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

Methods

The overall study lasted for four years (November 2016 to December 2020), and comprised 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.

Phase Two of the study ran from October 2017 to December 2020. During this stage we ran a ‘feasibility trial’. We recruited 32 participants with any severity of aphasia, who were at least six months post stroke. Participants were randomly assigned to one of two groups: intervention group and wait-list control group. The intervention group received up to six Solution Focused Brief Therapy sessions spaced over three months. They were 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 were also assessed at all three time points, and were then offered the same therapy after Time Three and reassessed three months later (at Time Four). During the assessment sessions, we asked 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 could compare the two groups.

All participants also received the usual care offered to them by their local NHS, social services and voluntary organisations. We recorded the services used and examined whether receiving the therapy changed how people use services. We also explored out how much it costs to deliver the therapy. Finally, we invited 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 also interviewed the therapists working on the project, and the research assistants.

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.