Professor Kneebone has over 25 years’ experience in applied practice, teaching, training, policy and research in clinical psychology. He has worked as a Rehabilitation Counsellor for Bedford, SA and CRS Australia and as Programme Area Leader of a head injury service. He has also worked as a Clinical Psychologist in community mental health and with older people in a physical rehabilitation setting (Health Department of Western Australia). He worked at Consultant level, for the NHS (National Health Service of Great Britain and Northern Ireland) in physical rehabilitation and neurorehabilitation settings in Surrey, UK for sixteen years. He has consistently achieved funding for his research in rehabilitation and has published numerous papers in peer-reviewed journals. These include journals with the highest ranking in this research area. Professor Kneebone is a Visiting Professor at the University of Surrey.
MEMBER OF THE CLINICAL COLLEGE, AUSTRALIAN PSYCHOLOGICAL SOCIETY
GENERAL REGISTRATION, PSYCHOLOGY BOARD OF AUSTRALIA, ENDORSEMENT IN CLINICAL PSYCHOLOGY & APPROVED SUPERVISOR
CHARTERED CLINICAL PSYCHOLOGIST, BRITISH PSYCHOLOGICAL SOCIETY
FULL MEMBER DIVISION OF CLINICAL NEUROPSYCHOLOGY, BRITISH PSYCHOLOGICAL SOCIETY
SPECIALIST REGISTER OF CLINICAL NEUROPSYCHOLOGISTS, BRITISH PSYCHOLOGICAL SOCIETY
Can supervise: YES
Clinical psychology and older people; stroke, particularly post stroke depression and anxiety. Depression in people who have multiple sclerosis. Neuro-rehabilitation evaluation; vocational rehabilitation; Fear of falling. Intellectual disability.
Advanced Clinical Skills
Psychological Management of Stroke presents a review and synthesis of the current theory and data relating to the assessment, treatment, and psychological aspects of stroke. Provides comprehensive reviews of evidence based practice relating to stroke. Written by clinical psychologists working in stroke services. Covers a broad range of psychological aspects, including fitness to drive, decision making, prevention of stroke, and involvement of carers and families. Reviews and synthesizes new data across a wide range of areas relevant to stroke and the assessment, treatment, and care of stroke survivors and their families. Represents a novel approach to the application of psychological theory and principles in the stroke field. © 2012 John Wiley & Sons, Ltd.
Hronis, A, Roberts, R, Roberts, L & Kneebone, I 2020, 'Potential for children with intellectual disability to engage in cognitive behaviour therapy: the parent perspective.', Journal of Intellectual Disability Research, vol. 64, no. 1, pp. 62-67.View/Download from: Publisher's site
BACKGROUND:This study aimed to obtain the opinions of parents and carers of children with intellectual disability (ID) as to whether cognitive behaviour therapy (CBT) could be useful for their children. METHODS:A mixed qualitative and quantitative method was employed. Twenty-one carers of children aged 10 to 17 having borderline to moderate intellectual functioning responded to an online questionnaire. Participants were provided with information about CBT and asked to respond to open-ended questions. Quantitative data pertained to questions about their child's ability to identify and describe thoughts, feelings and behaviours. Thematic analysis of responses was conducted using an inductive method of identifying themes from the qualitative data collected. RESULTS:Five themes emerged from the qualitative analysis: Emotional Attunement (i.e. parent's understanding and recognition of their child's emotions), Role of the Therapist (i.e. ways therapists could facilitate the intervention), Role of the Parent (i.e. ways parents could engage in the therapy process), Anticipated Obstacles (i.e. what may get in the way of the therapy) and Suggested Adaptations for Therapy (i.e. how CBT can be adapted to suit the needs of children with ID). Seventy-six per cent agreed that their child would be able to engage in CBT with assistance. CONCLUSIONS:The majority of parents believed that CBT is an intervention that children with ID could engage in, provided the therapy is adapted, and the therapist accommodates their needs.
Phillips, K, Brockman, R, Bailey, PE & Kneebone, II 2020, 'Schema in older adults: does the schema mode model apply?', Behavioural and Cognitive Psychotherapy, pp. 1-9.View/Download from: Publisher's site
BACKGROUND:The relevance of schema theory to psychopathology, in particular personality disorder, in younger adults is established. Investigations into the relevance of schema theory to older adults, however, is highly limited. AIMS:To consider the relationship of schema modes to psychopathology in older adults and establish whether maladaptive schema modes are associated with unmet needs and that this relationship is mediated by the healthy adult mode of responding in this population. METHOD:One hundred and four older adults were recruited from an established database. Participants completed questionnaires assessing psychopathology, schema modes (YAMI: Young-Atkinson Mode Inventory) and basic psychological needs (BPNS: Basic Psychological Needs Scale - autonomy, competence and relatedness). Ninety-four responses were included after applying exclusion criteria. RESULTS:The healthy adult schema mode was found to be associated with reduced psychopathology, and maladaptive child modes (angry and vulnerable child) to increased psychopathology. The healthy adult schema mode mediated the relationship between maladaptive child modes and needs satisfaction. CONCLUSIONS:As predicted by schema theory, the presence of one of the maladaptive child modes makes it difficult for an older individual to have their needs met, but the presence of healthy adult mode works to support this process.
Brady, B, Kneebone, II & Bailey, PE 2019, 'Validation of the Emotion Regulation Questionnaire in older community-dwelling adults.', The British journal of clinical Psychology, vol. 58, no. 1, pp. 110-122.View/Download from: Publisher's site
OBJECTIVE:To examine the psychometric properties of the Emotion Regulation Questionnaire (ERQ) among a sample of older community-dwelling males and females and to also assess gender differences in the association between emotion regulation and positive and negative affect. METHOD:The ERQ and the Positive and Negative Affect Schedule-10 were administered to 252 older adults (age range 60-89 years; 48.4% female). RESULTS:The two ERQ subscales, reappraisal and suppression, were internally consistent. Reappraisal was positively correlated with positive affect among both genders, and negatively correlated with negative affect among older women only. Suppression was positively correlated with negative affect among older men only and unrelated to positive affect for both genders. Confirmatory factor analysis showed that a two-factor solution fits the data from both genders. CONCLUSION:The results provide evidence to support the ERQ for use with older adults, while identifying clinically important gender differences in the associations between emotion regulation tendencies and affect in older age. PRACTITIONER POINTS:Reliability and validity of the 10-item Emotion Regulation Questionnaire is supported for use among older adults. Suppression positively correlated with negative affect among older men but not older women. Reappraisal negatively correlated with negative affect among older women but not men. The current data from a community-dwelling population may not generalize to older adults with clinical disorders.
