The Validity of the Distress Thermometer and Problem List in the Early Stages of Stroke Care

This thesis examined the application of psychological principles to stroke care. The literature investigating psychological adjustment post stroke was reviewed and the validity of the Distress Thermometer (DT) and Problem List was investigated in an empirical study. A systematic review focussed on the recently published literature using psychological theory to understand what cognitive factors are protective, or not, in the process of adjustment. Twenty papers were reviewed and nine theoretical models of psychological adjustment used. The most commonly referred to model was the Transactional Theory of Stress and Coping (Lazarus & Folkman, 1984). Factors found to be associated with positive mood included internal locus of control, finding meaning and satisfaction with treatment. The complex and dynamic nature of adjustment was highlighted by the role of time and individual differences. The results of the review provided support for a recently developed model of adjustment post stroke (Social Cognitive Transition Model for Stroke, SCoTs, Taylor, Todman & Broomfield, 2011). The DT and stroke specific Problem List offers a valuable tool for assessing and understanding distress post stroke. Forty-eight participants completed the DT, Problem List, Hospital Anxiety and Depression Scale (HADS, Zigmond & Snaith, 1983), Brief Assessment Schedule Depression Cards (BASDEC; Ashead et al, 1992) and the Visual Analogue Mood Scale Revised (Kontou et al., 2012) at one time point. Correlation coefficients were significant and positive between all measures, supporting concurrent validity. AUC analysis suggested a cut-off of 4.5 on the DT as suitable for the detection of anxiety. Cronbach's alpha found the Problem List to be most reliable when used as one whole scale, however this was most likely because of the large number of items in the overall scale, rather than the items being clearly associated to one another. Bladder and bowel problems were the most commonly reported distressing problem, with fatigue, worry and depression being frequently identified. These findings supported the used of the DT and Problem List in the early stages post stroke.