6/01/2017

1

Changes to communication related quality of life following online aphasia group therapy

Professor Deborah Theodoros

Professor Trevor Russell

Dr Anne Hill

Rachelle Pitt

School of Health and Rehabilitation Sciences, University of Queensland, AustraliaCentre for Research in Telerehabilitation, University of Queensland, Australia

Centre of Research Excellence in Telehealth, Australia

Learn and practice a range of

communication strategies

Problem solving with others

PWA need long term access to aphasia groups

Practice of a variety of speech acts

Friendships with others

Opportunity to participate in

natural conversation

Support for living with aphasia

Introduction – Aphasia group therapy

Benefits of group

therapy for aphasia

6/01/2017

2

Barriers to accessing aphasia groups

Transport difficulties

Reliability Organisation

Cost Distance

TimeFatigueStress

Health co-morbidities

Cognition

Mobility

Hemi-paresis

Geographical isolation

Distance

Lack of community transport

Limited services available

Limited SLP’s

Barriers to providing aphasia groups

Resource constraints

Rising healthcare costs

Funding difficultiesInadequate

staffingLack of group

materials

Clinician factors

Confidence

Skills

Balancing linguistic vs

psychosocial aims

Group structure factors

Availability of clients with shared

characteristics

Culturally and Linguistically

Diverse

Tailoring groups to needs of PWA

6/01/2017

3

Telerehabilitation – a potential solution

Delivery of medical rehabilitation services at a distance using electronic information and communication technologies (Rosen, 99)

Saves moneyReduced travel Saves time Improved access

Telerehabilitation – a potential solution

Delivery of medical rehabilitation services at a distance using electronic information and communication technologies (Rosen, 99)

Improved timelinessWide geographical area Increased intensity

6/01/2017

4

Evidence for telerehabilitation

• Promising results for synchronous (real-time) and asynchronous (remotely- monitored) aphasia management

• Current evidence primarily in the assessment of aphasia

• Intervention studies typically asynchronous, limited by small sample sizes or combine treatment approaches

• No studies investigating only aphasia group therapy

• Investigate the changes to communication related quality of life for people with aphasia following online aphasia group therapy

• Describe participant satisfaction with online aphasia group therapy

Aims

6/01/2017

5

Inclusion criteria

• over 18 years of age

• at least 12 months post-stroke

• adequate hearing and vision to operate computer equipment

• English speaking

Exclusionary criteria

• Concomitant neurological or cognitive disorder

• Technology provided by research team when needed

• Support from communication partner encouraged

• No minimum requirements for communication

Methods - Participants

• n = 18

• 10 females, 8 males

• 7 communication partners supported participants in using technology

• Age range 21 - 74 (mean =56.78, SD = 13.91)

• Months post onset (MPO) range 13 – 223 (mean = 66.61, SD = 61.61)

• Pre-assessment Mean Modality T-Score on Comprehensive Aphasia Test range 41.38 – 64.75 (mean = 55.18, SD = 6.99, aphasia cut-off 62.8)

Methods - Participants

6/01/2017

6

Methods - Participants

• 11 major city

• 5 inner regional areas

• 1 outer regional area

• 1 travelled outer regional Australia extensively during study

Methods - Telerehabilitation

1. Go to website

2. Enter name (or any character)

3. Click Enter room

6/01/2017

7

Methods - Telerehabilitation

4. Turn on microphone

5. Turn on web camera

Methods – Assessment

Primary outcome measure• Assessment for Living with Aphasia (ALA) pre-

and immediately post- intervention

Secondary measures• Aphasia friendly satisfaction questionnaire post

therapy – 14 questions, 5 point Likert scale

• Comprehensive Aphasia Test (pre- post)

• Quality Communication Life Scale (pre- post)

• Communicative Activities Checklist (pre- post)

• Qualitative interviews with participants and communication partners (post)

