Author Identifiers

Alia Rashid Khan

ORCID: 0000-0002-9915-7432

Date of Award

2021

Degree Type

Thesis

Degree Name

Masters of Medical Science

School

School of Medical and Health Sciences

First Advisor

Natalie Ciccone

Second Advisor

Erin Godecke

Third Advisor

Tapan Rai

Abstract

Background: Depression is a common consequence of stroke, and people with aphasia (PWA) post-stroke have a higher risk of developing depression compared to stroke survivors without aphasia. However, current stroke interventions featuring aphasia therapy tend to neglect the effect of the treatment on mood. There is also a lack of evidence on the impact of stroke education and counselling on PWA in early stroke recovery. Additionally, the research on post-stroke depression often excludes or insufficiently describes PWA in study populations. The influence of direct aphasia therapy on depression in PWA is undetermined. This sub-study investigated: i) the effect of aphasia therapy, stroke education and counselling on depression as measured by the Aphasia Depression Rating Scale (ADRS) at 12 and 26 weeks after stroke in people with aphasia; ii) the effect of change in communicative ability on depression and quality of life as measured by the Stroke and Aphasia Quality of Life-39 (SAQoL-39); and iii) the relationship between depression and quality of life at 12 and 26 weeks post-stroke after controlling for covariates mentioned below.

Method: The Very Early Rehabilitation of SpeEch (VERSE) trial was a randomized controlled trial that recruited 246 participants within the first 10 days post-stroke and provided them with different regimens of direct aphasia therapy. Education and counselling were provided as part of standard usual care within the trial and the content of these sessions was left to the discretion of the therapist. This sub-study ran linear mixed effects regression models at 12 and 26 weeks using baseline data, the amount of aphasia therapy (hours) and frequency (sessions per week) provided and ADRS and SAQoL-39 scores. The models controlled for age, gender, baseline stroke severity (NIHSS), baseline aphasia severity (Western Aphasia-Battery Aphasia Quotient score) and baseline cognition. Hospital site was included as a random effect in all models. Results: Eighteen models were run. Amount (hours) and frequency of direct aphasia therapy, stroke education and counselling had no significant effect on ADRS scores at 12 and 26 weeks 3 after stroke. The change of AQ scores from baseline to week 12 and from baseline to week 26 did not influence ADRS scores. The difference between AQ scores from baseline to week 12 and from baseline to week 26 was significant in predicting SAQoL-39. ADRS was a significant predictor of SAQoL-39 scores at weeks 12 and 26 after stroke.

Conclusion: The amount (hours) and frequency of direct aphasia therapy, stroke education and counselling did not significantly affect the development of depression in this cohort. Change in communicative ability and depression strongly predicted the quality of life for PWA as early as 12 weeks after stroke. There was no evidence that communication-based therapy had an effect on mood. Therapy that merges communicative and psychosocial strategies together could be explored to find a form of treatment that targets language ability and mood for people with early aphasia after stroke. Further research is required for the management of depression for PWA in the early phase of recovery.

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