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Baylor C, Cook KJ, McAuliffe MJ. "Take Us Into Account": Perspectives of Family Members of People With Parkinson's Disease Regarding Speech-Language Pathology Intervention. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:736-755. [PMID: 38092050 DOI: 10.1044/2023_ajslp-23-00273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE While communication changes associated with Parkinson's disease (PD) have been documented, research on the impact of these changes on family members is just beginning to emerge. With this new focus on family, questions arise as to how well speech-language pathology services address their needs communicating with their loved one with PD. The purpose of this study was to explore the experiences of family members of people with PD (PwPD) and their recommendations for speech-language pathology services that incorporated their needs. METHOD Seventeen spouses/partners of PwPD participated in focus groups that were recorded, transcribed, and analyzed using thematic analyses. RESULTS Three themes emerged, all focusing around the central tenet that the experiences of family members, and hence their need for speech-language pathology support, transitioned through the stages of PD progression. Theme 1 summarized increasing burdens on family to manage communication as PD progressed beyond a brief period of independent strategy use by PwPD. Theme 2 highlighted multifactorial contributors to communication burdens on families, with cognitive impairments being the most underrecognized. Theme 3 illustrated how families wanted more intervention options from speech-language pathologists (SLPs) that included them, but with a tailored approach for PD stages and personal preferences. CONCLUSIONS When SLPs provide families with either generic communication strategies or strategies that do not fit the individualized needs of PwPD and their families, we may inadvertently be increasing the burden on families. There is a need for systematic, evidence-based, family-centered interventions that include, but go beyond, current speech-focused interventions to meet the shared communication needs of PwPD and their families.
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Affiliation(s)
- Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Kate J Cook
- School of Psychology, Speech and Hearing | Te Kura Mahi ā Hirikapo, University of Canterbury, Christchurch, New Zealand
| | - Megan J McAuliffe
- School of Psychology, Speech and Hearing | Te Kura Mahi ā Hirikapo, University of Canterbury, Christchurch, New Zealand
- New Zealand Institute of Language, Brain & Behaviour, University of Canterbury, Christchurch
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Ryan B, Kneebone I, Rose ML, Togher L, Power E, Hoffmann T, Khan A, Simmons-Mackie N, Carragher M, Worrall L. Preventing depression in aphasia: A cluster randomized control trial of the Aphasia Action Success Knowledge (ASK) program. Int J Stroke 2023; 18:996-1004. [PMID: 37154589 PMCID: PMC10507993 DOI: 10.1177/17474930231176718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia. AIMS The objective of the study is to determine whether a tailored intervention program (Action Success Knowledge; ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12-month end point at cluster and individual participant level. METHODS A multi-site, pragmatic, two-level single-blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and their family members were recruited within 6 months post-stroke who scored ⩽12 on the Stroke Aphasic Depression Questionnaire Hospital Version-10 at screening. Each arm received manualized intervention over 6-8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset. RESULTS Twenty clusters (health regions) were randomized. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n = 231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm, respectively, receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modeling under the intention-to-treat protocol showed a significant difference on the Stroke and Aphasia Depression Questionnaire-21 (SADQ-21, N = 122, 17 clusters) in favor of the attention control (β = -2.74, 95% confidence interval (CI) = -4.76 to -0.73, p = 0.008). Individual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful. CONCLUSION ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members.
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Affiliation(s)
- Brooke Ryan
- Discipline of Clinical Psychology, University of Technology Sydney, Ultimo, NSW, Australia
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, University of Technology Sydney, Ultimo, NSW, Australia
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
| | - Miranda L. Rose
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Department of Communication Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma Power
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Asaduzzaman Khan
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Marcella Carragher
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Linda Worrall
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Bennett RJ, Nickbakht M, Saulsman L, Pachana NA, Eikelboom RH, Bucks RS, Meyer CJ. Providing information on mental well-being during audiological consultations: exploring barriers and facilitators using the COM-B model. Int J Audiol 2023; 62:269-277. [PMID: 35175887 DOI: 10.1080/14992027.2022.2034997] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being. DESIGN A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change). STUDY SAMPLE Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3). RESULTS Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss. CONCLUSION Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.
