Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia

• Published in: Clinical rehabilitation 2013-05, Vol.27 (5), p.398-408
• Main Authors: Thomas, Shirley A, Walker, Marion F, Macniven, Jamie A, Haworth, Helen, Lincoln, Nadina B
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aphasia; Aphasia - etiology; Aphasia - psychology; Aphasia - rehabilitation; Behavior modification; Behaviour therapy; Clinical trials; Cognitive Therapy - methods; Communication; Consent; Dementia; Depression; Emotions; Evaluative Studies; Female; Humans; Language; Male; Middle Aged; Mood Disorders - etiology; Mood Disorders - therapy; Moods; Questionnaires; Randomized controlled trials; Regression Analysis; Rehabilitation; ROC Curve; Self Concept; Self esteem; Statistics, Nonparametric; Stroke; Stroke - complications; Stroke - psychology; Stroke Rehabilitation; Strokes; Visual Analog Scale
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1177/0269215512462227

Objective: The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. Design: A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. Setting: Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. Subjects: Of 511 people with aphasia identified, 105 had low mood and were recruited. Interventions: Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. Main measures: Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales ‘sad’ item, and Visual Analogue Self-Esteem Scale. Results: Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue ‘sad’ (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group. Conclusions: Behavioural therapy seemed to improve the mood of people with aphasia.