6/01/2017

8

Methods – Online administration

Methods -

• Twelve, 1.5 hour therapy sessions

• Three to four people with aphasia in each group

• Specifically developed aphasia group intervention –TeleGAIN

• Multi-purpose group – across ICF domains

• Goals of intervention 1. Create opportunities for communicative success

2. Share personal life history

3. Provide support for living with aphasia through networking with others

Telerehabilitation Group Aphasia Intervention and Networking

6/01/2017

9

Methods -Telerehabilitation Group Aphasia Intervention and Networking

Methods -Telerehabilitation Group Aphasia Intervention and Networking

6/01/2017

10

Methods -Telerehabilitation Group Aphasia Intervention and Networking

Communication supports key to

• Allowing shared participation

• Sharing personal narratives

• Promote engagement

Methods – Data analysis

Assessment for Living with Aphasia• Paired samples t-test on five domains and total

score

Participant satisfaction questionnaire• Analysed descriptively

6/01/2017

11

Results – ALA

ALA Domain Pre-treatment Post-treatment Mean Difference

p

Total ScoreMean (SD)Range

101.89 (17.18)74.5 – 137.0

113.72 (17.31)88.0 – 142.5

11.83(10.38)-2.5 – 32

0.001

AphasiaMean (SD)Range

10.28 (2.47)5.5 – 15.0

12.28 (2.09)9.0 – 16.5

2 (1.89)0 – 5.5

0.003

ParticipationMean (SD)Range

45.64 (7.25)29.5 – 63.0

50.92 (7.99)37.0 – 66.5

5.28 (6.61)-5.5 – 18

0.005

EnvironmentMean (SD)Range

10.19 (3.05)5.5 – 16.0

11.83 (2.74)6.5 – 16.0

1.64 (1.57)-1 – 5

0.001

PersonalMean (SD)Range

32.86 (7.55)19.0 – 44.0

35.89 (5.01)27.5 – 44.0

3.03 (5.51)-3 – 17.5

0.002

Life with aphasiaMean (SD)Range

2.92 (0.79)2.0 – 4.0

3.28 (0.77)2.0 – 4.0

0.36 (0.72)-1 – 2

0.01

Results – Participant Satisfaction

0 2 4 6 8 10 12 14 16 18

Communication improved

Gained new skills

Easily see SLP

Easily hear SLP

Felt comfortable

Therapy at home is easier

Therapy online is good

Saved travel time

Saved money

Would have TeleGAIN again

TeleGAIN ran smoothly

TeleGAIN met expectations

Would recommend to others

Overall satisfaction

Number of participantsQuestion

4.50 (0.99)

4.50 (0.62)

4.89 (0.32)

5.00 (0)

4.89 (0.32)

4.61 (0.61)

4.67 (0.69)

4.39 (1.09)

4.17 (1.20)

4.67 (0.77)

4.17 (0.86)

4.50 (0.99)

4.83 (0.38)

4.72 (0.57)

Mean (SD)

6/01/2017

12

Discussion

• Online aphasia group therapy results in positive changes in communication related quality of life

• Consistent with face-to-face aphasia group therapy studies targeting many areas of functioning

• Most notable changes in Participation domain

• Group therapy online allowed for practice of a variety of different speech and discourse types

Can I please have a large

honey chicken?

Global warming – BIG CRISIS!

Discussion

• High satisfaction with TeleGAIN

• All participants would recommend to others

• Participants would have TeleGAIN again

• Satisfaction is an indicator for efficacy and motivation for rehabilitation

• Telerehabilitation can provide a motivating and engaging environment to promote change in functioning

Have you heard about

TeleGAIN?

It’s great!

