1
|
Allida SM, Hsieh CF, Cox KL, Patel K, Rouncefield-Swales A, Lightbody CE, House A, Hackett ML. Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke. Cochrane Database Syst Rev 2023; 7:CD003437. [PMID: 37417452 PMCID: PMC10327406 DOI: 10.1002/14651858.cd003437.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Depression is an important morbidity associated with stroke that impacts on recovery, yet is often undetected or inadequately treated. OBJECTIVES To evaluate the benefits and harms of pharmacological intervention, non-invasive brain stimulation, psychological therapy, or combinations of these to treat depression after stroke. SEARCH METHODS This is a living systematic review. We search for new evidence every two months and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review. We searched the Specialised Registers of Cochrane Stroke, and Cochrane Depression Anxiety and Neurosis, CENTRAL, MEDLINE, Embase, five other databases, two clinical trials registers, reference lists and conference proceedings (February 2022). We contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing: 1) pharmacological interventions with placebo; 2) non-invasive brain stimulation with sham stimulation or usual care; 3) psychological therapy with usual care or attention control; 4) pharmacological intervention and psychological therapy with pharmacological intervention and usual care or attention control; 5) pharmacological intervention and non-invasive brain stimulation with pharmacological intervention and sham stimulation or usual care; 6) non-invasive brain stimulation and psychological therapy versus sham brain stimulation or usual care and psychological therapy; 7) pharmacological intervention and psychological therapy with placebo and psychological therapy; 8) pharmacological intervention and non-invasive brain stimulation with placebo and non-invasive brain stimulation; and 9) non-invasive brain stimulation and psychological therapy versus non-invasive brain stimulation and usual care or attention control, with the intention of treating depression after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data from included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE. MAIN RESULTS We included 65 trials (72 comparisons) with 5831 participants. Data were available for: 1) 20 comparisons; 2) nine comparisons; 3) 25 comparisons; 4) three comparisons; 5) 14 comparisons; and 6) one comparison. We found no trials for comparisons 7 to 9. Comparison 1: Pharmacological interventions Very low-certainty evidence from eight trials suggests pharmacological interventions decreased the number of people meeting the study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; P = 0.002; 8 RCTs; 1025 participants) at end of treatment and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with inadequate response to treatment (RR 0.47, 95% CI 0.32 to 0.70; P = 0.0002; 6 RCTs; 511 participants) compared to placebo. More adverse events related to the central nervous system (CNS) (RR 1.55, 95% CI 1.12 to 2.15; P = 0.008; 5 RCTs; 488 participants; very low-certainty evidence) and gastrointestinal system (RR 1.62, 95% CI 1.19 to 2.19; P = 0.002; 4 RCTs; 473 participants; very low-certainty evidence) were noted in the pharmacological intervention than in the placebo group. Comparison 2: Non-invasive brain stimulation Very low-certainty evidence from two trials show that non-invasive brain stimulation had little to no effect on the number of people meeting the study criteria for depression (RR 0.67, 95% CI 0.39 to 1.14; P = 0.14; 2 RCTs; 130 participants) and the number of people with inadequate response to treatment (RR 0.84, 95% CI 0.52, 1.37; P = 0.49; 2 RCTs; 130 participants) compared to sham stimulation. Non-invasive brain stimulation resulted in no deaths. Comparison 3: Psychological therapy Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; P = 0.01; 521 participants) compared to usual care/attention control. No trials of psychological therapy reported on the outcome inadequate response to treatment. No differences in the number of deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Comparison 4: Pharmacological interventions with psychological therapy No trials of this combination reported on the primary outcomes. Combination therapy resulted in no deaths. Comparison 5: Pharmacological interventions with non-invasive brain stimulation Non-invasive brain stimulation with pharmacological intervention reduced the number of people meeting study criteria for depression at end of treatment (RR 0.77, 95% CI 0.64 to 0.91; P = 0.002; 3 RCTs; 392 participants; low-certainty evidence) but not the number of people with inadequate response to treatment (RR 0.95, 95% CI 0.69 to 1.30; P = 0.75; 3 RCTs; 392 participants; very low-certainty evidence) compared to pharmacological therapy alone. Very low-certainty evidence from five trials suggest no difference in deaths between this combination therapy (RR 1.06, 95% CI 0.27 to 4.16; P = 0.93; 487 participants) compared to pharmacological therapy intervention and sham stimulation or usual care. Comparison 6: Non-invasive brain stimulation with psychological therapy No trials of this combination reported on the primary outcomes. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that pharmacological, psychological and combination therapies can reduce the prevalence of depression while non-invasive brain stimulation had little to no effect on the prevalence of depression. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.
