Clinical and cost effectiveness of aphasia computer treatment versus usual stimulation


A study to assess the clinical and cost effectiveness of aphasia computer treatment versus usual stimulation or attention control long term post stroke (CACTUS)

Big CACTUS is a pragmatic randomised controlled trial (RCT) to compare outcomes for people with persistent aphasia using computerised speech and language therapy at home with those having usual care (standard speech and language therapy provision or general daily communication activity), or attention control (daily completion of puzzle book activities).

The research team, based at the University of Sheffield, with collaboration from the University of Manchester and Glasgow Caledonian University, have been awarded £1.5 million from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme to fund the study. We are very grateful to the Tavistock Trust for Aphasia for supporting the study by providing additional key funding.

Aphasia is a communication disorder often caused by stroke. It affects the ability to understand, talk, read and write. People with aphasia rarely receive treatment from NHS speech and language therapists for more than 3 months. It has been established that people with aphasia can continue to improve their communication with prolonged treatment (beyond 12 months), but this is rarely available.

Step-by-Step is a computer program designed to help people to practise exercises to improve their ability to find the correct words when they are talking. Following a successful pilot study (CACTUS), Big CACTUS aims to compare computer therapy with attention control (puzzle books) and usual care to see if use of computer software with assistance from a volunteer/speech therapy assistant can improve the ability of people with aphasia to talk.

This research will establish whether people with aphasia can continue to improve their ability to talk after completion of traditional NHS therapy, and whether this can be achieved cost effectively by offering computer treatment at home. Potential benefits to patients include the opportunity for continued treatment and thus improved ability to talk. It could also give patients independence and control over their therapy. The NHS would benefit by being able to support a long term aphasia treatment service without increasing demand on therapy resources.

This study started recruitment in October 2014, and finished recruiting on 18th August 2016.

Recruitment to the Big CACTUS study has now finished, with a final total of 278 participants.

UPDATE: Outcome assessments with participants are still underway. Data analysis will commence December 2017, and results will be published by the end of June 2018.