Brady, B, Kneebone, II & Bailey, PE 2019, 'Validation of the Five Facet Mindfulness Questionnaire Among Community-Dwelling Older Adults', Mindfulness, vol. 10, no. 3, pp. 529-536.View/Download from: Publisher's site
© 2018, Springer Science+Business Media, LLC, part of Springer Nature. The 24-item Five Facet Mindfulness Questionnaire – Short Form (FFMQ-SF) was developed to measure five facets of dispositional mindfulness: observing, describing, acting with awareness, non-judgment of inner experience, and non-reactivity to inner experience. The FFMQ-SF is increasingly used with older adult populations, despite not having been appropriately validated for such use. The present study examined the psychometric properties of the FFMQ-SF among community-dwelling older adults (N = 210). The five subscales of the FFMQ-SF were found to be internally consistent. Convergent validity analyses revealed that all facets of mindfulness except observing were negatively correlated with negative affect, and all facets except for non-judgment were positively correlated with positive affect. Similarly, all facets except for non-judgment were positively correlated with cognitive reappraisal emotion regulation tendencies. Only describing, acting with awareness, and non-judgment were negatively correlated with expressive suppression tendencies. The original five-factor structure of the FFMQ-SF was supported by confirmatory factor analyses. The two-factor higher order structure of the FFMQ-SF was also supported. Overall, the results support the psychometric properties of the FFMQ-SF for use with older adult samples.
Carragher, M, Ryan, B, Worrall, L, Thomas, S, Rose, M, Simmons-Mackie, N, Khan, A, Hoffmann, TC, Power, E, Togher, L & Kneebone, I 2019, 'Fidelity protocol for the Action Success Knowledge (ASK) trial: A psychosocial intervention administered by speech and language therapists to prevent depression in people with post-stroke aphasia', BMJ Open, vol. 9, no. 5.View/Download from: Publisher's site
© 2019 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Introduction Treatment fidelity is a complex, multifaceted evaluative process which refers to whether a studied intervention was delivered as intended. Monitoring and enhancing fidelity is one recommendation of the TiDIER (Template for Intervention Description and Replication) checklist, as fidelity can inform interpretation and conclusions drawn about treatment effects. Despite the methodological and translational benefits, fidelity strategies have been used inconsistently within health behaviour intervention studies; in particular, within aphasia intervention studies, reporting of fidelity remains relatively rare. This paper describes the development of a fidelity protocol for the Action Success Knowledge (ASK) study, a current cluster randomised trial investigating an early mood intervention for people with aphasia (a language disability caused by stroke). Methods and analysis A novel fidelity protocol and tool was developed to monitor and enhance fidelity within the two arms (experimental treatment and attention control) of the ASK study. The ASK fidelity protocol was developed based on the National Institutes of Health Behaviour Change Consortium fidelity framework. Ethics and dissemination The study protocol was approved by the Darling Downs Hospital and Health Service Human Research Ethics Committee in Queensland, Australia under the National Mutual Acceptance scheme of multicentre human research projects. Specific ethics approval was obtained for those participating sites who were not under the National Mutual Agreement at the time of application. The monitoring and ongoing conduct of the research project is in line with requirements under the National Mutual Acceptance. On completion of the trial, findings from the fidelity reviews will be disseminated via publications and conference presentations. Trial registrati...
dasNair, R, Griffiths, H, Clarke, S, Methley, A, Kneebone, I & Topcu, G 2019, 'Everyday memory measures in multiple sclerosis: a systematic review.', Neuropsychological Rehabilitation, vol. 29, no. 10, pp. 1543-1568.View/Download from: Publisher's site
Everyday memory is one of the most affected cognitive functions in multiple sclerosis (MS). Assessing everyday memory problems is crucial for monitoring the impact of memory deficits on individuals' day-to-day lives and evaluating the effectiveness of interventions that aim to improve cognitive functions. The aim of this systematic review was to identify the research literature on everyday memory measures used with people with MS, describe the types of measures used, and summarise their psychometric properties. Empirical studies of cognitive function in MS using standardised everyday memory measures were included. Online databases (MEDLINE, PsycINFO, PsycARTICLES, Embase) and Google Scholar were searched. Forty-four studies met the inclusion criteria. A total of 12 measures were identified, with varied uses and administration methods. The majority of papers did not report any psychometric properties for MS populations. The few papers that did, reported that the measures have good reliability and appear to have good face, concurrent, and ecological validity, but these need to be evaluated further. This review presents researchers and clinicians with an overview of the various everyday memory measures used in studies with people with MS, to help them choose the appropriate measure for their evaluations.
Dorstyn, D, Roberts, R, Murphy, G, Craig, A, Kneebone, I, Stewart, P, Chur-Hansen, A, Marshall, R, Clark, J & Migliorini, C 2019, 'Work and SCI: a pilot randomized controlled study of an online resource for job-seekers with spinal cord dysfunction.', Spinal cord, vol. 57, no. 3, pp. 221-228.View/Download from: Publisher's site
STUDY DESIGN:A prospective, parallel randomized controlled trial (RCT). OBJECTIVES:To test the preliminary effects of an online resource targeted to job-seekers with spinal cord injury or disorder (SCI/D), and to determine the feasibility of proceeding to a full-scale RCT. SETTING:A community cohort in Australia. METHODS:Forty-eight adults (M = 42 years, SD = 10.95, 27 males) were randomized to receive 4-weeks access to the Work and SCI resource (n = 25) or to a wait-list control group (n = 23). The Work and SCI intervention involved six stand-alone learning modules which provided job-searching and career-planning information through text, videos, and interactive activities. Self-report measures were administered at baseline and after 4 weeks: Job Procurement Self-Efficacy Scale (JSES), Life Orientation Test-Revised (LOT-R), and Patient Health Questionnaire-9 (PHQ-9). RESULTS:Online usage data identified high uptake of the Work and SCI resource, although study attrition was problematic. Intention-to-treat analyses failed to reach statistical significance, whereas complete data revealed a significant interaction effect for optimism (LOT-R). CONCLUSION:Further research to develop and enhance Work and SCI is indicated. Remediable strategies to optimize recruitment and statistical power in a future definitive RCT are discussed. SPONSORSHIP:This project was funded by the auDA Foundation (project 16019).
