ACT NoW: Assessing the Effectiveness of Communication Therapy in the North West
ACT NoW: Assessing the Effectiveness of Communication Therapy in the North West: a Pragmatic, Multi-centre Randomised Controlled Trial
Assessing Communication Therapy in the North West (ACT NoW) is a research project which aims
to evaluate the effectiveness, cost effectiveness and service user preferences for
communication therapy following stroke when compared to an attention control.
Stroke is the leading cause of long-term disability in the UK. About a third of stroke
survivors will suffer some level of communication problems following the stroke. Such
problems can affect parts or all of the motor apparatus responsible for producing speech,
thus affecting clarity of speech and overall intelligibility (a condition known as
dysarthria). Alternatively, stroke can affect the cognitive system for comprehending and
formulating language (a condition known as dysphasia or aphasia). Some people will suffer
impairment of both speech and language.
For these people, Speech and Language Therapy is often offered. Solid research evidence is a
pre-requisite for planning evidence-based service delivery and systematic reviews for
dysarthria and aphasia highlighted a lack of good quality research evidence of the
effectiveness of Speech and Language Therapy. To try and rectify this situation, the ACT NoW
study has been commissioned and funded by the NIHR Health Technology Assessment Programme.
The aims of the ACT NoW Study are to determine the relative effectiveness and cost
effectiveness of a Speech and Language Therapy (SLT) intervention for people with aphasia
and/or dysarthria following stroke, when compared with an attention control. We also aim to
explore the experience and the impact of the interventions from the perspective of both
users and carers, using qualitative research.
The ACT NoW study is a pragmatic, multi-centre randomize controlled trial (RCT) with a
nested qualitative study and full economic evaluation. The RCT involves comparison of two
arms within this target population: a manualized Speech and Language Therapy (SLT)
intervention; and an 'attention control'. Randomization will be stratified by
diagnosis/severity as well as site/centre, with an 'intention to treat' approach.
The qualitative study will comprise interviews with patients and carers, purposefully
sampled from each arm of the trial, to evaluate service user preferences for communication
therapy after stroke. Innovative methods of communication support have been developed to
enable people with communication difficulties to engage in the interview process.
The ACT NoW trial design was informed by a successful feasibility study.
We reached our target of 170 participants. This was the minimum we needed to achieve a
powerful study. A fabulous achievement thanks to phenomenal dedication and hard work from
everyone. Outcomes data were collect July 2010. Final data analysis is ongoing and results
will be available from December 2010. Audrey Bowen, the study Chief Investigator will be
presenting the results at the UK Stroke Forum in Glasgow (30th Nov- 2nd December 2010).
The results will be published in the NIHR HTA monograph and a short report on the results
will be available from the study website: http://www.psych-sci.manchester.ac.uk/actnow/
Please check the study websites for updates.
Stroke, Communication, Speech and Language Therapy
University of Manchester
University of Manchester
Long A, Hesketh A, Paszek G, Booth M, Bowen A. Development of a reliable self-report outcome measure for pragmatic trials of communication therapy following stroke: the Communication Outcome after Stroke (COAST) scale. Clin Rehabil. 2008 Dec;22(12):1083-94. doi: 10.1177/0269215508090091.
Long A, Hesketh A, Bowen A; ACT NoW Research Study.. Communication outcome after stroke: a new measure of the carer's perspective. Clin Rehabil. 2009 Sep;23(9):846-56. doi: 10.1177/0269215509336055. Erratum in: Clin Rehabil. 2010 Apr;24(4):383.