 5-hydroxytryptamine (5-HT), norepinephrine (NE), and dopamine (DA). This protocol provides a structured and reproducible bedside rehabilitation approach for combining psychological motivation with functional rehabilitation. However, as this was a retrospective cohort study, these findings are hypothesis-generating, and further prospective studies are needed to confirm causal relationships.

Introduction

Post-stroke depression (PSD) is the most common neuropsychiatric complication among stroke patients, affecting approximately one-third of stroke survivors^1,2. Its clinical manifestations are complex. Besides typical depressive symptoms, it often involves cognitive decline, sleep disorders, and other complex presentations, which seriously affect patients' enthusiasm for recovery, delay neurological recovery, and increase family and societal burdens^3,4,5. To address these challenges, this protocol describes a method....

Protocol

Ethical Statement:
This study was approved by the Ethics Committee of the Fujian University of Traditional Chinese Medicine Affiliated Rehabilitation Hospital (Approval No.: 2023KY-046-002). All procedures adhered strictly to the principles of the Declaration of Helsinki. Because this study involved only retrospective analysis of de-identified data extracted from routine electronic medical records, the Ethics Committee granted a waiver of individual informed consent for research purposes. All patients had provided general written consent for the use of their medical records for clinical research at the time of hospital admission, as required by in....

Results

Participant Flow and Baseline Comparability
A total of 286 medical records of patients with PSD were screened. After applying the inclusion and exclusion criteria, 112 records were excluded (78 did not meet inclusion criteria, 24 declined participations according to clinical records, and 10 had incomplete data). The remaining 174 patients were enrolled and underwent 1:1 propensity score matching, resulting in 87 patients in the MI‑ADL group and 87 patients in the conventional rehabilitation g.......

Discussion

In this retrospective cohort study, MI-guided bedside ADL training was associated with significantly greater improvements in functional independence (MBI), depressive symptoms (HAMD-17 and SDS), and serum levels of monoamine neurotransmitters (5‑HT, NE, DA) compared with conventional rehabilitation. These improvements were sustained at the 6‑month follow‑up. Consistent with previous reports describing the clinical burden of PSD and its negative impact on rehabilitation outcomes³⁰.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
1.5 mL microcentrifuge tube (labeled, sterile)	Eppendorf (Hamburg, Germany) / Sigma-Aldrich	EP022600028 (North America)	Generic descriptor “1.5 mL microcentrifuge tube” used in text; Eppendorf tube
3,4-Dihydroxybenzylamine (DHBA) internal standard	Sigma-Aldrich (St. Louis, MO, USA)	377679	Internal standard for HPLC-ECD
5-Hydroxytryptamine (5-HT) standard	Sigma-Aldrich (St. Louis, MO, USA)	H9523	Reference standard for HPLC-ECD
Dopamine (DA) standard	Sigma-Aldrich (St. Louis, MO, USA)	H8502	Reference standard for HPLC-ECD
Electrochemical Detection (HPLC-ECD) system	Agilent Technologies, Santa Clara, CA, USA	Agilent 1260 Infinity II
G*Power software (version 3.1.9.7)	Heinrich-Heine-Universität Düsseldorf, Germany	Software (no catalog number)	RRID:SCR_013726 (for G*Power v3.1)
Mobile phase components (sodium acetate, citric acid, di-n-butylamine, sodium octanesulfonate, EDTA, methanol, phosphoric acid)	Sigma-Aldrich / Merck / Sinopharm (various)	No single catalog number (standard laboratory reagents)	Reagents for HPLC-ECD mobile phase
Norepinephrine (NE) standard	Sigma-Aldrich (St. Louis, MO, USA)	A9512	Reference standard for HPLC-ECD
Serum-separating vacuum blood collection tube (5 mL)	BD (Becton, Dickinson and Company, Franklin Lakes, NJ, USA)	367986 (5 mL, PET plastic, gold Hemogard closure, SST™ gel separator)	Alternative cat. nos. 367983 (3.5 mL) or 367955 also suitable
SPSS software (version 25.0)	IBM Corp. (Armonk, NY, USA)	Software (no catalog number)	RRID:SCR_002865
ZORBAX SB-C18 reversed-phase column	Agilent Technologies		chromatographic separation column