Dorstyn, D, Roberts, R, Murphy, G, Kneebone, I, Craig, A, Chur-Hansen, A, Migliorini, C, Potter, E, Marshall, R, Clark, J, Neeson, S & Stewart, P 2019, 'Can targeted job-information for adults with spinal cord dysfunction be effectively delivered online? A pilot study.', Journal of Spinal Cord Medicine, vol. 42, no. 1, pp. 94-101.View/Download from: Publisher's site
OBJECTIVE: To pilot a novel email-based information package (Work and SCI) for job-seekers with an acquired spinal cord injury (SCI) or spinal cord dysfunction (SCI/D). STUDY DESIGN: Prospective, non-randomized, repeated measures trial. SETTING: Community dwelling cohort in Australia. PARTICIPANTS: Five people with SCI (mean age 46.4 years, SD = 10.2; 4 female) initially reviewed Work and SCI. Twenty-four with SCI/D subsequently enrolled, of whom 16 (mean age 46.4 years, SD = 11.1; 7 female), completed the intervention. INTERVENTION: Intervention participants accessed Work and SCI over a 4-week period. OUTCOME MEASURES: Individual changes in pre-post scores for the My Vocational Situation Scale, Job Procurement Self-Efficacy Scale, Patient Health Questionnaire-9 and Life Orientation Test-Revised were examined. RESULTS: Reliable change in pre-post scores across outcomes were reported by 38% (n = 6) of participants. Favorable comments on the Work and SCI resource were provided in addition to suggestions for improvement. CONCLUSIONS: Preliminary data suggest that Work and SCI may help to establish vocational interests among job-seekers with a SCI/D, however further work is needed to enhance participant compliance. This might include moderator support to promote and maintain participation. A controlled design will also help to identify factors that influence engagement with the Work and SCI resource.
Hronis, A, Roberts, R, Roberts, L & Kneebone, I 2019, 'Fearless Me!A (c): A feasibility case series of cognitive behavioral therapy for adolescents with intellectual disability', JOURNAL OF CLINICAL PSYCHOLOGY, vol. 75, no. 6, pp. 919-932.View/Download from: Publisher's site
Maddern, R & Kneebone, II 2019, 'Receiving Bad News: A Thematic Analysis of Stroke Survivor Experiences.', Journal of patient experience, vol. 6, no. 4, pp. 271-277.View/Download from: Publisher's site
Background:Breaking bad news to patients may be required in service provision to stroke survivors. While challenging, it may be critical to the retention of optimism and participation in rehabilitation. Objectives:To explore the experience of stroke survivors when receiving bad news (RBN) from medical practitioners. Methods:Data were obtained via 1:1 interviews conducted at stroke support groups with survivors at least 12 months into recovery and subsequently transcribed for thematic analysis and coded using NVivo. Results:Eight of 10 participants experienced RBN, and 2 participants did not. The themes of being "lucky to be alive" and waiting for "delayed information" were expressed by all participants early in the interviews. Three sub-themes emerged and were labelled alliance, dissent, and dissatisfaction, each with a further 3 contextual themes. The perception of RBN was marked amongst the dissent and dissatisfaction groups, with the latter reporting negative implications for their rehabilitation as well as negative emotions, such as anger and anxiety. The perception of a poor-quality relationship with medical practitioners was said to impede rehabilitation and recovery processes. The dissent group was characterized by initial disbelief after RBN and consequently poorer long-term outcomes, whilst the Alliance group experienced very good quality of care due to existing personal knowledge and therefore did not perceive RBN during their early medical meetings. Conclusions:In the period soon after their stroke, survivors required their medical practitioners to not only communicate knowledge and information, but also needed validation of their hopes and fears for the future from an empathically attuned clinician.
Osborn, R, Roberts, L & Kneebone, I 2019, 'Barriers to accessing mental health treatment for parents of children with intellectual disabilities: a preliminary study', Disability and Rehabilitation.View/Download from: Publisher's site
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Purpose: Parents of children with intellectual disability often experience heightened levels of psychological distress compared to parents of typically developing children due to increased parenting demands. Given these demands, parents may also have difficulty accessing mental health treatment for themselves. This research investigated whether parents of children with intellectual disability experience barriers in accessing mental health treatment for themselves related to the increased parenting demands of having a child with an intellectual disability. Materials and methods: 80 parents of children with intellectual disability were surveyed about barriers to accessing mental health treatment for themselves and interest in an e-treatment. Results: Parents who experienced mental health difficulties were more likely to experience barriers in accessing treatment. For parents who had experienced mental health difficulties, cost, arranging childcare, and availability of providers were significant barriers to accessing treatment. Older participants were less likely to report cost as a barrier. Participants with higher incomes were less likely to report work scheduling as a barrier. Participants reported interest in an e-treatment, with younger participants more likely to express interest. Conclusions: These preliminary findings suggest that parents of children with intellectual disability experience barriers to accessing treatment. Research directions include developing e-treatments for these carers.Implications for rehabilitation Having a child with an intellectual disability is associated with increased parenting demands, and significant stress for parents The results of this survey suggest that for parents who are experiencing mental health difficulties, cost, arranging childcare and availability of providers may act as barriers to accessing treatment for their own mental health concerns Rehabi...
Phillips, K, Brockman, R, Bailey, PE & Kneebone, II 2019, 'Young Schema Questionnaire - Short Form Version 3 (YSQ-S3): Preliminary validation in older adults.', Aging and Mental Health, vol. 23, no. 1, pp. 140-147.View/Download from: Publisher's site
The aim of the current study was to establish the reliability and validity of one of the most used schema questionnaires, Young Schema Questionnaire Short Form Version 3 (YSQ-S3) in older adults.104 participants aged 60-84 years were recruited. They were administered a battery of questionnaires, including the YSQ-S3, Young-Atkinson Mode Inventory (YAMI), Germans (Personality) Screener, the Geriatric Depression Scale (GDS), The Geriatric Anxiety Inventory (GAI) and the Basic Psychological Needs Scale (BPNS). The YSQ-S3 was completed a second time by 83 participants a median of 12 days later.Satisfactory internal consistency reliability was found for 13 of the 18 early maladaptive schemas (EMS) of the YSQ-S3. Test-retest reliability was satisfactory for 17 of 18 EMS. Convergent validity was evident from significant correlations between the EMS of the YSQ-S3 and the vulnerable child and angry child schema modes from the YAMI. Congruent validity was evident from correlations of the majority of the EMS with the GDS, the GAI, German's (Personality) Screener and the BPNS measure.By and large the YSQ-S3 demonstrates internal and test re-test reliability in as well as congruent and convergent validity, in older adults. This suggests the YSQ-S3 may be of use in work establishing the utility of schema therapy in this population, and that schema therapy with older people warrants further exploration. Notwithstanding this some re-development of some EMS items appears to be required for the YSQ-S3 to be more relevant to older people.