Collapse
Affiliation(s)
- Sabine M Allida
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Cheng-Fang Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Katherine Laura Cox
- Mental Health Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kulsum Patel
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | | | - C Elizabeth Lightbody
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | - Allan House
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maree L Hackett
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
- Mental Health Program, The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Northcott S, Thomas S, James K, Simpson A, Hirani S, Barnard R, Hilari K. Solution Focused Brief Therapy in Post-Stroke Aphasia (SOFIA): feasibility and acceptability results of a feasibility randomised wait-list controlled trial. BMJ Open 2021; 11:e050308. [PMID: 34408055 PMCID: PMC8375754 DOI: 10.1136/bmjopen-2021-050308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/14/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The Solution Focused Brief Therapy in Post-Stroke Aphasia feasibility trial had four primary aims: to assess (1) acceptability of the intervention to people with aphasia, including severe aphasia, (2) feasibility of recruitment and retention, (3) acceptability of research procedures and outcome measures, and (4) feasibility of delivering the intervention by speech and language therapists. DESIGN Two-group randomised controlled feasibility trial with wait-list design, blinded outcome assessors and nested qualitative research. SETTING Participants identified via two community NHS Speech and Language Therapy London services and through community routes (eg, voluntary-sector stroke groups). PARTICIPANTS People with aphasia at least 6 months post stroke. INTERVENTION Solution-focused brief therapy, a psychological intervention, adapted to be linguistically accessible. Participants offered up to six sessions over 3 months, either immediately postrandomisation or after a delay of 6 months. OUTCOME MEASURES Primary endpoints related to feasibility and acceptability. Clinical outcomes were collected at baseline, 3 and 6 months postrandomisation, and at 9 months (wait-list group only). The candidate primary outcome measure was the Warwick-Edinburgh Mental Well-being Scale. Participants and therapists also took part in in-depth interviews. RESULTS Thirty-two participants were recruited, including 43.8% with severe aphasia. Acceptability endpoints: therapy was perceived as valuable and acceptable by both participants (n=30 interviews) and therapists (n=3 interviews); 93.8% of participants had ≥2 therapy sessions (90.6% had 6/6 sessions). Feasibility endpoints: recruitment target was reached within the prespecified 13-month recruitment window; 82.1% of eligible participants consented; 96.9% were followed up at 6 months; missing data <0.01%. All five prespecified feasibility progression criteria were met. CONCLUSION The high retention and adherence rates, alongside the qualitative data, suggest the study design was feasible and therapy approach acceptable even to people with severe aphasia. These results indicate a definitive randomised controlled trial of the intervention would be feasible. TRIAL REGISTRATION NUMBER NCT03245060.
Collapse
Affiliation(s)
- Sarah Northcott
- Centre for Language and Communication Science, City, University of London, London, UK
| | - Shirley Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Shashivadan Hirani
- Centre for Health Services Research, City, University of London, London, UK
| | - Rachel Barnard
- Centre for Language and Communication Science, City, University of London, London, UK
| | - Katerina Hilari
- Centre for Language and Communication Science, City, University of London, London, UK
| |
Collapse
|
3
|
Behn N, Moss B, McVicker S, Roper A, Northcott S, Marshall J, Thomas S, Simpson A, Flood C, James K, Goldsmith K, Hilari K. SUpporting wellbeing through PEeR-Befriending (SUPERB) feasibility trial: fidelity of peer-befriending for people with aphasia. BMJ Open 2021; 11:e047994. [PMID: 34341046 PMCID: PMC8330561 DOI: 10.1136/bmjopen-2020-047994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/12/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate systematically the fidelity of a peer-befriending intervention for people with aphasia. DESIGN SUpporting wellbeing through Peer-befriending (SUPERB) was a feasibility randomised controlled trial comparing usual care to usual care +peer-befriending. This paper reports on the fidelity of all intervention aspects (training and supervision of providers/befrienders; intervention visits) which was evaluated across all areas of the Behaviour Change Consortium framework. SETTING Community. PARTICIPANTS People with aphasia early poststroke and low levels of distress, randomised to the intervention arm of the trial (n=28); 10 peer-befrienders at least 1-year poststroke. INTERVENTION Peer-befrienders were trained (4-6 hours); and received regular supervision (monthly group while actively befriending, and one-to-one as and when needed) in order to provide six 1-hour peer-befriending visits over 3 months. MAIN MEASURES Metrics included number and length of training, supervision sessions and visits. All training and supervision sessions and one (of six) visits per pair were rated against fidelity checklists and evaluated for inter-rater and intrarater reliability (Gwets AC1 agreement coefficient). Per-cent adherence to protocol was evaluated. RESULTS All peer-befrienders received 4-6 hours training over 2-3 days as intended. There were 25 group supervision sessions with a median number attended of 14 (IQR=8-18). Twenty-six participants agreed (92.8%) to the intervention and 21 (80.8%) received all six visits (median visit length 60 min). Adherence was high for training (91.7%-100%) and supervision (83%-100%) and moderate-to-high for befriending visits (66.7%-100%). Where calculable, inter-rater and intrarater reliability was high for training and supervision (Gwets AC1 >0.90) and moderate-to-high for intervention visits (Gwets AC1 0.44-1.0). CONCLUSION Planning of fidelity processes at the outset of the trial and monitoring throughout was feasible and ensured good-to-high fidelity for this peer-befriending intervention. The results permit confidence in other findings from the SUPERB trial. TRIAL REGISTRATION NUMBER NCT02947776.
