Project Ref: SHLS19035
Within the United Kingdom there are 100,000+ strokes per year and an estimated 1.1 million stroke survivors. In Scotland, 6.4% of adults report having had a stroke; current incidence is approximately 180 per 100,000 people. Stroke is expensive, costing £8.9 billion globally per year due to health costs, informal care expenditure, productivity losses, and benefit payments. Post-stroke mood disturbance is common. Statistics suggest many stroke survivors experience anxiety (9.8%) and/or depression (33.5%). Psychological problems are also common amongst family carers with many reporting anxiety (48.9%) and/or depression (28.9%) at three months. Furthermore, a significant proportion of mood disturbance remains undiagnosed and/or is inadequately treated. There is growing recognition of the importance of psychological health for stroke survivors and families/carers. Guidelines highlight psychological care is essential, recommending implementation of patient/family-centred psychological interventions that promote acquisition of coping skills to support adaptation following stroke. However, there are few long-term family-orientated interventions to help stroke survivors and families manage the psychological consequences of stroke.
Mindfulness Based Stress Reduction (MBSR) uses meditation to increase levels of mindfulness for people coping with physical, psychological, and emotional distress. A systematic review/meta-analysis of 115 RCTs (8683 participants) examined the effectiveness of MBSR and Mindfulness Based Cognitive Therapy for different patient groups and found a small-medium effect size in different chronic conditions: depression (d=0.37;95%CI 0.28-0.45), anxiety (d=0.49; 95%CI 0.37-0.61), stress (d=0.51; 95%CI 0.36-0.67), QoL (d=0.39; 95%CI 0.08-0.70). Likewise, our systematic review (MBSR post-stroke/TIA) revealed positive psychosocial benefits, indicating MBSR may
be effective in self-managing symptoms of anxiety and depression following stroke.
HEADS: UP (Helping Ease Anxiety and Depression after Stroke) is a stroke-specific adaptation of the standard MBSR course. A funded study, currently underway (see: http://www.stroke.org.uk/research/helping-people-affected-stroke-self-manage-symptoms-anxiety-and-depression
), is testing the feasibility of the 9-week HEADS: UP course. The PhD study described here will complement that work, increasing the accessibility of HEADS: UP.
For this PhD study, a co-creation development and feasibility study to adapt a Mindfulness Based Stress Reduction (MBSR) intervention, HEADS: UP, for people with aphasia is envisaged.
We anticipate a mixed methods study with a high degree of patient and public involvement. The study design will align with the UK Medical Research Council’s guidance for complex interventions. In year 1, a literature review together with consultation/co-production work with people with aphasia will inform selection of appropriate theoretical and methodological underpinnings for subsequent work, including choice of research design. The PhD may progress to feasibility testing.
The successful applicant will be a graduate speech and language therapist, psychologist, nurse, or other allied health professional with a 2:1 minimum in their undergraduate degree. A relevant MSc qualification is desirable. Ideally applicants will have experience of working (clinically and/or in a research context) with people with stroke/stroke-related aphasia.
As part of their application, candidates are requested to identify and critique a published research paper relating to the studentship topic. The critique should be no more than 500 words.