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Objective: To evaluate the cost effectiveness of a behavioural therapy intervention shown to be clinically effective in comparison with usual care for stroke patients with aphasia., Design: Randomised controlled trial with comparison of costs and calculation of incremental cost effectiveness ratio., Setting: Community., Participants: Participants identified as having low mood on either the Visual Analog Mood Scale sad item (≥50) or Stroke Aphasic Depression Questionnaire Hospital version 21 (SADQH21) (≥6) were recruited., Interventions: Participants were randomly allocated to behavioural therapy or usual care using internet-based randomisation generated in advance of the study by a clinical trials unit., Main Measures: Outcomes were assessed at six months after randomisation, blind to group allocation. The costs were assessed from a service use questionnaire. Effectiveness was defined as the change in SADQH21 scores and a cost-effectiveness analysis was performed comparing the behavioural group with the usual care control group. The cost analysis was undertaken from the perspective of the UK NHS and Social Services., Results: The greatest difference was in home help costs where there was a saving of £56.20 in the intervention group compared to an increase of £61.40 in the control group. At six months the SADQH21 score for the intervention group was 17.3 compared to the control group value of 20.4. This resulted in a mean increase of 0.7 in the control group, compared to a mean significant different decrease of 6 in the intervention group (P = 0.003). The Incremental Cost-Effectiveness Ratio indicated that the cost per point reduction on the SADQH21 was £263., Conclusion: Overall the behavioural therapy was found to improve mood and resulted in some encouraging savings in resource utilisation over the six months follow-up., (© The Author(s) 2014.)

Objective: To assess the internal consistency, validity and factor structure of a revised version of the Visual Analog Mood Scales (VAMS-R) in healthy older adults and aphasic stroke patients., Design: Cross-sectional study., Participants: Fifty healthy older people and 71 aphasic stroke patients., Setting: Community and hospital., Measures: The healthy participants were asked to complete the Hospital Anxiety and Depression Scale (HADS) and the VAMS-R. The aphasic stroke patients completed the VAMS-R and Visual Analogue Self Esteem Scale (VASES) and the Stroke Aphasic Depression Questionnaire 21 (SADQH-21) was completed by a nurse or carer., Results: The internal consistency of the scale was high (healthy adults alpha 0.74, aphasic stroke patients alpha 0.80). The VAMS-R correlated significantly with the HADS in healthy participants (HADS Anxiety r (s) = 0.59, P < 0.001, HADS Depression r (s) = 0.49, P = 0.001) and the VASES (r (s) = -0.69, P < 0.001) and SADQH-21 (r (s) = 0.43, P = 0.001) in stroke patients. Exploratory factor analysis identified three factors in the scale: negative mood states, energy levels and happiness. The three factors accounted 73% of the variance in healthy participants and 70% of the variance in aphasic stroke patients., Conclusions: The VAMS-R showed better psychometric properties than the original VAMS. Reversing the happy and energetic items improved the ability of the scale to assess mood states.

Purpose: There are few validated measures to assess mood in stroke patients and even fewer suitable for all stroke patients, including those with communication problems. The aim of this study was to compare the Stroke Aphasic Depression Questionnaire Hospital version (SADQ-H), Signs of Depression Scale (SODS), Visual Analogue Mood Scale (VAMS) and Visual Analogue Self-esteem Scale (VASES) in screening for mood problems after stroke., Methods: Fifty healthy older adults and 100 stroke patients in hospital completed the VAMS and VASES. A nurse completed the SADQ-H and SODS in relation to the stroke patients. A relative/carer completed the SADQ-H and SODS in relation to the healthy older adults. Those without communication problems also completed the Hospital Anxiety and Depression Scale (HADS)., Results: The internal consistency of the scales was low in healthy older adults. In stroke patients the internal consistency of the SADQ-H, VAMS, and VASES was high (alpha = .71-.84) but that of the SODS was low (alpha = .53). In healthy older adults, correlations between the HADS and the VAMS and VASES were high but low between the HADS and SADQ-H and SODS. In stroke patients, the HADS depression scale correlated significantly with all the scales (0.35-0.55) but only the SADQ-H 10, VAMS, and VASES were significantly correlated with the HADS anxiety scale (0.40-0.52). Appropriate cut-offs were found for the SADQ-H (17/18), SADQ-H 10 (5/6), SODS (1/2), and VAMS 'sad' item (22/23) in comparison to depression on the HADS. No appropriate cut-offs were identified in comparison to anxiety on the HADS., Conclusions: The SADQ-H, SADQ-H10 and SODS were all appropriate for screening for possible depression after stroke but not for screening for possible anxiety. The SADQ-H 10 had greater internal consistency and higher sensitivity and specificity than the SODS and is shorter than the SADQ-H. It was also significantly correlated with both the anxiety and depression scales of the HADS. The SADQ-H 10 was therefore recommended as the most appropriate for screening purposes. The VAMS and VASES provided no clear cut-offs for use in screening but scores were highly correlated with the HADS. They are therefore more suitable for assessing severity of low mood rather than for screening purposes. The cut-offs identified need further validation in an independent sample of stroke patients, including a higher proportion with low mood.

