909 research outputs found
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Social support in people with chronic aphasia
Background & Aims : Stroke and aphasia can have a profound impact on people's social activities, and family and social relationships. This study looked at patterns of social support in people with chronic aphasia following stroke. It examined the relationship between social support and quality of life, exploring which aspects of social support (social network versus perceived social support) were most associated with health-related quality of life (HRQL). Methods & Procedures : A cross-sectional interview-based survey study was conducted. A cluster-sampling framework was used to recruit participants with chronic aphasia following stroke (> 1 year) from three different sites in the south-east of England. Measures included the Stroke and Aphasia Quality of Life Scale-39 item version (SAQOL-39), the MOS Social Support Survey (SSS), and a social network questionnaire. Descriptive statistics, correlation, t -tests, and ANOVAs were used as appropriate. Outcomes & Results : The results of those able to self-report (83 out of 95 participants, 87%) are reported here. In terms of social networks, the mode of the size of network was 4. Size of network was associated with HRQL for women only. Most participants (71%) reported they had the same amount of contact with their children following the stroke, while 64% reported they saw their friends less. Those who had the same level of contact with their family as before the stroke had the highest HRQL scores; those who saw them either less or more than before the stroke had lower HRQL. In terms of perceived social support, the SSS scores were negatively skewed with a mean (SD) of 3.69 (.95), suggesting that participants felt overall well supported. Two types of support were significantly correlated with HRQL: social companionship and informational support. Clinical implications : Therapy services for people with aphasia could consider ways to enhance social companionship and informational support as this may positively impact on HRQL. Implications could include complementing and supporting existing social networks, and facilitating access to information and social participation
Degree of explanation
Partial explanations are everywhere. That is, explanations citing causes that explain some but not all of an effect are ubiquitous across science, and these in turn rely on the notion of degree of explanation. I argue that current accounts are seriously deficient. In particular, they do not incorporate adequately the way in which a causeâs explanatory importance varies with choice of explanandum. Using influential recent contrastive theories, I develop quantitative definitions that remedy this lacuna, and relate it to existing measures of degree of causation. Among other things, this reveals the precise role here of chance, as well as bearing on the relation between causal explanation and causation itself
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Psychological distress after stroke and aphasia: the first six months
Objective: We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia.
Design: Prospective longitudinal observational study.
Setting and subjects: Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke.
Main measures: Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months.
Results: Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R2 = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (Ï2 (1) = 8.61, P<0.01).
Conclusions: Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with oneâs social network are particularly important and contribute to long-term psychological distress
Adjustment with aphasia after stroke: study protocol for a pilot feasibility randomised controlled trial for SUpporting wellbeing through PEeR Befriending (SUPERB)
Background: Despite the high prevalence of mood problems after stroke, evidence on effective interventions particularly for those with aphasia is limited. There is a pressing need to systematically evaluate interventions aiming to improve wellbeing for people with stroke and aphasia. This study aims to evaluate the feasibility of a peer-befriending intervention.
Methods/design: SUPERB is a single blind, parallel group feasibility trial of peer befriending for people with aphasia post-stroke and low levels of psychological distress. The trial includes a nested qualitative study and pilot economic evaluation and it compares usual care (nâ=â30) with usual care + peer befriending (nâ=â30). Feasibility outcomes include proportion screened who meet criteria, proportion who consent, rate of consent, number of missing/incomplete data on outcome measures, attrition rate at follow-up, potential value of conducting main trial using value of information analysis (economic evaluation), description of usual care, and treatment fidelity of peer befriending. Assessments and outcome measures (mood, wellbeing, communication, and social participation) for participants and significant others will be administered at baseline, with outcome measures re-administered at 4 and 10âmonths post-randomisation. Peer befrienders will complete outcome measures before training and after they have completed two cycles of befriending. The qualitative study will use semi-structured interviews of purposively sampled participants (nâ=â20) and significant others (nâ=â10) from both arms of the trial, and all peer befrienders to explore the acceptability of procedures and experiences of care. The pilot economic evaluation will utilise the European Quality of life measure (EQ-5D-5âL) and a stroke-adapted version of the Client Service Receipt Inventory (CSRI).
Discussion: This study will provide information on feasibility outcomes and an initial indication of whether peer befriending is a suitable intervention to explore further in a definitive phase III randomised controlled trial.
Trial registration: ClinicalTrials.gov identifier NCT02947776, registered 28th October 2016
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âLiving with aphasia the best way I canâ: a feasibility study exploring solution focused brief therapy for people with aphasia
Objective: Post-stroke aphasia can profoundly affect a personâs social and emotional well-being. This study explored the feasibility of solution focused brief therapy as an accessible intervention, and investigated its impact on participantsâ psychosocial well-being.
Participants and methods: Small-scale repeated measures feasibility study. Participants received between three and five therapy sessions. They were assessed on psychosocial outcome measures pre and post therapy, and took part in post-therapy in-depth qualitative interviews. Three men and two women with chronic aphasia took part; age range 40s to 70s.
