Adapting Cognitive Stimulation Therapy (CST) for Pre-Frail Stroke Survivors: Intervention Development and Acceptability

Livsey, Sophie (2025) Adapting Cognitive Stimulation Therapy (CST) for Pre-Frail Stroke Survivors: Intervention Development and Acceptability. Doctoral thesis, University of East Anglia.

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Abstract

Background: Frailty, marked by unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity, is common in stroke survivors and linked to poorer outcomes. Multicomponent interventions (MCIs) show potential for reducing or preventing frailty, and may be helpful for a stroke survivor population. Given both frailty and stroke are associated with psychological difficulties such as cognitive impairment, depression, poor quality of life, there is a rationale for including psychological components within MCIs for post-stroke frailty.

Method: A systematic review was conducted on psychological outcomes of MCIs for frail or pre-frail individuals. Using a theory- and evidence-based approach, Cognitive Stimulation Therapy was adapted for stroke survivors (sCST) and a small-scale, singlearm pilot acceptability study was conducted. Pre-frail stroke survivors attended eight sample sessions of sCST and provided quantitative and qualitative acceptability feedback via a questionnaire and interview, respectively.

Results: Narrative synthesis of 16 studies indicated that MCIs are associated with improved depression, cognition, processing speed, visuospatial skills, and verbal fluency and highlighted that inclusion of cognitive or psychosocial intervention components increases the likelihood of these outcomes. Framework analysis of interviews with four pre-frail stroke survivors identified 22 sub-themes relating to the acceptability of sCST spanning the seven constructs of the Theoretical Framework of Acceptability: affective attitude, burden, ethicality, coherence, opportunity costs, perceived effectiveness, and self-efficacy. Notably, participants found sessions enjoyable and beneficial but highlighted issues with intervention location, clarity of purpose, and difficulty level.

Conclusions: Clinical Psychologists can contribute to frailty management research through exploration of the relationships between frailty, cognition, mood, and selfefficacy. Further refinements of sCST are required and research to assess its effectiveness as it may have useful applications for frailty prevention after stroke.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Nicola Veasy
Date Deposited:	27 Oct 2025 14:20
Last Modified:	27 Oct 2025 14:20
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100785
DOI:

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