Objective: The Stroke Aphasic Depression Questionnaire (SADQ) was developed to detect depressed mood in aphasic patients in the community., Design: Correlation analysis between new questionnaire and established measures., Setting: Patients at home., Methods: Seventy stroke patients who had been discharged from hospital were assessed on the SADQ, the Hospital Anxiety and Depression Scale and the Wakefield Depression Inventory. The SADQ was also administered to 17 aphasic patients on two occasions at a four-week interval., Results: Results indicated that scores on the SADQ were significantly related to other measures of depression (r(s) = 0.22-0.52, p <0.05). A shortened 10-item version showed higher validity (r(s) = 0.32-0.67, p <0.01). Test-retest analysis indicated the SADQ is reliable over a four-week interval (r(s) = 0.72, p <0.001)., Conclusions: The SADQ may be used for assessing depressed mood in aphasic patients in the community though further validation is required.

The Assessment of Communicative Effectiveness in Severe Aphasia (ACESA) was developed to measure the communicative effectiveness of people with severe aphasia following a stroke. The reliability was evaluated. Ten patients with severe communication difficulties (particularly limited expression) were assessed and videoed. The videos were rated by three trained raters. Reliability was calculated to demonstrate intrarater and interrater reliability, and test-re-test reliability. Reliability was good but needed to be improved across raters. It was concluded that the ACESA has the potential to be a useful clinical and research tool.

The study investigates the effect of speech therapy on the mood of aphasic stroke patients and their spouses. Patients were randomly allocated to receive speech therapy for 24 weeks starting at 10 weeks post stroke. Patient's mood was measured by means of simple rating scales and an adjective checklist. The mood of relatives was measured by The Goldberg General Health Questionnaire and The Wakefield Depression Inventory. Whereas depression and anxiety were surprisingly uncommon in aphasic patients, many spouses suffered depression and minor psychiatric disturbances. There were no significant differences between treated and untreated patients and their spouses on any measure. Speech therapy was not shown to have any psychological benefits.

The paper describes the spontaneous recovery of language abilities of 52 stroke patients who were aphasic for more than 4 weeks. These patients had been randomly allocated to receive no speech therapy and had been assessed at 6-weekly intervals after a stroke. There was improvement in language abilities over time. Age, sex and aphasia type were not related to the amount of improvement. An aphasic patient's level of language ability at 6 months could be predicted on the basis of the test score on the Porch Index of Communicative Ability at 4 weeks.

Communication abilities were assessed on a wide range of tests in 56 aphasic stroke patients, 33 classified as "moderate" and 23 as "severe". Thirty-six of the patients had received language treatment. The biographical variables of age, months post-onset and handedness were shown to be differentially correlated with improvements. In particular, there were some significant trends of decreasing improvement with increasing months post-onset on expressive verbal tasks in treated moderate aphasics and on comprehension tasks in treated severe aphasics. Untreated patients did not show the same clear pattern of trends; however, these patients were reassessed after a shorter period and covered a smaller range of months post-onset. The role of treatment deserves further clarification. The results also indicate that language recovery is relatively independent of age and of handedness.

Aphasic stroke patients were randomly allocated to either a speech therapy group receiving treatment twice a week for 24 weeks or a no-treatment control group. Patients in both groups improved and there were no significant differences in language recovery between the 104 patients allocated to the treatment group and the 87 allocated to the no-treatment group. This treatment regimen, which is representative of clinical practice, is ineffective for most aphasic stroke patients.