Collapse
Affiliation(s)
- Nicholas Behn
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Becky Moss
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Sally McVicker
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Abi Roper
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Sarah Northcott
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, City University of London, London, UK
| | - Shirley Thomas
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Chris Flood
- School of Health and Social Care, London South Bank University, London, UK
| | - Kirsty James
- Biostatistics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Biostatistics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Katerina Hilari
- Centre for Language and Communication Science Research, City University of London, London, UK
| |
Collapse
|
4
|
Berthier ML, Edelkraut L, Mohr B, Pulvermüller F, Starkstein SE, Green-Heredia C, Dávila G. Intensive aphasia therapy improves low mood in fluent post-stroke aphasia: Evidence from a case-controlled study. Neuropsychol Rehabil 2020; 32:148-163. [PMID: 32867571 DOI: 10.1080/09602011.2020.1809463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Depressive symptoms are a major drawback of aphasia, negatively impacting on functional outcomes. In a previous study, Intensive Language-Action Therapy (ILAT) was effective in improving depression and low mood in persons with chronic non-fluent aphasia. We present a proof-of-concept case-control study that evaluates language and mood outcomes amongst persons with fluent post-stroke aphasia.Participants: Thirteen Spanish speaking persons with fluent aphasia due to chronic stroke lesions in the left hemisphere participated in the study.Intervention: Five participants (intervention group) received ILAT for 3 h/day during two consecutive weeks, for an overall of 30 h, and 8 participants (control group) entered a waiting-list no-treatment arm.Results: The main finding was that participants receiving active treatment showed significant improvements on depression and aphasia severity scores, whereas no significant changes were found in the control group.Conclusions: The implementation of ILAT was efficient in improving clinical language deficits in people with fluent aphasia and contributes to improvement in mood after therapy.Trial registration: EUDRACT (2008-008481-12).
Collapse
Affiliation(s)
- Marcelo L Berthier
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech and Language Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain
| | - Lisa Edelkraut
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech and Language Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech and Language Therapy, University of Málaga, Málaga, Spain
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,Zentrum für Neuropsychologie und Intensive Sprachtherapie, ZENIS, Berlin, Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany
| | - Sergio E Starkstein
- Division of Psychiatry, School of Medicine, The University of Western Australia, Perth, Australia
| | | | - Guadalupe Dávila
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech and Language Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech and Language Therapy, University of Málaga, Málaga, Spain
| |
Collapse
|
5
|
Power E, Bryant L, Shrubsole K. Making aphasia implementation stick: ensuring the sustainability of implementation. SPEECH LANGUAGE AND HEARING 2020. [DOI: 10.1080/2050571x.2019.1707349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Emma Power
- Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Lucy Bryant
- Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Kirstine Shrubsole
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Smale KJ, Carr SE, Schwartz AF, das Nair R, Lincoln NB. An evaluation of treatment integrity in a randomised controlled trial of memory rehabilitation for people with multiple sclerosis. Clin Rehabil 2014; 29:493-9. [PMID: 25239086 DOI: 10.1177/0269215514548733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/26/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the treatment integrity of a memory rehabilitation programme for people with multiple sclerosis. SUBJECTS Data were drawn from the intervention group of a randomised controlled trial of memory rehabilitation. This comprised 24 participants with multiple sclerosis. MEASURES Four core session components were identified from the treatment manual: recap, activities, take-home activity and other. One video-recording of each of ten intervention sessions was transcribed and amount of time spent on components recorded. RESULTS There were no significant differences between early and late stages of the programme in time spent on the core components (recap Z= -0.87, P=0.49; activities Z = -0.29, P=0.89; take-home activity Z = -0.59, P=0.69; other Z = -0.58, P=0.69). Thus, adherence to the manual was good with no evidence of programme drift. CONCLUSIONS Good adherence indicates the intervention was delivered as described in the manual and strengthens confidence in the findings of the randomised controlled trial.
Collapse
Affiliation(s)
- Kathryn J Smale
- Division of Rehabilitation and Ageing, University of Nottingham, UK
| | | | | | - Roshan das Nair
- Division of Rehabilitation and Ageing, University of Nottingham, UK
| | - Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, UK
| |
Collapse
|