Rebecca Jane Roberts - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: Illness Perceptions
Patient Activation
Autism
Stroke
Cognitive Screening
Self-Management
Augmented Reality
Neurorehabilitation
Social Skills
Post-Stroke Depression
Cognitive Impairment

Critical Review of the Literature
Autistic children’s social skills do not always align with those of their neurotypical peers and research suggests that this can negatively impact quality of life. This review aimed to assess the effectiveness of Extended Reality interventions in helping autistic children to enhance their social skills. Five electronic databases were systematically searched and twenty-one studies were identified. The majority targeted social-emotional reciprocity and were of relatively low quality. There was insufficient evidence to determine whether effects were generalisable, sustained or important to autistic people. Research in this field is in its infancy and evidence of effectiveness should be viewed with caution. Future studies should aim for high-quality, theory-driven research, and involve autistic people to ensure meaningful outcomes. PROSPERO ID: CRD42021229442.
Service Improvement Project
‘Patient activation’, defined as a patient’s knowledge, skills and confidence in managing their health condition, is essential for collaborative neurorehabilitation. It is therefore in the interest of neurorehabilitation services to monitor and seek to improve this. The process of increasing patient activation at a Community Neurorehabilitation Service in Buckinghamshire (CNRS) was hereby explored. This research used a mixed methods design to investigate whether patient activation increases throughout intervention with CNRS and if so, what factors contribute to this. Quantitative analysis showed that activation did increase significantly and this was not impacted by demographic factors. Qualitative interviews with eight former patients and four therapists suggested that the nature of the therapeutic relationship and wider social support may have been important in contributing to the change. Negative past experiences of services and cognitive difficulties seemed to be associated with lower activation. As a result, CNRS embedded a number of service improvements including increased opportunities for peer support and greater consideration of the patient’s wider health journey and emotional difficulties. Future research should seek to measure the impact of these improvements, as well as investigating the potential causal role of the factors identified in this qualitative research.
Theoretically Driven Research Project
Understanding cognitive impairment and emotional difficulties after stroke are key priorities for research and clinical practice. However, cognitive screening tools are not always sensitive to impairments after stroke, and psychological distress in this population remains poorly understood, despite high prevalence and secondary implications. Part one of this research aimed to determine the sensitivity and clinical validity of a new stroke-specific, cognitive screening tool, the OCS-Plus, compared with the MoCA, a more established screening tool. Part two sought to better understand why cognitive impairment is associated with greater psychological distress after stroke, by exploring the role of illness appraisals. Eighty participants were consecutively recruited from Oxfordshire stroke wards over a 15-month period and completed a battery of assessments of mood, cognition and illness appraisals which were analysed cross-sectionally. The OCS-Plus was found to have good convergent validity and sensitivity when compared with the MoCA. Cognitive impairment significantly predicted depressive symptoms but was not predictive of anxiety when controlling for depression. The relationship with low mood was shown to be mediated by perceptions of control in this sample. Specifically, this research showed that higher levels of cognitive impairment were significantly associated with lower perceived control and accounted for the relationship between cognitive impairment and mood. Perceptions of threat and illness coherence were also predictive of low mood but were not predicted by degree of cognitive impairment. Illness appraisals may therefore be a target for intervention in the early stages after stroke, although prospective research is required to establish causality.