BEADS Trial

The Challenge

Approximately one-third of stroke patients experience depression, which can have negative effects on recovery and quality of life (QoL). Currently, we do not have sufficient evidence to indicate which psychological interventions are effective and affordable to the NHS for treating post-stroke depression. 

We aimed to determine whether or not it is feasible to conduct a future large-scale study to evaluate a psychological intervention, called behavioural activation (BA) therapy, for treating post-stroke depression.

BA aims to improve mood by identifying what stroke patients enjoy doing and helping them to undertake these activities. BA can be used with all stroke patients with depression, including people with cognitive or communication difficulties.

The Research

We recruited 48 post-stroke patients who had suffered a stroke between 3 months and 5 years previously. People with dementia or significant aphasia were excluded. Participants were divided into two groups at random. About half of the participants received BA over a 4-month period and the other half did not.

Participants received all other available care. After 6 months, participants completed questionnaires about their mood, activity level and QoL. We also interviewed 16 participants and 10 carers about their views on the research process and the therapy.

The Results

Although we were able to recruit participants to the study, we recruited fewer than the original target of 72 participants owing to delays in starting recruitment. However, we have identified ways to improve participant recruitment in a future study. We found that it was feasible to deliver BA, and the therapy was found to be acceptable to participants, carers and therapists. The results indicate that the benefits of conducting a large-scale future study would outweigh the costs. However, the main consideration would be whether or not we could identify enough stroke services able to run the study for a long enough period to recruit the large number of participants required for a full trial which could provide a definitive answer about the effectiveness of BA therapy for people with depression post-stroke.

The Impact

Potential to inform the next update of the stroke clinical guidelines.

Presentations on behavioural activation have been delivered at local and national conferences.

Publications

• Thomas SA, Drummond AER, Lincoln NB, Palmer RL, das Nair R, Latimer NR, et al. Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT. Health Technol Assess 2019;23(47)
• Behavioural Activation Therapy for Depression after Stroke (BEADS): a study protocol for a feasibility randomised controlled pilot trial of a psychological intervention for post-stroke depression. Thomas, S.A., Coates, E., das Nair, R. et al. (10 more authors) (2016)  Pilot and Feasibility Studies, 2 (1).
• Behavioural activation therapy for depression after stroke (BEADS): a feasibility randomised controlled pilot trial of a psychological intervention for post-stroke depression. Thomas SA, Drummond A, Lincoln NB, Palmer R, das Nair R, Latimer N, Hackney G, Hatton R, Walters S, Mandefield L, et al. INTERNATIONAL JOURNAL OF STROKE. 12: 15-15. Nov 2017 . Conference proceedings

Study staff

Links

• ISRCTN Registration
• University of Nottingham Webpage
• CALM (Communication and Low Mood) Study