Title: Evaluating the efficiency and acceptability of methods of delivering evidence based aphasia intervention (intensive language action therapy) to patients in the UK within the NHS: a pilot trial.
Funder: Health Education England

Abstract: Aphasia is a disturbance in language function following neurological damage. It can affect the ability to read, write, understand and produce the spoken word (RCSLT, 2009). Stroke is the most common cause of chronic disability in adults (Department of Health, 2007) and is the primary cause of aphasia (Brady et al, 2012, Intercollegiate stroke working party 2012). ILAT is an intensively delivered group intervention for the treatment of acquired aphasia. Current research indicates that ILAT is a promising intervention for aphasia (Cherney et al, 2010). However, ILAT has not yet been evaluated in comparison to usual care or no intervention within a randomised trial design.The use of ILAT has been restricted in the National Health service due to the resources required to provide this large number of hours of intervention intensively delivered by a Speech and Language Therapist (SLT). Meinzer et al, report it may be deliverable by trained volunteers thus reducing the resource required to deliver ILAT. Therefore, this mixed methods randomised controlled pilot trial aims to test the feasibility and acceptibility of evaluating the impact of ILAT delivered by Speech and Language Therapy assistants and/or volunteers for patients, carers and the NHS to inform a future large, multicenter trial.The research will examine the feasibility and acceptability of using volunteers and speech and language therapy assistants to facilitate ILAT and the feasibility of evaluating ILAT in a randomised controlled design for the following aims: 1. To examine the feasibility of undertaking a randomised control trial to compare the clinical effectiveness of ILAT facilitated by trained assistants/laypersons with usual treatment. estimate recruitment rates assess the most appropriate outcome measures to evaluate whether the goal of the ILAT intervention isachieved estimate the completion rates and acceptability of selected outcome measures assess the feasibility of the randomisation process exploring any delays/difficulties in delivering group therapy in a timely way following randomisation explore the feasibility of delivering ILAT using SLT assistants/ volunteers 2. To evaluate the acceptability of ILAT delivered by trained assistants/volunteers using interviews with participants, SLT's, assistants and laypersons.Semi-structured interviews will be completed for participants and service providers (SLT assistants/volunteers) to explore acceptability of ILAT.

Lay abstract: Aphasia is an acquired language disorder and is a common and devastating consequence of stroke. People with aphasia typically receive speech and language therapy. Research suggests that people with aphasia achieve the most improvement when therapy is delivered intensively. However intensively delivered therapy requires more therapist time than current NHS resources allow. Intensive Language Action Therapy (ILAT) is an intensively delivered therapy that aims to improve the ability of people with aphasia to speak and has shown to be a promising intervention through preliminary research studies (Cherney et al, 2010). ILAT is a group therapy. 3-4 people with aphasia of similar severity need to be grouped together. Therapy sessions happen 5 days a week for 2 weeks. Participants practice using increasing amounts of language to make requests in group barrier games as therapy progresses. Use of other means of communication such as gesture or pointing are restricted in order to focus on spoken language use. Speech and language therapy (SLT) assistants or volunteers may be able to deliver ILAT under the supervision of a SLT, which would reduce the resources needed to provide this intensive therapy and therefore make it available on the NHS. This study will test out whether it is feasible to deliver ILAT with SLT assistants and volunteers under SLT supervision in the NHS and to test out if it is feasible to conduct a randomised controlled trial comparing ILAT to usual care. Up to 32 people with aphasia will be invited to participate in the study, They will be randomly assigned to usual care or ILAT. Those people who have been assigned to ILAT will then be grouped together with people with similar severity of aphasia and will review a course of ILAT. The study aims to run 4 courses of ILAT. The people with aphasia who participate in the study will complete assessments. The assessments will focus on how many and how accurately people with aphasia can say words and sentences and how well people with aphasia can speak with other people in everyday life. The assessment will also look at how people with aphasia and their carers feel about their communication. These assessments will be completed before the people with aphasia are randomized to usual care or ILAT and repeated 4 months after randomization to usual care or ILAT. People with aphasia, SLT assistants and volunteers who participate in the study will be invited to participate in an interview to discuss their perceptions, experiences and whether ILAT is acceptable when delivered by SLT assistants and volunteers. These interviews will be completed about 2 weeks after completing a course of ILAT. Those people with aphasia who are assigned to normal SLT intervention will be asked about their experiences of participating in the study 4 months after being assigned to normal SLT intervention. The study therefore aims to: determine if it is possible to evaluate ILAT compared to usual SLT care using a randomised controlled trial design, explore the feasibility of recruiting people with aphasia and allocating them to ILAT therapy groups, explore whether it is feasible to deliver ILAT using SLT assistants and volunteers within the NHS, determine the most acceptable assessments to use to measure whether ILAT is effective. This study will provide important information to determine if ILAT can be used in the NHS delivered by SLT assistants and volunteers. If this is the case then there is the potential for people with aphasia to receive intensive therapy without needing to increase the amount of therapist time.

Research activity codes: 6.7 PHYSICAL
Health categories: NEUROLOGICAL