Ryan, B, Bohan, J & Kneebone, I 2019, 'Help-seeking and people with aphasia who have mood problems after stroke: perspectives of speech–language pathologists', International Journal of Language and Communication Disorders, vol. 54, no. 5, pp. 779-793.View/Download from: Publisher's site
© 2019 Royal College of Speech and Language Therapists Background: Access to treatments for mood disorders may pose a challenge to individuals with compromised communication ability. Speech–language pathologists (SLPs) have previously reported that their clients with aphasia decline formal psychological support; however, their role in their clients' help-seeking has not been explored. Aims: To investigate SLPs' perspectives on how they currently support help-seeking for mood problems in people with aphasia and factors they perceive to be impacting service uptake. Methods & Procedures: A qualitative interview study was conducted. SLPs in Australia working with people with aphasia in a clinical role were recruited. Transcripts of the interviews were subject to qualitative analysis to identify relevant themes. Outcomes & Results: Eighteen interviews were conducted. One overarching theme and three sub-themes were identified as central to SLPs' experience. The overarching theme was of a 'double whammy' impact on help-seeking: people with aphasia were subject to universal barriers associated with seeking help as well as additional barriers imposed by compromised communication. Three themes contributed to the overarching theme: (1) SLPs' understanding of barriers and facilitators to patients with aphasia seeking help; (2) the role of the SLP as a skilled helper for mood management; and (3) mood and communication as competing rehabilitation priorities. Conclusions & Implications: SLPs report both universal barriers to help-seeking and those specific to their clients with aphasia and attempts to overcome these; however, there appears to be a dearth of accessible mental health services for people with aphasia known to SLPs, including psychological/counselling professionals who are skilled in communicating with people with aphasia. Health professionals working within and across post-stroke and mental health services should recognize that people with post-stroke aphasia are ...
Sekhon, JK, Oates, J, Kneebone, I & Rose, M 2019, 'Counselling training for speech–language therapists working with people affected by post-stroke aphasia: a systematic review', International Journal of Language and Communication Disorders, vol. 54, no. 3, pp. 321-346.View/Download from: Publisher's site
© 2019 Royal College of Speech and Language Therapists Background: Speech–language therapists use counselling to address the psychological well-being of people affected by post-stroke aphasia. Speech–language therapists report low counselling knowledge, skill and confidence for working in post-stroke aphasia which may be related to a lack of counselling training specific to the needs of this client group. Aims: To identify current training in counselling for speech–language therapists to address psychological well-being in people affected by post-stroke aphasia. Specifically, the intent was to establish the objectives, content, amount, teaching methods and outcomes of counselling training provided to speech–language therapists working with people affected by post-stroke aphasia. Methods & Procedures: Eleven databases were searched from inception to January 2018 using terms relating to counselling, psychological well-being, speech–language therapy, stroke, aphasia and training. Studies using any research methodology and design were included. Nine studies were critically appraised and synthesized as a systematic review using the Search, AppraisaL, Synthesis and Analysis (SALSA) framework. Main Contribution: Information on counselling training came from the UK, United States and Australia. Student speech–language therapists received training in goal-setting and generic counselling skills. After qualification, speech–language therapists received counselling training from mental health professionals within stroke workplaces, from external providers and further education. A range of teaching techniques and counselling approaches were described. Self-report and themes from qualitative data were the primary measures of counselling training outcomes. Moderate correlations were reported between counselling training and levels of speech–language therapists' knowledge, comfort, confidence and preparedness to counsel people affected by post-stroke aphasia. Conclusions: Resear...
Brady, B, Kneebone, II, Denson, N & Bailey, PE 2018, 'Systematic review and meta-analysis of age-related differences in instructed emotion regulation success.', PeerJ, vol. 6, pp. e6051-e6051.View/Download from: Publisher's site
The process model of emotion regulation (ER) is based on stages in the emotion generative process at which regulation may occur. This meta-analysis examines age-related differences in the subjective, behavioral, and physiological outcomes of instructed ER strategies that may be initiated after an emotional event has occurred; attentional deployment, cognitive change, and response modulation. Within-process strategy, stimulus type, and valence were also tested as potential moderators of the effect of age on ER. A systematic search of the literature identified 156 relevant comparisons from 11 studies. Few age-related differences were found. In our analysis of the subjective outcome of response modulation strategies, young adults used expressive enhancement successfully (g = 0.48), but not expressive suppression (g = 0.04). Response modulation strategies had a small positive effect among older adults, and enhancement vs suppression did not moderate this success (g = 0.31 and g = 0.10, respectively). Young adults effectively used response modulation to regulate subjective emotion in response to pictures (g = 0.41) but not films (g = 0.01). Older adults were able to regulate in response to both pictures (g = 0.26) and films (g = 0.11). Interestingly, both age groups effectively used detached reappraisal, but not positive reappraisal to regulate emotional behavior. We conclude that, in line with well-established theories of socioemotional aging, there is a lack of evidence for age differences in the effects of instructed ER strategies, with some moderators suggesting more consistent effectiveness for older compared to younger adults.
Cadilhac, DA, Busingye, D, Li, JC, Andrew, NE, Kilkenny, MF, Thrift, AG, Thijs, V, Hackett, ML, Kneebone, I, Lannin, NA, Stewart, A, Dempsey, I & Cameron, J 2018, 'Development of an electronic health message system to support recovery after stroke: Inspiring virtual enabled resources following vascular events (iVERVE)', Patient Preference and Adherence, vol. 12, pp. 1213-1224.View/Download from: Publisher's site
© 2018 Cadilhac et al. Purpose: Worldwide, stroke is a leading cause of disease burden. Many survivors have unmet needs after discharge from hospital. Electronic communication technology to support post-discharge care has not been used for patients with stroke. In this paper, we describe the development of a novel electronic messaging system designed for survivors of stroke to support their goals of recovery and secondary prevention after hospital discharge. Participants and methods: This was a formative evaluation study. The design was informed by a literature search, existing data from survivors of stroke, and behavior change theories. We established two working groups; one for developing the electronic infrastructure and the other (comprising researchers, clinical experts and consumer representatives) for establishing the patient-centered program. Following agreement on the categories for the goal-setting menu, we drafted relevant messages to support and educate patients. These messages were then independently reviewed by multiple topic experts. Concurrently, we established an online database to capture participant characteristics and then integrated this database with a purpose-built messaging system. We conducted alpha testing of the approach using the first 60 messages. Results: The initial goal-setting menu comprised 26 subcategories. Following expert review, another 8 goal subcategories were added to the secondary prevention category: managing cholesterol; smoking; physical activity; alcohol consumption; weight management; medication management; access to health professionals, and self-care. Initially, 455 health messages were created by members of working group 2. Following refinement and mapping to different goals by the project team, 980 health messages across the health goals and 69 general motivational messages were formulated. Seventeen independent reviewers assessed the messages and suggested adding 73 messages and removing 16 (2%). Overall, 1,233 ...