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Affiliation(s)
- Rebecca J Bennett
- Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, The University of Western Australia, Perth, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mansoureh Nickbakht
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Lisa Saulsman
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, The University of Western Australia, Perth, Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Romola S Bucks
- School of Psychological Science, The University of Western Australia, Perth, Australia.,The Raine Study, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Carly J Meyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
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El-Helou R, Ryan B, Kneebone I. Development of the "Kalmer" relaxation intervention: co-design with stroke survivors with aphasia. Disabil Rehabil 2022; 45:1517-1529. [PMID: 35549790 DOI: 10.1080/09638288.2022.2069294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Anxiety is common after stroke and more prevalent in survivors with aphasia. Relaxation is an effective first-line therapy. The current study aimed to obtain the perspectives of stroke survivors with aphasia to inform the development of an accessible, technology-based, relaxation intervention. MATERIALS AND METHODS Qualitative co-design methods were used with twelve people with aphasia after stroke. The "Kalmer" Relaxation treatment package materials were iteratively based on participants' experiences and preferences; barriers and facilitators to treatment compliance were explored. Participants were also asked to consider how the intervention might be evaluated in a research trial. RESULTS A thematic analysis highlighted the importance and need for the development of an appropriate and inclusive relaxation product, to be implemented by health professionals early post-stroke. Several behavioural strategies to improve treatment adherence were recommended. Participants had varying perspectives on clinically meaningful treatment outcomes. CONCLUSIONS Overall, a co-designed accessible relaxation product was viewed as a necessary component of usual stroke care. Acceptability and feasibility and preliminary efficacy of the "Kalmer" intervention should be trialled in future studies. IMPLICATIONS FOR REHABILITATIONCo-designing psychological interventions for people with aphasia after stroke is needed to meet the needs of this at-risk population.Technology-based relaxation interventions to manage anxiety after stroke are viewed positively by people with aphasia and deemed acceptable and feasible.Clinical trials of these co-designed relaxation interventions are required before recommending integration into routine practice.
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Affiliation(s)
- Rebecca El-Helou
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Brooke Ryan
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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Escher AA, McKinnon S, Berger S. Effective interventions within the scope of occupational therapy practice to address participation for adults with aphasia: A systematic review. Br J Occup Ther 2021. [DOI: 10.1177/03080226211057835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Occupational therapists work with clients with impaired communication to re-engage in valued occupations. This systematic review seeks to answer the question: What are effective interventions within the scope of occupational therapy practice to address participation for adults with aphasia? Method A systematic review of the literature was completed using PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Database of Systematic Reviews, and OT Seeker databases. Intervention studies within the scope of occupational therapy practice with a participation outcome, and published in peer reviewed journals from 2000 to 2019, were included. The quality of each study was assessed using the Mixed Methods Appraisal Tool. Findings Thirteen articles fit the inclusion criteria. Categories of interventions that emerged from the data include community-based groups, individually tailored programs, adaptation/presentation of materials, interprofessional interventions, and psychoeducation. Conclusion There is evidence to support the use of interventions within the scope of occupational therapy practice to increase participation for people with aphasia. Specifically, the use of community-based groups and adaptation of materials are effective to facilitate participation. Most of the studies were pre-post one group design; however, they demonstrated positive results for participation outcomes. More research is needed on people with aphasia that focuses on participation in meaningful occupations.
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Affiliation(s)
- Anne A Escher
- Department of Occupational Therapy, Boston University, Boston, MA, USA
| | - Sarah McKinnon
- Post-Professional OTD Program, Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Sue Berger
- Department of Occupational Therapy, Boston University, Boston, MA, USA
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Strong KA, Randolph J. How Do You Do Talk Therapy With Someone Who Can't Talk? Perspectives From Mental Health Providers on Delivering Services to Individuals With Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2681-2692. [PMID: 34674537 DOI: 10.1044/2021_ajslp-21-00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Aphasia is correlated with depression and anxiety, and it has a negative impact on quality of life. Aphasia is also frequently misunderstood among mental health care providers. The aim of this study was to explore the experiences of mental health providers who provide services to people living with aphasia. Method Interpretative phenomenological analysis was used to analyze interviews of six mental health providers who had some experience in providing services to people with aphasia. Results Three main themes among mental health care providers' experiences providing services to people with aphasia were identified: barriers, interprofessional collaboration, and therapy looks different. Subthemes associated with barriers included insufficient training and knowledge of aphasia, the stigma of receiving mental health services, and accessibility to services. Subthemes related to interdisciplinary collaboration included referrals, knowledge and awareness, and strategies and tools. Subthemes supporting therapy looks different included a new approach to therapy and challenges. Conclusions Mental health providers' experiences reveal the need for an action-oriented approach to overcome barriers, a nontraditional approach to talk therapy for people with aphasia, and increased collaboration with speech-language pathologists (SLPs). Future research should explore expanding the collaboration between SLPs and mental health providers to increase shared knowledge and skills in issues related to reducing depression and anxiety to support the well-being of people with aphasia.
