Population Registry for Aphasia after Stroke

(I-PRAISE); a feasibility study.

Project reference number: HLSLTC0011

Background

Annually, aphasia affects ~50,600 people in the UK, impacts on ability to speak, understand, read & write, is linked to poorer functional recovery, return to work, activities of daily living, depression & isolation after stroke, leading to fewer friendships & smaller social networks; 61% continue to experience communication problems 1 year after stroke. Speech and Language Therapy (SLT) is effective in post-stroke aphasia. However optimisation of therapy for clinical populations remains elusive. Existing evidence for NHS practice is derived from research populations, often excluding the most and least severely affected; rarely recruiting participants with acute aphasia, inadequately describing participant and home circumstances, feasibility, and the full spectrum of participation, impairment, and economic outcomes. With existing studies using different assessment tools, outcome measures, trial endpoints and variable therapy content descriptions, interpretation and clinical application of findings is a challenge. Uncertainties remain about prevalence, therapy & service needs, clinically feasible treatment approaches, adherence, optimum intervention time points, typical duration, discharge needs & long term recovery. Access to and uptake of third sector support groups or IT, peer & social support also remain unclear. Identifying high quality, effective SLT interventions within current NHS resources is urgently required.

In order to address these research uncertainties, the Collaboration of Aphasia Trialists (CATs; an international network of multidisciplinary aphasia researchers) developed the International Population Registry for Aphasia after Stroke (I-PRAISE). The aim is to collect clinical data from the aphasia population to generate robust evidence on which to base clinical recommendations.

Aim

The aim of this PhD studentship is to pilot data collection in Scotland. This I-PRAISE pilot will employ primary data collection using a standard protocol to generate robust & clinically relevant data to explore the current NHS & third sector approaches to assessment, treatment, rehabilitation & support of people with aphasia after stroke, to inform optimum delivery of person-centred therapy and support.

The objectives of this studentship are to:

  1. Identify core data for collection in the Scottish Pilot, taking into account the views of stakeholders including clinicians, participants and I-PRAISE investigators.
  2. Engage stakeholders to optimise adherence to the pilot protocol.
  3. Describe current approaches to the treatment of aphasia and explore how clinical treatments can be adequately captured.
  4. Pilot the collection of this core dataset in a clinical setting in Scotland
  5. Describe long-term outcomes in those with aphasia and assess the quality of data collected across the pilot
  6. Disseminate research findings including current clinical practice and long-term outcomes, in the I-PRAISE and CATs networks.
  7. Inform the optimisation of further data collection across the I-PRAISE network.

Implications: Leveraging the collection of patients’ and clinicians’ data is an important way of improving quality and efficiency of healthcare delivery and generating new knowledge. Currently, rich data that are collected as part of routine care are often seen as a by-product of health care rather than as an asset to improve health care delivery. I-PRAISE has the potential to inform clinical practice by using information generated in every-day clinical settings to improve the quality and efficiency of stroke care for people with aphasia.

References:

  1. http://www.stroke.org.uk/aphasia [Last Accessed 15th April 2014] 2014.
  2. Gialanella B, et al. Topic in Stroke Rehabilitation 16, 437-444. 2009.
  3. Doucet T, et al. Ann Phys Rehabil Med 55, 112-127. 2012.
  4. Paolucci S, et al. Cerebrovasc Dis 20, 400-406. 2005.
  5. Thomas SA, Lincoln NB. Stroke 39, 1240-1245. 2008.
  6. Cruice M, et al. Aphasiology 20, 1210-1225. 2006.
  7. Parr S, et al Talking About Aphasia: Living with Loss of Language after Stroke. Buckingham; 1997.
  8. Davidson B, et al. Top Stroke Rehabil 15, 325-340. 2008.
  9. Pedersen PM, et al. Cerebrovasc Dis 17, 35-43. 2004.
  10. Brady M, et al. Cochrane Database of Systematic Reviews Art. No.: CD000425. DOI: 10.1002/14651858.CD000425.pub3.[5]. 2012.
  11. McArthur K. Improving efficiency in stroke trials. MD Thesis University of Glasgow. 2014.
  12. Murdoch TB, Detsky AS. JAMA 309[13], 1351-1352. 2013.

Application deadline

The application deadline for October intake is 1st of July.

Research supervisors

Candidates are encouraged to contact the following researchers for further details:

Modes of study

This project is available as a:

  • PhD: 3 years full-time.
  • 1 + 3 route to PhD: Undertaking MRes [1 year full-time] + PhD as above

Eligibility

Applicants will normally hold a UK honours degree 2:1 (or equivalent); or a Masters degree in a subject relevant to the research project. Equivalent professional qualifications and any appropriate research experience may be considered. A minimum English language level of IELTS score of 6.5 (or equivalent) with no element below 6.0 is required. Some research disciplines may require higher levels.

Specific requirements of the project

The successful applicant will be able to demonstrate knowledge and understanding of aphasia, have an interest in research design, registry development, participant and public involvement in research, and long-term outcomes following stroke.