Chan, DKY, Sherrington, C, Naganathan, V, Xu, YH, Chen, J, Ko, A, Kneebone, I & Cumming, R 2018, 'Key issues to consider and innovative ideas on fall prevention in the geriatric department of a teaching hospital', Australasian Journal on Ageing, vol. 37, no. 2, pp. 140-143.View/Download from: Publisher's site
© 2018 AJA Inc. Falls in hospital are common and up to 70% result in injury, leading to increased length of stay and accounting for 10% of patient safety-related deaths. Yet, high-quality evidence guiding best practice is lacking. Fall prevention strategies have worked in some trials but not in others. Differences in study setting (acute, subacute, rehabilitation) and sampling of patients (cognitively intact or impaired) may explain the difference in results. This article discusses these important issues and describes the strategies to prevent falls in the acute hospital setting we have studied, which engage the cognitively impaired who are more likely to fall. We have used video clips rather than verbal instruction to educate patients, and are optimistic that this approach may work. We have also explored the option of co-locating high fall risk patients in a close observation room for supervision, with promising results. Further studies, using larger sample sizes are required to confirm our findings.
Clunne, SJ, Ryan, BJ, Hill, AJ, Brandenburg, C & Kneebone, I 2018, 'Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review.', Journal of Medical Internet Research, vol. 20, no. 12, pp. e291-e291.View/Download from: Publisher's site
Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia. The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia. A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia. A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs' use for stroke survivors with or without aphasia. One evidence-based program scored at least 80% (16/19 and 16/20, respectively) on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluati...
Dorstyn, D, Roberts, R, Murphy, G, Kneebone, I, Craig, A & Migliorini, C 2018, 'Online Resource to Promote Vocational Interests Among Job Seekers With Multiple Sclerosis: A Randomized Controlled Trial in Australia.', Archives of Physical Medicine and Rehabilitation, vol. 99, no. 2, pp. 272-280.View/Download from: Publisher's site
To provide a preliminary evaluation of the effectiveness of an online resource for job seekers with multiple sclerosis (MS).Randomized controlled design.Community-dwelling cohort.Adults (N = 95) with relapsing-remitting or progressive MS were randomly assigned to one of two groups. Forty-five accessed an email delivered, 7 module resource, Work and MS, over a 4 week period. Waitlist control participants (n=50) were offered the opportunity to access Work and MS 4 weeks postenrollment.Primary outcomes focused on vocational interests (My Vocational Situation Scale) and self-efficacy in job-seeking activities (Job-Procurement Self Efficacy Scale). Secondary outcomes focused on perceived workplace difficulties (Multiple Sclerosis Work Difficulties Questionnaire [MSWDQ]), optimism (Life Orientation Test - Revised), and mood (Patient Health Questionnaire-9).Intention-to-treat analyses revealed pre-post gains: participants who accessed Work and MS reported improved confidence in their career goals (My Vocational Situation Scale g=.55; 95% confidence interval [CI], .14-.96; P=.008) and positively reappraised potential workplace difficulties (MSWDQ g range, .42-.47; P range, .023-.042). The effect on job self-efficacy was not significant, but changed in the expected direction (g=.17; 95% CI, -.23 to .57; P=.409). Completer data revealed larger, significant effect estimates (g range, .52-.64; P range, .009-.035).Findings provide preliminary support for the utility of a job information resource, Work and MS, to augment existing employment services. The results also suggest the need to test employment-ready interventions in a larger study population. This might include the addition of online peer support to increase intervention compliance.
Golding, K, Fife-Schaw, C & Kneebone, I 2018, 'A pilot randomized controlled trial of self-help relaxation to reduce post-stroke depression.', Clinical Rehabilitation, vol. 32, no. 6, pp. 747-751.View/Download from: Publisher's site
To consider the potential of self-help relaxation training to treat depression after stroke.Randomized controlled trial with cross-over at three months.Community.In total, 21 people with stroke, aged 49-82 years.Autogenic relaxation CD.Hospital Anxiety and Depression Scale-Depression (HADS-D) subscale.No difference in depression change scores was identified between the treatment and control groups; however, on two follow-ups, significant positive differences relative to screening were found for the treatment group (at 2 months Z = -2.55, P = .011 and 12 months Z = -2.44, P = .015). A partial η(2) = .07 was identified.Self-help relaxation holds promise as a self-help treatment for depression after stroke. Findings from this trial, considered with others of relaxation for depression, suggest that a study including a total of 80 participants would likely be sufficient to establish efficacy of the treatment, relative to controls, in those with stroke.
Hronis, A, Roberts, L & Kneebone, I 2018, 'Assessing the confidence of Australian mental health practitioners in delivering therapy to people with intellectual disability', Intellectual and Developmental Disabilities, vol. 56, no. 3, pp. 202-211.View/Download from: Publisher's site
© AAIDD. Research supports the use of psychological therapies among people with mild to moderate intellectual disability (ID). One barrier to people with ID accessing psychological treatments is the confidence of mental health practitioners. This article explores the confidence of Australian clinicians in providing therapy to people with ID. One hundred and fifty-two psychologists and counselors in Australia completed a survey exploring self-reported confidence when working with clients who have ID and mental health difficulties. Clinicians were most confident with generic counseling skills, but less confident with elements of assessments and interventions. The use of treatment protocols was endorsed as helpful particularly among those with low confidence. This highlights the need for dissemination of treatment guides and training to help increase clinician confidence.
Loft, CC, Jones, FW & Kneebone, II 2018, 'Falls self-efficacy and falls incidence in community-dwelling older people: the mediating role of coping', International Psychogeriatrics, vol. 30, no. 5, pp. 727-733.View/Download from: Publisher's site
Copyright © International Psychogeriatric Association 2017 Background:: A cognitive behavioral model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people. Method:: In a cross-sectional design, 160 community-dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale–International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analyzed via mediation analysis using a bootstrapping approach. Results:: Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (0.003, 0.021) and an effect size of κ 2 = 0.035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and positive reappraisal. Conclusions:: Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls.
Osborn, R, Girgis, M, Sladakovic, J, Morse, S, Kneebone, I, Shires, AG, Durvasula, S & Roberts, L 2018, 'Mindfulness-Integrated CBT (MiCBT) for Reducing Distress in Parents of Children with Intellectual Disability (ID): a Case Series."', Journal of Developmental and Physical Disabilities, vol. 30, no. 4, pp. 559-568.View/Download from: Publisher's site
Caring for a child with an intellectual disability (ID) is associated with significant psychological distress. Interventions include cognitive behavioural therapy (CBT) and Mindfulness-based Stress Reduction (MBSR). Mindfulness-integrated CBT (MiCBT) may offer a balance between CBT's change focus and MBSR's acceptance focus for these parents. Five participants were recruited and provided one to one MiCBT tailored to parental carers of children with ID. Four participants completed the Depression Anxiety Stress Scales 21 (DASS-21) pre-treatment and post-treatment. Reliable change analysis was used to identify clinically reliable change. One participant dropped out after four sessions, four completed eight of the available eight sessions. Two participants reported reductions in depressive and stress symptoms, and one of these, additionally reported a reduction in anxiety symptoms. All four participants who completed treatment rated the treatment as acceptable. MiCBT shows promise as an intervention to assist parental carers of children with ID.