Results: Participants found the therapy acceptable and it was possible to adapt the approach so as to be communicatively accessible. Quantitative assessments showed encouraging trends in improved mood: pre-therapy GHQ-12 mean (SD): 4.80 (4.60), median: 6; post therapy mean (SD): 2.00 (2.55), median: 1; and improved communicative participation: pre-therapy CPIB mean (SD): 7.80 (5.76), median: 7; post therapy mean (SD): 12.20 (4.44), median: 14. Measures of social network and connectedness, however, remained stable. Themes emerging from the qualitative analysis included changes to mood, communicative participation, mobility and everyday activities.
Conclusions: This small-scale study suggests solution focused brief therapy is a promising approach in helping people with aphasia build positive change in their lives
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âStruggling to stay connectedâ: comparing the social relationships of healthy older people and people with stroke and aphasia
Background: Having a stroke and aphasia can profoundly affect a personâs social relationships. Further, poor social support is associated with adverse post-stroke outcomes such as psychological distress, worse quality of life, and worse recovery. To date, no study has used complex measures of social network and perceived social support to compare stroke survivors with aphasia, without aphasia, and the general older population. A better understanding of which aspects of social support are most affected by stroke and aphasia may inform stroke services.
Aims: To compare the social networks and perceived functional social support of people following a stroke, with and without aphasia, and healthy older adults.
Methods & Procedures: Cross-sectional interview-based study. People with a first stroke were recruited from two acute stroke units and interviewed 6Â months post onset. We recruited 60 stroke participants without aphasia, average age 69.8 (SDÂ =Â 14.3), and 11 stroke participants with aphasia, average age 66.5 (SDÂ =Â 13.7). One hundred and six healthy older adults were recruited via the community, average age 62.8 (SDÂ =Â 9.5). All participants completed the Medical Outcomes Study Social Support Survey (SSS) and the Stroke Social Network Scale (SSNS). One-way independent groups ANOVAs were used to compare stroke participants with aphasia, stroke participants without aphasia, and healthy older adults. Outcomes &
Results: After adjusting for multiple comparisons (p < .004), there was a significant difference on overall social network between the three groups (p < .001), with those with aphasia scoring significantly lower than healthy older adults (p < .001). The difference between healthy older adults and people with aphasia on the friends domain of the social network scale was also significant (p = .002). There was no significant difference between the three groups on overall perceived functional social support.
Conclusions: People with aphasia have less diverse social networks than healthy older adults, with friendships particularly affected. Stroke services should monitor for social isolation, and consider ways to support people following a stroke in maintaining or establishing diverse social networks
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Social support after a stroke
Background:
The social consequences of having a stroke can be severe, with social isolation a reported problem. It is little explored, however, what factors predict who will feel well supported and retain a strong social network after a stroke, nor is it well understood why friendships and other social contacts are lost.
Aims:
This thesis explored: 1) how social support and social network change over time following a stroke, and whether this is different for those with aphasia; 2) what factors predict perceived social support and social network six months post stroke; 3) why people lose contact with friends, and whether there are any protective factors; 4) how the changing dynamics within the family unit are perceived by the stroke survivor.
Design and setting:
Repeated measures cohort study. Participants were recruited from two acute stroke units and assessed at two weeks (baseline), three months and six months post stroke. A subset of participants was selected for in-depth qualitative interviews 8 â 15 months post stroke.
Measures and methods:
Stroke Social Network Scale; MOS Social Support Survey; General Health Questionnaire; National Institute of Health Stroke Scale; Frenchay Aphasia Screening Test; Frenchay Activities Index; and the Barthel Index. Multiple regression, ANOVA, correlation and t-tests were used as appropriate.
Results:
87 participants were recruited of whom 71 were followed up at six months. At six months, 56% of participants were male, 16% had aphasia, and the average age was 69 years old. 29 participants took part in qualitative interviews. Perceived social support at six months was not significantly different from pre-morbid levels; social network, however, did significantly reduce (p = .001). Those with aphasia had comparable levels of perceived social support but significantly reduced social networks (p < .05) compared to those without aphasia.
Concurrent predictors of perceived social support at six months were: a personâs social network, their marital status, and their level of psychological distress (adjusted R2 = .37). There was only one baseline predictor of social support at six months: perceived social support prior to the stroke (adjusted R2 = .43). Concurrent predictors of social network at six months were: perceived social support, ethnic background, aphasia and extended activities of daily living (adjusted R2 = .42). There were two baseline predictors: pre-morbid social network and aphasia (adjusted R2 = .60).
There was a significant reduction in the Friends factor of the social network measure (p < .001). The main reasons for losing friends were: changing social desires especially a sense that many participants were âclosing inâ on themselves; aphasia; loss of shared activities; reduced energy levels; physical disability; environmental barriers; and unhelpful responses of others. Family were generally robust members of the social network post stroke. The spouse was the main provider of all support functions. Nonetheless, beneath the apparent stability of the quantitative data there were changes in how family relationships functioned, including some distressing role shifts, for example, receiving rather than providing support.
Conclusion:
Contact with family and perceived social support remained stable post stroke. In contrast, a personâs social network, in particular contact with friends, was found to reduce, especially for those with aphasia. Indeed, aphasia was the only stroke-related factor at the time of the stroke that predicted social network six months later. Intervention aimed at addressing social isolation may be most effective if it takes into account the multiple reasons for friendship loss, including new language and physical disabilities, as well as changing social desires
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