Recipient organisationUniversity of SheffieldSource-published name: The University of Sheffield
Funding£1.4M
PeriodJan 2014 — Jun 2018
In plain English
AI plain-English summary
People who have lost the ability to speak or understand language after a stroke are testing whether daily computer therapy at home can help them recover words and hold conversations again. This matters because aphasia—a language impairment that can strike suddenly after a stroke—often persists for years, yet most speech therapy stops within months. The standard approach leaves many people unable to name family members, order food, or join a conversation, with no clear evidence on whether cheap, self-managed computer exercises can fill that gap. If the trial shows that tailored computer therapy improves word-finding and real-world communication, the NHS could offer a low-cost, scalable way to extend language rehabilitation long after the initial stroke. That would shift care from a short burst of therapist-led sessions to a long-term, home-based model that patients can sustain themselves, potentially improving quality of life for thousands of people living with chronic aphasia. The research also tracks costs and quality-of-life measures, so funders will know whether the approach is worth the money.
View original technical description
Design A pragmatic randomised controlled trial (RCT) to compare outcomes for people with persistent aphasia using computerised speech and language therapy(SLT)at home with those having usual care or attention control. A feasibility phase with a review of progression criteria half way through the recruitment phase is planned. Setting Computer therapy exercises will be provided in participants’ own homes. Recruitment, assessment and tailoring computer exercises will be coordinated by 20 Speech and language therapy (SLT) departments across the UK. Target population People presenting with aphasia at least 4 months post stroke with no upper limit. Health technologies being assessed Participants will be supported to self manage continued daily aphasia therapy exercises using available computer software for 6 months. Computer exercises will be tailored to individual needs by a SLT (up to 4 hours per patient) followed by monthly volunteer visits for support. Available software is subject to improvements over time, however the underlying therapy principles will remain the same. Measurement of costs and outcomes All outcome measures will be made at baseline, 6, 9 and 12 months by blinded research speech and language therapist assessors at each site. Primary outcomes: 1.The change in the number of words (of personal relevance to the participant) named correctly at 6 months will be measured by a picture naming task. This was successfully used to measure change in impairment in the pilot carried out by this team. 2.Improvement in functional communication will be measured by blinded ratings of video recorded conversations between a SLT and participants, using the activity scale of the Therapy Outcome Measures, at 6 months, as validated in the ACTNoW study. Conversations will be structured around topics of personal relevance to participants. Key secondary Improvement in patient perception of communication will be measured using the COAST - a patient reported measure of communication participation and related quality of life, validated for evaluating SLT interventions in the HTA ACTNoW project. The primary and key secondary endpoints will be analysed using a Hochberg testing procedure which allows for an investigation of all three endpoints whilst maintaining the overall Type I error at 5%. Cost effectiveness A cost-utility analysis will be undertaken from the NHS and personal social service perspective. A societal perspective will be included due to volunteer involvement. Intervention and SLT time costs will be estimated for individuals. The EQ5D will be administered at all time points and combined with standard valuation sources to measure quality adjusted life years (QALYs) gained in each group. An accessible version of the EQ5D, tested in the pilot study, enables scores to be elicited directly from patients with aphasia. This will be administered alongside the standard version completed by carers (where available) by proxy. EQ5D and CarerQoL scores will also be elicited from carers. An economic model developed alongside the pilot study will be updated. Differences between costs and QALYs in the 3 groups will be described and the incremental cost effectiveness ratio(ICER)will be calculated. Other secondary Evidence of therapy effect will also be measured by repeating all the above measures at 9 and 12 months from baseline. Generalisation of therapy to retrieval of untreated items will be measured by naming words from the Naming test within the Comprehensive Aphasia Test. Use of the target words in conversation Carer perception of communication participation will be measured using the Carer COAST. Adverse events will be recorded through patient/carer diaries (death, subsequent stroke, hospitalisation, negative effects of the computer treatment) Health service use will be evaluated through SLT diaries for all groups. Analysis Primary and key secondary endpoints will be a
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