Telemedicine Cognitive Behavioral Therapy for Anxiety After Stroke: Proof-of-Concept Randomized Controlled Trial

Area of Science:

• Neurology
• Psychiatry
• Digital Health

Background:

• Anxiety significantly impacts stroke survivors, yet treatment access is limited.
• A quarter of stroke survivors experience disabling anxiety.
• Current treatment delivery models pose challenges for this population.

Purpose of the Study:

• To evaluate the feasibility of a telemedicine model for delivering guided self-help cognitive behavioral therapy (CBT) for anxiety after stroke (TASK-CBT).
• To assess the feasibility of conducting all trial procedures remotely within a randomized controlled trial workflow.
• To explore the utility of wrist-worn actigraphy sensors for measuring objective outcomes in clinical trials for anxious stroke survivors.

Main Methods:

• Recruited 27 adult community-based stroke patients.
• Randomly allocated participants to either TASK-CBT (n=14) or a relaxation therapy comparator (TASK-Relax, n=13).
• All trial procedures, including enrollment and intervention delivery, were conducted remotely.

Main Results:

• Remote self-enrollment, electronic signatures, intervention delivery, and automated follow-up were feasible.
• All participants in the TASK-CBT group completed all sessions.
• TASK-CBT demonstrated lower anxiety levels compared to TASK-Relax at weeks 6 and 20.
• Wrist-worn actigraphy sensors were worn for a mean of 33 days.

Conclusions:

• Preliminary feasibility data support a larger definitive clinical trial for TASK-CBT.
• The use of wrist-worn actigraphy sensors is feasible and potentially valuable for anxious stroke survivors.
• Remote telemedicine models can effectively deliver interventions to stroke survivors.