Piper, SE, Bailey, PE, Lam, LT & Kneebone, II 2018, 'Predictors of mental health literacy in older people', ARCHIVES OF GERONTOLOGY AND GERIATRICS, vol. 79, pp. 52-56.View/Download from: Publisher's site
Chan, EKW, Shen, Q, Cordato, D, Kneebone, I, Xu, Y-H & Chan, DKY 2017, 'Delirium post-stroke: short- to long-term effect on anxiety and depression compared to effect on cognition.', Topics in Stroke Rehabilitation, vol. 24, no. 8, pp. 597-600.View/Download from: Publisher's site
Background Delirium is common after stroke and has significant negative impact on mortality, morbidity, cognitive function, and institutionalization. Despite these known effects, any impact of delirium on the emotional well-being of stroke survivors is unclear. Methods A post hoc analysis was performed on our prospective cohort study of 156 stroke patients. Hospital Anxiety and Depression (HAD) scale scores were compared between patients with delirium and patients without delirium at 1-month, 6-month, and 12-month post-stroke. Results Contrary to the negative impact of delirium on cognition and functional status, we did not discern any influence on HAD scale scores in the short to long term. The median scores of the HAD anxiety scale were 4 (interquartile range IQR 3) at 1 month, 5.5 (IQR 8.75) at 6 months, and 6 (IQR 5) at 12 months in the delirium group compared to 5 (IQR 7) at 1 month (p = 0.6), 4 (IQR 7) at 6 months (p = 0.4), and 6 (IQR 5.75) at 12 months (p = 0.9) in the non-delirium group, respectively. Similarly, the median scores of the HAD depression scale were 5 (IQR 4) at 1 month, 4 (IQR 6.5) at 6 months, and 3 (IQR 6) at 12 months in the delirium group compared to 6 (IQR 5.75) at 1 month (p = 0.9), 5 (IQR 7) at 6 months (p = 0.9), and 6 (IQR 5) at 12 months (p = 0.5) in the non-delirium group. Conclusion Delirium may not have a significant effect on the development of anxiety or depression after stroke which differs in its effect on cognitive function and functional status.
Crayton, E, Verney, N & Kneebone, I 2017, 'Developing a social support group for older people in a physical rehabilitation setting', Clinical Psychology Forum, no. 295, pp. 25-30.
Quality of life and recovery from a variety of conditions, can be positively affected by social support. This article describes the development of an activity-based support group at an inpatient rehabilitation hospital for older people.
Dorstyn, D, Black, R, Mpofu, E & Kneebone, I 2017, 'Utilizing the ICF to understand depressive symptomology in multiple sclerosis: An exploratory systematic review.', Rehabilitation Psychology, vol. 62, no. 2, pp. 143-164.View/Download from: Publisher's site
PURPOSE: Acceptance of the International Classification of Functioning, Disability and Health (ICF) in research and clinical practice has been delayed, despite its multiperspective approach to health measurement. This review utilized the ICF to examine evidence on the associations between depressive symptoms and psychosocial functioning in a patient cohort: multiple sclerosis (MS). RESEARCH METHOD: Forty-nine studies, involving 7,548 adults with relapsing or progressive forms of MS, were quantitatively evaluated. Data were categorized according to ICF domains: activities of individuals along with their participation in life areas and influential environmental and personal factors. Effect size estimates, in the form of Pearson's r, 95% confidence intervals and Fail-safe Ns were calculated. RESULTS: Depression severity was linked to reduced social activities and participation levels (29%, n = 14 studies). Limited quality and/or frequency of informal support from family and friends was also identified as an environmental barrier to participation (29%, n = 14 studies). Intrapersonal markers of depressive symptomatology (e.g., low self-efficacy, anxiety, poor coping, illness attitudes and beliefs) were routinely reported (53%, n = 29 studies). CONCLUSIONS: The ICF can help guide the selection of clinical measures to assess psychosocial functioning in adults with MS and highlight areas necessitating further research and/or intervention. For those reporting depressed mood, this might include interventions premised on supporting activity and participation in addition to reinforcing interpersonal strengths. To enhance the utility of the ICF in MS care, further research is needed to operationalize its domains and to map this framework onto existing measurement tools. (PsycINFO Database Record
Dorstyn, D, Roberts, R, Murphy, G, Kneebone, I, Migliorini, C, Craig, A, Hutchinson, C & Field, D 2017, 'Piloting an email-based resource package for job seekers with multiple sclerosis', Disability and Rehabilitation, vol. 39, no. 9, pp. 867-873.View/Download from: Publisher's site
© 2016 Informa UK Limited, trading as Taylor & Francis Group Purpose: Media-based rehabilitation provides a powerful opportunity to examine vocational behaviors in the disability sector. However, this research is preliminary at best. This paper reports pilot data. Method: Eighteen adults with multiple sclerosis (MS) accessed an email-delivered, resource-based package, Work and MS. Pre- and post-access vocational self-efficacy and identity (Job-Procurement Self Efficacy Scale, My Vocational Situation Scale- primary outcomes), life orientation and depressed mood (Life Orientation Test – revised and Patient Health Questionnaire-9 – secondary outcomes) were assessed. Pre- and post-change scores were examined with Wilcoxon signed ranks tests and Hedges g effect sizes with associated 95% confidence intervals. Reliable change analyses were additionally calculated to determine the clinical significance of individual change scores. Results: Significant and positive effects were reported for vocational self-efficacy, identity, and optimism. Reliable change scores in one or more of these key outcomes were reported by 30% of the sample. Satisfaction with the content and delivery of the email-based intervention was also noted. Conclusions: Preliminary evidence suggests that Work and MS can help to promote vocational goals, interests and strengths among job seekers with a disability by providing a set of tools, information and linkages relating to vocational pursuits and career development. Replication with a randomized control design is indicated. Implications for RehabilitationResearch indicates a high unemployment rate among working-age adults with MS.A combination of disease-specific, psychological, programmatic and societal variables contribute to employment instability in this group.This pilot study demonstrates that an e-mail-based resource package, Work and MS, provides an innovative and feasible option for promoting consumer engagement with vocational services and, po...
