Why is this research needed?
Up to three quarters of stroke survivors experience challenges with their mental health, ranging from anxiety to suicidal thoughts. Thanks to our Priority Setting Partnership with the James Lind Alliance, we also know that the number one research priority for the stroke community in rehabilitation and long-term care is finding ways to help people affected by stroke to cope with these challenges.
At the moment, there aren’t a lot of options for support with mental health after stroke. However, there are lots of promising new therapies which could help. One of these is Acceptance and Commitment Therapy (ACT), which focuses on accepting and adjusting to your feelings and committing to doing things that align with your personal goals.
In the WAterS project, which we also funded, Dr Emma Patchwood trialled an ACT-informed mental health intervention for stroke survivors. Emma trained a group of Stroke Association staff to deliver WAterS online. The results were promising, but we don’t yet know whether this kind of intervention could work for stroke survivors in general.
She has teamed up with Professor Audrey Bowen and other expert collaborators in Manchester and Nottingham for the next stage. Together, the team will be working on two questions:
- How can we make sure that ACT-informed mental health support works for a broad range of stroke survivors, including minority ethnic communities and people with aphasia?
- Could this intervention be delivered by people beyond the Stroke Association, like NHS staff?
What are the aims of this research?
The overall aim of WAterS-2 is to create a new, more inclusive version of WAterS that can be delivered by a broad range of stroke professionals.
First, the team will co-create this new version with stroke survivors and with health and social care professionals who could potentially deliver it.
The team are particularly interested in understanding what could make WAterS accessible to and useful for people belonging to ethnic minorities and people with aphasia. These groups are often excluded from mental health research, so mental health support is usually not designed with their needs in mind.
The team also want to understand how best to deliver staff training. At the moment, ACT is largely delivered by clinical psychologists, but the original WAterS study showed that other stroke professionals can deliver ACT-informed support with the right training. In WAterS, it was Stroke-Association Co-ordinators who delivered the support, but there are stroke professionals working elsewhere, like the NHS and social care organisations, who may also be able to deliver it.
Once the team have developed the new version, they will train stroke professionals in several different organisations to deliver it with small groups of stroke survivors, then monitor how it goes using questionnaires and interviews. In this stage, they want to understand what users and providers of the new WAterS-2 therapy think of it. For example: What are the benefits? Is it safe? What works and doesn’t work about training?
What is the benefit of this research?
ACT is one of a number of promising new therapies that could help support mental health after stroke, but these therapies are not yet widely available.
Ultimately, the WAterS-2 team want to create a network of ACT experts across the UK who can train and support other stroke professionals to deliver ACT. Together with their work on making ACT more inclusive, this would mean that more people affected by stroke are able to access genuinely helpful mental health support.
What PSP priorities does this research link to?
From 2019 to 2021, we worked with the James Lind Alliance on the Stroke Priority Setting Partnership (PSP). During the PSP process, we collaborated with people with lived experience of stroke and stroke professionals to find out what they thought were the top priorities in stroke research. From this, we identified the top ten priorities in two areas: prevention, diagnosis and short-term care, and rehabilitation and long-term care.
Now, when researchers apply to us for funding, we require that their work addresses at least one of these priorities, or a priority from the Childhood Neurological Disabilities PSP Top 10 as it relates to childhood stroke.
WAterS-2 addresses the following priorities from the Stroke PSP:
- Rehabilitation and long-term care 1: Mental and emotional difficulties after stroke
- Rehabilitation and long-term care 5: Resourcing and organising community stroke services
- Rehabilitation and long-term care 10: Improving stroke survivor and carer experience of the stroke pathway
Meet the team
WAterS-2 is co-led by Dr Emma Patchwood and Professor Audrey Bowen at the University of Manchester.
Emma is a Postdoctoral Research Fellow at the University of Manchester and led the development of the previous iteration of WAterS.
Emma says, “WAterS-2 feels like an exciting project, addressing so many important issues around how we can best support people to psychologically adjust after stroke. I’m thrilled that Stroke Association continue to invest in this work and I am really hopeful that we’ll learn and achieve a lot, working with the excellent, multi-disciplinary team we’ve established for this project.”
Audrey is Professor of Neurological Rehabilitation at the University of Manchester. She is especially interested in improving services for people with neurological or communication difficulties.
Audrey says, “I am delighted that Stroke Association has funded this study which builds on Emma’s previous work and is a top priority for people with lived experience of stroke”
The other members of the team are:
- Ann Bamford, a stroke survivor and the Honorary Lay Lead for Patient, Carer and Public Involvement in research at the University of Manchester. Ann leads on involvement and accessibility, ensuring that people with lived experience of stroke have a say in how the new therapy is developed.
- Dr Verity Longley, an Occupational Therapist and Lecturer in Psychology at Manchester Metropolitan University. Verity is an expert in health inequalities and works with Ann, Paul and Jess to ensure the new version of the therapy is accessible and inclusive.
- Dr Paul Conroy, a Speech and Language Therapist (SLT) and Senior Clinical Lecturer in SLT at the University of Manchester. Paul works with Ann, Verity and Jess to ensure the new version of the therapy is accessible to people with aphasia.
- Jess Zadik, the Health Inequalities Research Lead for Northern Care Alliance NHS Foundation Trust. She works with Ann, Verity and Paul to ensure the new version of the therapy is accessible and inclusive to people from minority ethnic communities.
- Dr Sarah Cotterill, a Senior Lecturer in the Centre for Biostatistics at the University of Manchester. Sarah oversees the statistical analysis aspects of the project.
- Dr Victoria Teggart, Dr Lorraine King, and Dr Natalie Hampson, Consultant Clinical Neuropsychologists. Together, they ensure that the new version of the therapy still fits with the general principles of ACT, as well as identifying others who could become members of the ACT expert network. This role was formerly held by Dr Geoff Hill.
- Dr Niki Chouliara, a Research Fellow in the Faculty of Medicine and Health Sciences at the University of Nottingham. Niki advises on implementing the findings of WAterS-2. She is also co-lead on the Stroke Association-funded TELSTAR project, working on developing guidelines for whether, when and how telerehabilitation should be offered after stroke.
- Dr Shirley Thomas, Associate Professor in Rehabilitation Psychology at the University of Nottingham. Shirley advises on research methods and how to measure the effectiveness of the new therapy. Like Niki, she is also a member of the TELSTAR team.