6/01/2017

13

Discussion

• Frequency and experience of technology breakdowns impacted on satisfaction

• Frequent loss of audio or video in some groups

• Disruptive if research team had to call the participant

• Significant audio delay impacted conversation exchange

• Future research should ensure the quality of the connection does not impact on the group

Discussion

• Agreed with benefits of telerehabilitation

• Participants were geographically isolated, experienced transport issues or co-morbidities or had limited services in their area

• Telerehabilitation provided access to services

• Aphasia severity, time post onset, age and availability of communication support at home should not exclude people from accessing online therapy

6/01/2017

14

Conclusion

• Delivery of aphasia group therapy via telerehabilitation is feasible and results in improvements in communication related quality of life

• Participants are highly satisfied with online aphasia group therapy

• Offers an alternative to face-to-face therapy for people with aphasia and improve access to services

• Future research • Address technology breakdowns

• Larger efficacy trial

• Implementation trial

• Cost-effectiveness

Acknowledgements

• This project was funded by the National Stroke Foundation Australia

• Thank you to the participants for their involvement in this project and willingness to try something new

• Thank you to Dr Kyla Brown, Eril McKinnon, Dr Joanne Folker, Alexia Rhode and Megan Swales for assisting with data collection

6/01/2017

15

ReferencesAttard, M., Lanyon, L., Togher, L., & Rose, M. (2015). Consumer perspectives on community aphasia groups: a narrative literature review in the context of psychological well-being. Aphasiology, 29(8), 983-1019Baron, C., Hatfield, B., & Georgeadis, A. (2005). Management of communication disorders using family member input, group treatment and telerehabilitation. Topics in Stroke Rehabilitation, 12(2), 49-56Beeson, P., & Holland, A. (2007). Aphasia groups in a university setting. In R. Elman (Ed.), Group treatment of neurogenic communication disorders: The expert clinician's approach (2nd ed., pp. 145-158). San Diego, CA: Plural Publishing.Brown, K., Davidson, B., Worrall, L., & Howe, T. (2013). 'Making a good time': the role of friendship in living successfully with aphasia. International journal of speech language pathology, 15(2), 165Brown, K., Worrall, L., Davidson, B., & Howe, T. (2010). Snapshots of success: An insider perspective on living successfully with aphasia. Aphasiology, 24(10), 1267-1295Brumfitt, S., & Sheeran, P. (1997). An evaluation of short-term group therapy for people with aphasia. Disability and Rehabilitation, 19(6), 221-230Canadian Association of Speech-Language Pathologists and Audiologists. (2006). Position paper on the use of telepractice for CALSPA Speech-Language Pathologists and Audiologists. Retrieved from Centre for Clinical Research Excellence in Aphasia Rehabilitation. (2014). Australian Aphasia Rehabilitation Pathway.Elman, R. (2007a). Group treatment of neurogenic communication disorders: The expert clinician's approach (2nd ed.). San Diego, CA: Plural Publishing.Elman, R. (2007b). The importance of aphasia group treatment for rebuilding community and health. Topics in Language Disorders, 27(4), 300-308Elman, R., & Bernstein-Ellis, E. (1999a). The efficacy of group communication treatment in adults with chronic aphasia. Journal of Speech, Language, and Hearing Research, 42, 411-419Elman, R., & Bernstein-Ellis, E. (1999b). Psychsocial aspects of group communication treatment - Preliminary Findings. Seminars in Speech and Language, 20(1), 65-72Marshall, R. (1993). Problem-Focused Group Treatment for Clients With Mild Aphasia. American Journal of Speech-Language Pathology, 2(2), 31-37Mashima, P., & Doarn, C. (2008). Overview of telehealth activities in speech-language pathology. Telemedicine and e-Health, 14(10), 1101-1117Rose, M., & Attard, M. (2015). Practices and challenges in community aphasia groups in Australia: Results of a national survey. International Journal of Speech-Language Pathology, 0(0), 1-11Rosen, M. (1999). Telerehabilitation. Neurorehabilitation, 12(1), 11-26Ross, A., Winslow, I., Marchant, P., & Brumfitt, S. (2006). Evaluation of communication, life participation and psychological well‐being in chronic aphasia: The influence of group intervention. Aphasiology, 20(5)Theodoros, D. (2012). A new era in speech-language pathology practice: Innovation and diversification*. International Journal of Speech-Language Pathology, 14(3), 189-199World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization.World Health Organization and The World Bank. (2011). The world report on disability. Geneva, Switzerland: World Health Organization.