Study design

Aims and Background

One third of people who have a stroke will have aphasia, a language disability. Aphasia can affect talking, understanding, reading or writing. For 15% of stroke survivors, aphasia will be a life-long condition, and it is estimated there are over 300,000 people living in the UK with chronic aphasia. Aphasia can be challenging condition to live with, and people with aphasia tell us that it can affect their mood and confidence. However, due to their language difficulties they are often excluded from stroke research exploring interventions to address their emotional well-being.

We want to explore whether an existing therapy, Solution Focused Brief Therapy, can be adapted for people with aphasia. We will ask participants how they experience receiving the therapy and how acceptable they find it. We are keen to include people with different types of aphasia, both mild and more severe. We will use the information from this study to help us design a future large-scale study evaluating the effectiveness of this approach.

Methods

The overall study will last for 38 months (November 2016 to December 2019), and comprise two Phases. The first year was the Development Phase. During this time we ran a small pilot study for people with very severe aphasia. We also wrote the protocol for the trial, gained ethical approval to run the trial, ran a series of workshops with our Aphasia Advisory Group, trained the clinicians and research assistants, and worked with two partner NHS sites (East London Foundation Health Trust and Central London Community Healthcare).

We are now in the Phase Two of the study (October 2017 to December 2019). During this stage we are running a ‘feasibility trial’. We are recruiting 32 participants with any severity of aphasia, who are at least six months post stroke. Participants will be randomly assigned to one of two groups: intervention group and wait-list control group. The intervention group will receive up to six Solution Focused Brief Therapy sessions spaced over three months. They will be assessed immediately prior to the therapy (at Time One), immediately post therapy (at Time Two), and three months later (at Time Three). The wait-list control group will also be assessed at all three time points, and will then be offered the same therapy after Time Three and reassessed three months later (at Time Four). During the assessment sessions, we will ask participants about how their aphasia affects their mood, confidence and everyday life using questionnaires specifically designed to be accessible to people with aphasia. This design means we can compare the two groups.

All participants will also receive the usual care offered to them by their local NHS, social services and voluntary organisations. We will record the services used and examine whether receiving the therapy changes how people use services. We will also work out how much it costs to deliver the therapy. Finally, we will invite all participants to take part in a less structured, ‘in-depth’ interview to explore their experiences of taking part in the study, including their experiences of receiving the therapy. We will also interview the therapists working on the project.

Clinical Implications

This trial has been designed to assess the acceptability of the intervention for people with varying presentations of aphasia, and the feasibility of conducting a successful definitive trial evaluating clinical and cost effectiveness in the future. Given the high levels of distress and isolation experienced by people living with aphasia, and the current poor evidence base, there is a pressing need to investigate effective psychological interventions. Solution Focused Brief Therapy is potentially a relatively brief approach deliverable by Speech and Language Therapists.