Plain English Summary
Background and study aims
After stroke it can be common to feel low in mood or lacking in confidence and this can affect how much people feel like getting out and being active.. A course has been designed called Regaining Confidence After Stroke (RCAS) which aims to help stroke survivors and their carers cope with life after stroke. The course is held in the community and encourages discussion between people with similar problems. There has not been much work done to test whether the course is a useful treatment in improving mood, confidence and coping. This study aims to test the benefits of the course and identify any possible problems in the way the course is delivered.
Who can participate?
Letters inviting people to take part in the study are being sent to stroke survivors who have a Nottingham City GP and who have had a stroke within the last 2 years. They also need to be over 18 years, able to get out to group meetings and able to speak English. They will usually have been discharged from all other rehabilitation or therapy.
What does the study involve?
After agreeing to take part in the study participants are asked to answer questions about their mood, confidence and level of ability and independence. Half of the people who agree to take part are chosen at random and invited to attend the RCAS course which is a set of 11 group sessions held once a week for around 2 hours. Sessions involve an introductory talk or video followed by group discussion, with the aim of sharing problems and ideas for coping and making realistic adjustment to the after-effects of stroke.. Those who are not chosen to attend the group just continue to receive their usual care. After 3 months and 6 months everyone who agreed to take part in the study is asked to fill out the same forms that were completed at the beginning of the study. Carers of those invited to attend the group are invited to attend 3 of the sessions and asked to fill out some forms about how they are feeling and coping. Some of the stroke survivors who attend the RCAS course, and their carers, are interviewed by a member of the research team asking for their views on the course.
What are the possible benefits and risks of participating?
There are no particular risks associated with this study. We hope that by attending the RCAS course it will help improve participants’ mood and confidence, but we don’t know for certain whether it will.
Where is the study run from?
The study is being run from Nottingham University. The course sessions will be held in a community venue in the Nottingham City area.
When is the study starting and how long is it expected to run for?
June 2013 to November 2013
Who is funding the study?
Stroke Association and NHS Nottingham City Research Capability grant
Who is the main contact?
An evaluation of the Regaining Confidence after Stroke (RCAS) course
An unfortunate common consequence of stroke is psychological distress, which refers to many negative mood states including depression and anxiety. It can have a detrimental effect upon rehabilitation. Regaining Confidence after Stroke (RCAS) is a group therapy that has been used nationwide for the last 10 years; it is designed to help stroke survivors with low mood or adjustment difficulties at the time of discharge from rehabilitation. We have received funding from the Stroke Association to conduct an initial evaluation of the RCAS course in improving mood, confidence and coping, and increasing activity levels in stroke survivors, and improving mood and coping in their carers. The study will also provide information about the most appropriate outcome measures, the number of required participants, and the acceptability of the course to stroke survivors and their carers, which will be useful for any followup studies.
Participants will be recruited from research sites in Nottingham and Leicester, and will be divided into two groups on the basis of chance. Group A will receive the RCAS course and Group B will receive usual care. The participants will be given several questionnaires before the intervention and after 3 and 6 months to determine the effectiveness of the course and at least 12 participants will be interviewed to obtain their opinions on the therapy. The stroke survivors carers will be asked to provide similar information. In addition, a sample of sessions will be recorded to check that the course is being delivered correctly. We expect that the proposed study will help to improve longterm psychological adjustment following a stroke, which may improve recovery and quality of life in stroke survivors.
NRES Committee East Midlands-Nottingham1 , ref: 12/EM/0319 - 2011
Randomised; Interventional; Design type: Treatment
Primary study design
Secondary study design
Randomised controlled trial
Quality of life
Patient information sheet
Topic: Stroke Research Network; Subtopic: Primary Care, Rehabilitation; Disease: Community study
Psychological intervention, Delivery of the RCAS course: Participants will be recruited from research sites in Nottingham and Leicester, and will be divided into two groups on the basis of chance. Group A will receive the RCAS course and Group B will receive usual care. The participants will be given several questionnaires before the intervention and after 3 and 6 months to determine the effectiveness of the course and at least 12 participants will be interviewed to obtain their opinions on the therapy. The stroke survivors carers will be asked to provide similar information. In addition, a sample of sessions will be recorded to check that the course is being delivered correctly.
Primary outcome measure
As of 19/09/2016:
General health, measured by GHQ-30 questionnaire at baseline, 3 months and 6 months
General Health Questionnaire 28; Timepoint(s): Not available
Secondary outcome measures
Confidence after stroke, assessed using the COPE and Confidence after Stroke Measure (CASM) questionnaire at baseline, 3 months and 6 months
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
Potential participants will be invited to take part in the study if they:
1. Have a clinical diagnosis of stroke
2. Are less than two years after stroke onset
3. Are resident in the community
4. Have been discharged from other rehabilitation therapies
5. Are not involved in other trials of psychological interventions
6. Give informed consent
7. These participants will be suffering from psychological distress or struggling to adjust to life after stroke
8. Carers will be invited to take part if they either live with or have regular contact with a stroke survivor
Target number of participants
Planned Sample Size: 60; UK Sample Size: 60
Total final enrolment
Participant exclusion criteria
Potential participants will be excluded if they:
1. Have a Barthel score of less than 10
2. A Sheffield Screening Test for Acquired Language Disorders receptive score of less than 8
3. Do not speak English or have previously attended the RCAS course
4. This will exclude those who will be unable to participate in the group sessions or complete the outcome measures and also those whose previous experience of the RCAS course may affect their expectation of outcome
5. Carers will be excluded if they are under 18 years of age or do not speak English, as this would prevent them from completing the outcome measures
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Institute of Work, Health & Organisations
The Stroke Association (UK)
Funding Body Type
Funding Body Subtype
NHS Nottingham City Research Capability grant
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
The study has been written up as a Masters thesis which was recently submitted to the University of Nottingham. Further plans are to be confirmed at a later date
Intention to publish date
Participant level data
Not expected to be available
Basic results (scientific)
2019 results in: https://www.ncbi.nlm.nih.gov/pubmed/31367463 (added 02/08/2019)