Evaluating intensive language action therapy in the NHS: a feasibility study

Introduction: There is uncertainty about how best to deliver intensive Speech and Language Therapy (SLT) for aphasia efficiently under resource constraints. Methods: This thesis: synthesised systematic review evidence to identify the intervention with the best available evidence for treating conversation difficulties; developed an intervention, programme theory and treatment protocol; tested procedures for its full-scale evaluation in a pilot randomised trial; and, tested its feasibility, acceptability and delivery fidelity. Results: An overview of 11 systematic reviews (229 primary research studies) found Intensive Language Action Therapy (ILAT) improved conversation, could be delivered intensively and possibly efficiently. A mapping review of 31 ILAT studies identified five intervention component categories that target principles of experience-dependent learning, believed to trigger the proposed mechanism of action - Hebbian learning. A pilot study confirmed the feasibility of conducting a randomised trial of assistant/volunteer led ILAT versus usual care in NHS settings. ILAT (n=10) was compared to usual care (n=13) with conversational ability rated using the Therapy Outcome Measure’s (TOMs) Impairment and Activity scales. An adjusted for baseline mean difference of -0.28(95% CI -0.79-0.23) and -0.24(95% CI -0.54- 0.59) was found on the impairment and activity scales respectively. The absence of a treatment effect could reflect the play of chance in a small sample. Qualitative research confirmed that ILAT is acceptable to patients (n=13) and feasible for SLT-facilitated assistants (n=3) and volunteers (n=2) to deliver. Fidelity to delivery of most aspects of the intervention was good, except for provision of the target therapy dose and prompting patients to expand their language use. Conclusion: ILAT is an intensive conversational therapy for aphasia with the potential to be delivered efficiently by assistants/volunteers, and is acceptable to consumers and health professionals. Further preliminary research is needed on outcome measure assessment, acceptability and delivery of intended dose prior to a definitive trial.