Aphasia
Conditions
Brief summary
To undertake a pilot study that will evaluate the feasibility and acceptability of procedures to inform the design and delivery of a definitive RCT of SPA (which would assess the clinical and cost effectiveness of SPA for people with aphasia)
Detailed description
Beyond language function, people with aphasia (PWA) report a range of health problems which negatively affect wellbeing, including reduced confidence and social isolation. These psychosocial outcomes of aphasia are not sufficiently met by healthcare services: improvements in language function do not appear to lead to improvements in wellbeing. National clinical guidelines for stroke reflect this observation and highlight the need for community integration and participation of people with aphasia. This research is about singing groups for people with aphasia (SPA) and is intended to address this need by focusing on the wellbeing and social participation needs of people with aphasia after stroke. The Investigators engagement activities and early development project provided strong impetus for the proposed study: people with aphasia repeatedly told the investigators that singing in groups may help the participants to reconnect with society, and that this will improve wellbeing. The investigators have planned a pilot study that will allow an assessment of the extent to which the study processes and the singing groups themselves are feasible to run and are acceptable to participants. The information from this work will help the investigators to decide whether to conduct a larger randomised controlled trial (RCT) which would be a fair test of whether SPA can improve the lives of individuals with post stroke aphasia.
Interventions
BEHAVIORALSinging group + resource pack
SPA is a community-based, 10 weekly singing group. Each SPA session comprises 30 minutes of settling in/wrap-up and departure, and 60 minutes of group singing. Sessions will be led by a community music leader, co-facilitated by a person with aphasia, and involve the group singing from a songbook. Musical accompaniment will be provided by the facilitator(s). Small percussion instruments will be available for participants, enabling involvement of those with limited singing ability. Intervention content integrates the Information-Motivation-Behavioural (IMB) skills model of health behaviour change to support individuals in developing the social skills and confidence needed to improve psychosocial outcomes. Participants will also receive the resource pack.
BEHAVIORALResource pack
Resource pack with information on living with aphasia and local community activities.
Sponsors
University of Exeter
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of aphasia after stroke * Willingness to be randomised to either control or SPA (and able to attend the singing venue) * Conversational English speaker pre-morbidly * Capacity to consent (assessed by recruiting team using standard tools)
Exclusion criteria
* \<18 years old * Currently engaged in a speech or language therapy programme * Intention to relocate outside the geographical region during the study * Current participation in another study involving a lifestyle intervention * Currently attending a singing/music group
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| ICEpop CAPability measure for Adults (ICECAP-A) | Measures change from baseline to 3 months post intervention, change from baseline to 6 months post intervention, and change from 3 months to 6 months post intervention | A 5-item measure of capability for the general adult (18+) population for use in economic evaluation. It focuses on wellbeing and comprises five attributes: Attachment, Stability, Achievement, Enjoyment, Autonomy. |
| modified Reintegration to Normal Living (mRNL) | Measures change from baseline to 3 months post intervention, change from baseline to 6 months post intervention, and change from 3 months to 6 months post intervention | An 11-item measure that captures social participation (e.g. recreation, movement in the community, and interaction in family or other relationships). |
| EQ-5D-5L (health-related quality of life states consisting of five dimensions) | Measures change from baseline to 3 months post intervention, change from baseline to 6 months post intervention, and change from 3 months to 6 months post intervention | A 5-item measure of health-related quality of life (plus EQ-VAS visual analogue scale), that can be used for cost utility analysis. |
| Stroke and Aphasia Quality of Life Scale (SAQOL - 39) | Measures change from baseline to 3 months post intervention, change from baseline to 6 months post intervention, and change from 3 months to 6 months post intervention | A 39-item health-related quality of life measure with 4 subdomains: physical, psychosocial, communication, and energy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Very Short Version of the Minnesota Aphasia test | Measures change from baseline to 6 months post intervention | A diagnostic tool to identify aphasia type. Comprised of 4 activities: Identifying names, oral reading words, naming pictures, and written spelling. Audio-recorded to allow for diagnosis of aphasia severity. |
| Communication Outcome After STroke (COAST) | Measures change from baseline to 6 months post intervention | A 20-item measure of communication effectiveness for people with any type of communication problem following stroke |
| Service Receipt Inventory | Measures change from baseline to 6 months post intervention | Record of types and amount of use of health and social care resources including clinical contacts, formal and informal social care. Completed by Assessor drawing on participant and family accounts. |
| Care related Quality of Life (CarerQoL-7D)48 | Measures change from baseline to 6 months post intervention | For completion by carers. A 7-item measures of the impact of providing informal care on carers. Utility tariffs to calculate a weighted sum score of the CarerQol-7D are also available. |
| Adverse incidents | Measured continuously throughout the intervention (for the intervention group only) and also (for all participants) at 3months and 6months post intervention. | Adverse events used to gauge the safety of the intervention |
Other
| Measure | Time frame | Description |
|---|---|---|
| Intervention fidelity (intervention group only): Singing group attendance | During the intervention, up to 10 weeks | A register of attendance at the singing group |
| Qualitative Interviews | Interviews to be conducted 3 months post-intervention | 15 Qualitative interviews across the intervention and control groups to discuss individuals' experiences of the trial processes and the intervention. Participants will report on the acceptability of trial and intervention activities |
| Retention | From Randomisation through study completion, an average of 36 weeks | An assessment of the retention rates in the trial |
| Intervention fidelity (intervention group only): Observations | During the intervention, up to 10 weeks | The research team will observe and record the extent to which the group facilitators are following the key elements of the intervention manual and the participants are adhering to facilitator instructions |
| Intervention fidelity (intervention group only): Video recordings | During the intervention, up to 10 weeks | The research team will video-record a selection of singing group sessions to assess facilitator and participant adherence |
| Intervention fidelity (intervention group only): Session adherence | During the intervention, up to 10 weeks | Group facilitators will record which aspects of the intervention manual have been followed during the group session |
| Recruitment | From the start of participant identification through to participant randomisation, over a period of 8 months | An assessment of the recruitment to the trial |
Countries
United Kingdom
Outcome results
None listed