Primary objective—feasibility and acceptability outcomes
stroke, ABI, WL, fatigue
STROKE, RECRUITMENT
Our study met the target sample size and had low attrition rates (< 20% across all arms). The WL design that allowed all participants access to an intervention is potentially relevant to these good retention rates and is certainly consistent with many health services that have waiting periods between assessment and intervention. In taking forward feasibility results to an effectiveness trial, the re-randomisation element also allows for a more efficient design, where all participants recruited can fulfil the important roles of a comparison group (WL) and as a member of either AP or AE groups and thus increase group size. To further enhance recruitment, recruitment via self-referrals and ABI charity routes is potentially more efficient for future trials, as found in previous BA studies in stroke [Group size was important for acceptability; while smaller groups facilitated greater companionship, groups with too few group members were sometimes perceived as less beneficial and therefore a larger minimum group size may be warranted in future trials. Care should be taken when forming randomised groups with participants at various timepoints post-ABI as this may affect group cohesion. Participants noted that including content on how ABI varies by diagnosis and time post-event within session may be beneficial in ensuring group cohesion.Both groups received high ratings of helpfulness and enjoyability. Although we incorporated strategies to mitigate the cognitive demands of planning activities in the AP group, some participants reported difficulties in concentrating throughout sessions and remembering details about session content. There was however no overall statistical difference in self-reported “cognitive barriers” between groups, suggesting that the demands of the AP group were not generally greater than the types of activity/social groups often run by e.g., charities at the recruited sample size. Exploring whether cognitive demands differ in group BA, compared to one-to-one BA, is warranted.Though qualitative data indicated that online groups were preferred over in-person groups due to no travel time, a greater number of attention, fatigue, and organisational—as well as technological—barriers were reported for online groups. The degree to which these barriers reduce in a few years’ time (as experience of videoconferencing technology increases) is an interesting question. Whilst in-person groups may remain essential for some individuals to benefit, there is no doubt that online delivery has great potential to increase accessibility and save costs to both therapists and patients in terms of travel.