Discussion
anxiety, major mood, stroke, pain, depressive, psychiatric, depressive symptoms, depression
STROKE, RECRUITMENT, DISORDERS
Our longitudinal investigation was different from the few known meditation studies in stroke populations [In addition to the lengthy recruitment period, the number of individual participants was double the number of individuals participating in a dyad and fewer IC than SS enrolled in the study. To maintain the enrollment rate, the original inclusion criteria were revised to allow for individual SS and IC to participate aside from dyads. Known barriers associated with dyad enrollment include a lack of participation readiness by both members of the dyad [Sixty-six percent of the participants were retained compared to the pre-set 80% retention criteria at the 8-week post-intervention visit. However, 83% of the participants assigned to the meditation group were retained through the 4-week intervention. The additional 4- and 8-week post-intervention follow-up visits were incorporated to evaluate the feasibility of evaluating sustained meditation efficacy beyond the immediate structured 4-week meditation period. Most non-completers were lost to follow-up, defined as incomplete ascertainment of depressive symptom data through the 8-week post-intervention visit. We routinely (e.g., once a week for 3 weeks) attempted to contact participants who did not attend their scheduled visits. Repeated attempts at re-contact were mostly unsuccessful. Due to budgetary and timeline restraints of our feasibility study, we were unable to implement a comprehensive retention plan (e.g., trial innovation network toolbox) [The DIGS questionnaire was administered during a telephone interview at baseline, was approximately 1 h, and may have influenced rates of withdrawal or loss to follow-up. The questionnaire was incorporated to evaluate the feasibility of including a formal diagnostic interview for major mood and other psychiatric disorders and conditions. The use of a shorter diagnostic measure that exclusively evaluates depression may be considered in future studies. Since few participants routinely completed daily meditation practice questionnaires, it is unclear if participants established daily meditation practice. Qualitative reports from the participants assigned to the intervention group indicated that the daily email reminders to complete the meditation practice questionnaire were confusing. Furthermore, some participants indicated difficulties Intervention adherence was lower (mean session attendance rate of 55%) than our established criteria for adherence (75% or greater session attendance). Almost all intervention participants attended at least two group sessions. A meta-analysis of the effects of meditation on depression found that group meditation conferred a greater reduction in depressive symptoms than individual meditation, and a greater duration of unstructured meditation demonstrated a greater reduction in depressive symptoms [The primary objective was to determine the feasibility of a 4-week meditation RCT in the stroke population. Inferences as to the effects of the meditation intervention on depression symptom severity, anxiety, and pain should be made with caution [