Eccles, A, Morris, R & Kneebone, I 2017, 'Psychometric properties of the Behavioural Outcomes of Anxiety questionnaire in stroke patients with aphasia.', Clinical Rehabilitation, vol. 31, no. 3, pp. 369-378.View/Download from: Publisher's site
To evaluate the psychometric properties of an observational, carer-completed anxiety screen for aphasic stroke patients.Phase 1: A cross-sectional questionnaire design to establish psychometric properties. Phase 2: A randomized longitudinal design with treatment and control to evaluate sensitivity to change and repeatability/reliability.Phase 1: 111 patient-carer dyads were recruited through stroke charities: patient mean age 69.7(10. 7), 6.2(5. 2) years since stroke, 76 male; carer mean age 64.7(12. 2), 27 male. Phase 2. A subsample of 50 dyads (29 completed).All patients completed the Tension Rating Circles and the Frenchay Aphasia Screening Test. Carers completed the Behavioural Outcomes of Anxiety questionnaire, observational versions of the Hospital Anxiety and Depression Scale (HADS-A) and the Generalised Anxiety Disorder-7, and a feedback questionnaire.Phase 2: 25 dyads were offered relaxation training and 25 acted as controls.The Behavioural Outcomes of Anxiety questionnaire correlated .77 with the HADS-A and Cronbach's Alpha was .82 demonstrating validity and internal consistency. Using HADS-A cut-off > 7 as criterion the area under the curve was 0.90 and at cut-off of > 16 sensitivity (0.85) and specificity (0.85) were both good. Scores declined significantly more in a group given anxiety training (n = 12) than in a control group (n = 17), demonstrating sensitivity to change and construct validity. Two-week repeatability/reliability was .92. Feedback suggested the scale was acceptable.The Behavioural Outcomes of Anxiety questionnaire shows promise as an anxiety screen for stroke patients with aphasia and is sensitive to change. Further analysis of dimensionality and discriminant validity is needed.
Golding, K, Fife-Schaw, C & Kneebone, I 2017, 'Twelve month follow-up on a randomised controlled trial of relaxation training for post-stroke anxiety.', Clinical Rehabilitation, vol. 31, no. 9, pp. 1164-1167.View/Download from: Publisher's site
OBJECTIVE: To follow up participants in a randomised controlled trial of relaxation training for anxiety after stroke at 12 months. DESIGN: Twelve month follow-up to a randomised controlled trial, in which the control group also received treatment. SETTING: Community. PARTICIPANTS: Fifteen of twenty one original participants with post-stroke anxiety participated in a one year follow-up study. INTERVENTIONS: A self-help autogenic relaxation CD listened to five times a week for one month, immediately in the intervention group and after three months in the control group. MAIN MEASURES: Hospital Anxiety and Depression Scale-Anxiety subscale and the Telephone Interview of Cognitive Status for inclusion. Hospital Anxiety and Depression Scale-Anxiety subscale for outcome. All measures were administered by phone. RESULTS: Anxiety ratings reduced significantly between pre and post-intervention, and between pre-intervention and one year follow-up (χ(2)(2) = 22.29, p < 0.001). CONCLUSIONS: Reductions in anxiety in stroke survivors who received a self-help autogenic relaxation CD appear to be maintained after one year.
Hronis, A, Roberts, L & Kneebone, II 2017, 'A review of cognitive impairments in children with intellectual disabilities: Implications for cognitive behaviour therapy', British Journal of Clinical Psychology, vol. 56, no. 2, pp. 189-207.View/Download from: Publisher's site
Kneebone, II & Dewar, SJ 2017, 'Reliability and validity of the Attributional Style Questionnaire- Survey in people with multiple sclerosis.', Therapeutic Advances in Neurological Disorders, vol. 10, no. 1, pp. 33-40.View/Download from: Publisher's site
The current study aimed to examine the psychometric properties of an attributional style measure that can be administered remotely, to people who have multiple sclerosis (MS).A total of 495 participants with MS were recruited. Participants completed the Attributional Style Questionnaire-Survey (ASQ-S) and two comparison measures of cognitive variables via postal survey on three occasions, each 12 months apart. Internal reliability, test-retest reliability and congruent validity were considered.The internal reliability of the ASQ-S was good (α > 0.7). The test-retest correlations were significant, but failed to reach the 0.7 set. The congruent validity of the ASQ-S was established relative to the comparisons.The psychometric properties of the ASQ-S indicate that it shows promise as a tool for researchers investigating depression in people with MS and is likely sound to use clinically in this population.
© 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Background: Anxiety is common after stroke and is associated with poorer recovery. People with aphasia after stroke are typically excluded from studies of anxiety prevalence and so the number of those affected is unclear. Aims: To make a preliminary estimate of the prevalence of significant anxiety in people with aphasia after stroke. Methods & Procedures: Carers to community-dwelling people with aphasia after stroke, N = 111, completed the Behavioural Outcomes of Anxiety scale (BOA), a modified Hospital Anxiety and Depression Scale–Anxiety sub-scale (HADS-A), and a modified Generalised Anxiety Disorder-7 item (GAD-7) scale to determine the presence of significant anxiety in the person for whom they cared. Associates of anxiety in people with aphasia after stroke were also investigated. Outcomes & Results: The BOA identified 49 people (44%) as having significant anxiety. Findings for the HADS-A = 46 (41%) were similar; however, for the GAD-7, the rate was substantially lower = 18 (16%). Anxiety after stroke had a modest but significant association with younger age (all measures) and with the Frenchay Aphasia Severity Test scores (BOA and HADS-A only). Conclusions: The prevalence of anxiety in people with aphasia after stroke is high and likely higher than in those with stroke with no aphasia when measured using a validated tool for this population. Risk factors for anxiety appear to be severity of aphasia and younger age. This finding should be tempered by the fact that this is a preliminary study in a relatively small sample consisting of those attending stroke groups and the use of caregiver assessments may overestimate the prevalence of mood disorder.
Golding, K, Kneebone, I & Fife-Schaw, C 2016, 'Self-help relaxation for post-stroke anxiety: a randomised, controlled pilot study.', Clinical Rehabilitation, vol. 30, no. 2, pp. 174-180.View/Download from: Publisher's site
To consider relaxation as a potential treatment for anxiety in stroke survivors living in the community, including feasibility and acceptability.Randomised two group design (intervention and control).All participants (n = 21) were stroke survivors living in the community who reported experiencing anxiety (Hospital Anxiety and Depression Scale - Anxiety Subscale ⩾ 6).The intervention group were asked to listen to a self-help autogenic relaxation CD, five times a week, for at least one month. Participants completed the Hospital Anxiety and Depression Scale at screening and then monthly for three months.At each assessment following screening, participants who received the relaxation training were significantly more likely to report reduced anxiety compared to those who had not received the training (Month 1 P = 0.002; Month 2 P < 0.001; Month 3 P = 0.001). After one month, seven of the intervention group (n = 10) had completed the relaxation training as directed and planned to continue using it. The intervention appeared practical to deliver and relatively inexpensive, with minimal adverse effects.Preliminary evidence suggests that autogenic relaxation training delivered in a self-help CD format is a feasible and acceptable intervention, and that anxiety is reduced in stroke survivors who received the intervention. Future studies should seek to recruit a larger and more heterogeneous sample of 70 participants.