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Affiliation(s)
- Katie A Strong
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
| | - Jenna Randolph
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
- Encore Rehabilitation Services, Farmington Hills, MI
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Bennett RJ, Meyer CJ, Ryan BJ, Eikelboom RH. How Do Audiologists Respond to Emotional and Psychological Concerns Raised in the Audiology Setting? Three Case Vignettes. Ear Hear 2021; 41:1675-1683. [PMID: 33136641 DOI: 10.1097/aud.0000000000000887] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Emotional and psychological well-being are essential to overall health, but there is little research showing how to approach emotional and psychological concerns in the audiological setting. This study investigated audiologists' self-reported clinical behaviors in response to emotional and psychological concerns and/or symptoms raised by audiology clients. DESIGN A sample of 83 Australia-based audiologists completed a survey including vignettes presenting older adults with hearing loss and experiencing symptoms consistent with either depression or grief. Content analysis was used to explore: (1) audiologists' self-reported usual response when clients present with emotional and psychological concerns and/or symptoms in the audiological setting; (2) audiologists' ability to identify and describe psychological symptoms; and (3) audiologists' self-reported clinical behaviors relating to client referral for psychological support. RESULTS When asked to describe their usual clinical course of action in response to the vignettes, over one half the audiologists described actions that address the clients concerns related to psychological well-being. Where audiologists described how they would provide psychological support, they described modifications to the audiological rehabilitation program including involving significant others in the rehabilitation process, recommending additional support outside of the audiology setting (such as General Practitioner or psychologists), and providing emotional support and counseling. When prompted, the majority of participants recognized the two cases with depression as having a mental health condition; however, 48% of participants indicated the control case as also having a mental health condition. When asked directly, the majority of audiologists indicated that they would refer the three vignettes for specialist support; however, less than one third described referral to a General Practitioner and less than 5% described referral to a mental health professional as their normal course of action in the open response item. Twenty-five different professions/people were reported as potential sources for referral. CONCLUSION These findings support the need for further training and/or resources for audiologists to enable them to appropriately detect, describe and refer for emotional and psychological concerns and/or symptoms raised by clients' in the audiology setting.
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Affiliation(s)
- Rebecca J Bennett
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Carly J Meyer
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Carragher M, Ryan B, Worrall L, Thomas S, Rose M, Simmons-Mackie N, Khan A, Hoffmann TC, Power E, Togher L, Kneebone I. Fidelity protocol for the Action Success Knowledge (ASK) trial: a psychosocial intervention administered by speech and language therapists to prevent depression in people with post-stroke aphasia. BMJ Open 2019; 9:e023560. [PMID: 31061014 PMCID: PMC6502036 DOI: 10.1136/bmjopen-2018-023560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Treatment fidelity is a complex, multifaceted evaluative process which refers to whether a studied intervention was delivered as intended. Monitoring and enhancing fidelity is one recommendation of the TiDIER (Template for Intervention Description and Replication) checklist, as fidelity can inform interpretation and conclusions drawn about treatment effects. Despite the methodological and translational benefits, fidelity strategies have been used inconsistently within health behaviour intervention studies; in particular, within aphasia intervention studies, reporting of fidelity remains relatively rare. This paper describes the development of a fidelity protocol for the Action Success Knowledge (ASK) study, a current cluster randomised trial investigating an early mood intervention for people with aphasia (a language disability caused by stroke). METHODS AND ANALYSIS A novel fidelity protocol and tool was developed to monitor and enhance fidelity within the two arms (experimental treatment and attention control) of the ASK study. The ASK fidelity protocol was developed based on the National Institutes of Health Behaviour Change Consortium fidelity framework. ETHICS AND DISSEMINATION The study protocol was approved by the Darling Downs Hospital and Health Service Human Research Ethics Committee in Queensland, Australia under the National Mutual Acceptance scheme of multicentre human research projects. Specific ethics approval was obtained for those participating sites who were not under the National Mutual Agreement at the time of application. The monitoring and ongoing conduct of the research project is in line with requirements under the National Mutual Acceptance. On completion of the trial, findings from the fidelity reviews will be disseminated via publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12614000979651.
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Affiliation(s)
- Marcella Carragher
- School of Allied Health, Human Services and Sport, La Trobe University—Melbourne Campus, Melbourne, Victoria, Australia
| | - Brooke Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Shirley Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Miranda Rose
- School of Allied Health, Human Services and Sport, La Trobe University—Melbourne Campus, Melbourne, Victoria, Australia
| | - Nina Simmons-Mackie
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond, Louisiana, USA
| | - Asad Khan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Leanne Togher
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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