None listed
Conditions
Brief summary
Stroke is one of the leading causes of death and chronic disability in Australia. Chronic aphasia associated with stroke affects access to services, creates social isolation, depression and decreases quality of life. People with aphasia following a stroke experience a sudden loss of language ability but their intelligence is not affected. As a consequence of their communication disability, the person’s access to services is limited, adversely affecting rehabilitation outcomes and often resulting in increased rates of depression and social isolation, and decreased quality of life. Current rehabilitation for aphasia consists of long-term, infrequent and predominantly one-to-one therapy, the cost of which is taxing on an already-stretched health system. The proposed study will determine if the outcomes of an intensive, comprehensive and time-limited rehabilitation are better than current speech pathology intervention and evaluate the cost effectiveness of this model. Access to aphasia rehabilitation and meaningful outcomes for this under-served population will therefore be improved. UQ’s CCRE Aphasia Rehabilitation researchers have taken evidence from the bench to bedside by using principles of neuroplasticity from animal models to stroke recovery, and built an evidence base for the new intervention. Using implementation science we will determine the best methods to help translate new evidence into public policy and improve clinical practice. The overarching aim of this research is to determine the effectiveness of a new model of care for aphasia rehabilitation compared to usual care. There is a critical gap between the treatment that people with aphasia require to live successfully, and the limited services that are provided in most cases. Speech pathologists from our major Partner Organisation, Queensland Health (QH), have been seeking a new model of care to meet the National Clinical Guidelines of Stroke Management recommendation that aphasia therapy be delivered intensively (NSF, 2010; Wenke, 2012). At the same time, The University of Queensland (UQ) research team have developed and piloted an intensive, comprehensive, aphasia program, the Language Impairment and Functioning Therapy (LIFT) program. This program is the translation of decades of aphasia research into an intensive, comprehensive, time limited package and is the first of its kind in Australia. Intensive programs ensure that experience-dependent neuroplasticity occurs; comprehensive programs ensure that all clinical guidelines are adhered to and patients and their family have their needs met; and time-limited programs ensure costs are contained. This project seeks to develop a partnership whereby we work with our Partner Organisations (POs) to trial the LIFT program as a cost effective solution to closing the main evidence-practice gap in aphasia rehabilitation. Our partnership also recognises the nee d to translate the research into everyday health care. The pioneering research of implementation science brings potential solutions to overcoming the barriers to implementing intensive and comprehensive aphasia rehabilitation such that patients and health systems benefit from clinically effective and cost effective programs. Primary aim: 1) Assess the clinical effectiveness of LIFT compared to usual care; Secondary aims: 2) Assess the cost-effectiveness of LIFT compared to usual care; 3) Describe the barriers and enablers to uptake of LIFT by POs; 4) Develop a strategy for implementing LIFT into routine clinical practice. Hypothesis: Clinical and cost effectiveness outcomes for LIFT will be significantly better than usual care.
Interventions
The University of Queensland's Aphasia LIFT program seeks to integrate all aspects of what people with aphasia and their families want with evidence-based components into a “package”. LIFT involves over 50 hours of intervention per participant and incorporates individual impairment-based therapy, individual functional therapy computer therapy and group sessions for information sharing and discussion of topics related to living with aphasia & topics requested by participants. It seeks to provide
The University of Queensland's Aphasia LIFT program seeks to integrate all aspects of what people with aphasia and their families want with evidence-based components into a “package”. LIFT involves over 50 hours of intervention per participant and incorporates individual impairment-based therapy, individual functional therapy computer therapy and group sessions for information sharing and discussion of topics related to living with aphasia & topics requested by participants. It seeks to provide participants with tools to practice language themselves through use of commercial computerised aphasia programs in treatment, as well as instruction on how to develop their own personalised therapy materials. Mobile technology such as iPads & iPhones are used frequently both to achieve communication goals such as being able to text short messages to family and friend and to maintain practice schedules. In the maintenance phase (weeks 4-7) participants will use a tablet-based therapy program at home, monitored and updated regularly by the speech pathologist. Data will be gathered on time spent on the therapy tasks as well as progress. The speech pathologist will also 'check-in' with the participant via telephone to talk through any issues and check that the participant is adhering to the program. In addition, LIFT links them into community resources (peer-led aphasia groups, stroke groups, interest groups, other professionals) so that the psychosocial benefits of the group are maintained. Family members are also part of the program. The program culminates in a challenge day in which participants present what they have achieved in front of family and friends. Group-level data demonstrates that Aphasia LIFT yielded positive and enduring outcomes in language impairment, functional communication, and communication-related quality of life in individuals with aphasia. The intervention arms are: Usual care: Any aphasia therapy up to 12 months post stroke, delivered by typical speech pathology service providers in outpatient hospital setting or community based rehabilitation setting in the patients’ homes or centres. LIFT: 3 week intensive program + 4 weeks maintenance, delivered by trained speech pathologists at The UQ CCRE Aphasia Clinic and other rehabilitation centres of our Partner Organisations. Participants in LIFT attend 10 x 60 minute sessions per week each of individual therapy, 5 x 60 minute sessions per week of computer-based therapy and 2 x 60 minute sessions per week of group therapy.
Sponsors
Professor Linda Worrall
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Participants with aphasia: Confirmed stroke (medical chart) and confirmed aphasia using the Frenchay Aphasia Screening Test. Score above cut-off on the Montreal Cognitive Assessment cognitive screen. Willing to forego other speech therapy for the duration of the study and during follow-up Able to toilet independently or with the assistance of an accompanying caregiver. Requires at least 7 more weeks of therapy as reported by the referring speech pathologist English language, hearing and vision sufficient for therapy as judged by the referring speech pathologist and the research assistant. 2. Family members/carers of participants with aphasia: Able to speak English 3. Treating speech pathologists Qualified practising speech pathologists, employed by either UQ or the partner hospitals, who are providing either LIFT or usual care to the people with aphasia in this study. 4. Speech pathology stakeholders Speech pathology managers, speech pathologists and consumers (i.e. people with aphasia and their family members/carers)
Exclusion criteria
1. Participants with aphasia: Co-existing neurological or mental health condition (e.g., dementia, severe depression) Severe apraxia of speech or severe dysarthria Global aphasia preventing completion of assessments tasks Transition care patients who receive aphasia services at home on discharge from hospital 2. Family members/carers of people with aphasia: Must not have dementia or other cognitive impairments Must not have uncorrected vision or hearing impairments that will prevent participation 3. Treating speech pathologists No exclusion criteria 4. Speech pathology stakeholders No exclusion criteria
Outcome results
None listed