Kneebone, II 2016, 'A Framework to Support Cognitive Behavior Therapy for Emotional Disorder After Stroke', Cognitive and Behavioral Practice, vol. 23, no. 1, pp. 99-109.View/Download from: Publisher's site
© 2015. Emotional disorders are common after stroke, but lacking is a complete framework to inform their treatment with cognitive behavioral therapy (CBT). This paper describes such a framework. It considers modification of CBT in light of cognitive and communication disability, and the involvement of carers in treatment, and presents brief case studies to illustrate the different elements of the framework. The development of a modified CBT should form the foundation for randomized controlled trials (RCT) to support treatment in this population. Service delivery issues include pathways to treatment, therapist confidence, and the overall positioning of CBT within stroke care.
Emotional difficulties are common after stroke and have an impact on rehabilitation outcome. It is a challenge to manage these problems effectively, particularly in times of resource stringency. One proposal for how to do this has arisen out of an approach to general mental health management: a system of 'stepped care'. Such a system directs intervention by considering level of need, thereby making the most efficient use of available resources. It is the purpose of this article to articulate a stepped psychological care approach for emotional problems after stroke. Method: Narrative review and elaboration of the model proposed by the Department of Health in England for the management of emotional problems after stroke. Results: A stepped care model for the management of emotional problems after stroke is presented in detail, including descriptions of specific interventions and guidance to inform the level of management. Conclusions: The stepped psychological care proposal for emotional problems after stroke requires evaluation but is potentially of use within comparable healthcare systems.Implications for RehabilitationEmotional problems are common after stroke and effect rehabilitation outcomes.A stepped care approach to these problems offers the ability to cater to all according to need.Greater specification of the services at each step can be outlined.While recommended, such an approach requires evaluation to prove its efficacy.
Kneebone, II, Fife-Schaw, C, Lincoln, NB & Harder, H 2016, 'A study of the validity and the reliability of the Geriatric Anxiety Inventory in screening for anxiety after stroke in older inpatients', Clinical Rehabilitation, vol. 30, no. 12, pp. 1220-1228.View/Download from: Publisher's site
© The Author(s) 2015.Objectives: To investigate the validity and reliability of the Geriatric Anxiety Inventory in screening for anxiety in older inpatients post-stroke. Design: Longitudinal. Subjects: A total of 81 inpatients with stroke aged 65 years or older were recruited at four centres in England. Main measures: At phase 1 the Geriatric Anxiety Inventory and the Hospital Anxiety and Depression Scale were administered and then the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 4th edition (phase 2). The Geriatric Anxiety Inventory was repeated a median of seven days later (phase 3). Results: Internal reliability of the Geriatric Anxiety Inventory was high (α = 0.95) and test-retest reliability acceptable (.,B = 0.53). Construct validity was evident relative to the Hospital Anxiety and Depression Scale - Anxiety subscale (.,B = 0.61). At a cut off of 6/7, sensitivity of the Geriatric Anxiety Inventory was 0.88, specificity 0.84, with respect to the Structured Clinical Interview anxiety diagnosis. Hospital Anxiety and Depressions Scale - Anxiety subscale sensitivity was 0.88, specificity 0.54 at the optimum cut off of 5/6. A comparison of the areas under the curve of the Receiver Operating Characteristics for the two instruments indicated that the area under the curve of the Geriatric Anxiety Inventory was significantly larger than that of the Hospital Anxiety and Depressions Scale - Anxiety subscale, supporting its superiority. Conclusions: The Geriatric Anxiety Inventory is an internally consistent, reliable (stable) and valid instrument with acceptable sensitivity and specificity to screen for anxiety in older inpatients with stroke.
Palmer, C, Kneebone, II, Strauss, C & Jones, A-M 2016, 'Using reliability of change analysis to evaluate post-acute neuro-rehabilitation', NEUROREHABILITATION, vol. 38, no. 1, pp. 93-98.View/Download from: Publisher's site
Worrall, L, Ryan, B, Hudson, K, Kneebone, I, Simmons-Mackie, N, Khan, A, Hoffmann, T, Power, E, Togher, L & Rose, M 2016, 'Reducing the psychosocial impact of aphasia on mood and quality of life in people with aphasia and the impact of caregiving in family members through the Aphasia Action Success Knowledge (Aphasia ASK) program: study protocol for a randomized controlled trial.', Trials, vol. 17, pp. 1-7.View/Download from: Publisher's site
People with aphasia and their family members are at high risk of experiencing post stroke depression. The impact of early interventions on mood and quality of life for people with aphasia is unknown.This study will determine whether an early intervention for both the person with aphasia after stroke and their family members leads to better mood and quality of life outcomes for people with aphasia, and less caregiver burden and better mental health for their family members. This is a multicenter, cluster-randomized controlled trial. Clusters, which are represented by Health Service Districts, will be randomized to the experimental intervention (Aphasia Action Success Knowledge Program) or an attention control (Secondary Stroke Prevention Information Program). People with aphasia and their family members will be blinded to the study design and treatment allocation (that is, will not know there are two arms to the study). Both arms of the study will receive usual care in addition to either the experimental or the attention control intervention. A total of 344 people with aphasia and their family members will be recruited. Considering a cluster size of 20, the required sample size can be achieved from 18 clusters. However, 20 clusters will be recruited to account for the potential of cluster attrition during the study. Primary outcome measures will be mood and quality of life of people with aphasia at 12 months post stroke. Secondary measures will be family member outcomes assessing the impact of caregiving and mental health, and self-reported stroke risk-related behaviors of people with aphasia.This is the first known program tailored for people with aphasia and their family members that aims to prevent depression in people with aphasia by providing intervention early after the stroke.This trial is registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) as ACTRN12614000979651 . Date registered: 11 September 2014.
Hughes, CC, Kneebone, II, Jones, F & Brady, B 2015, 'A theoretical and empirical review of psychological factors associated with falls-related psychological concerns in community-dwelling older people', INTERNATIONAL PSYCHOGERIATRICS, vol. 27, no. 7, pp. 1071-1087.View/Download from: Publisher's site
Kneebone, II, Guerrier, S, Dunmore, E, Jones, E & Fife-Schaw, C 2015, 'A Longitudinal Examination of the Hopelessness Theory of Depression in People Who Have Multiple Sclerosis', BEHAVIOURAL NEUROLOGY, vol. 2015.View/Download from: Publisher's site
Menlove, L, Crayton, E, Kneebone, I, Allen-Crooks, R, Otto, E & Harder, H 2015, 'Predictors of Anxiety after Stroke: A Systematic Review of Observational Studies', JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, vol. 24, no. 6, pp. 1107-1117.View/Download from: Publisher's site
Broomfield, NM, Kneebone, II & Laidlaw, K 2014, 'Neuropsychological (mood and cognition) consequences of stroke', Clinical Psychology Forum, vol. 2014, no. 264, pp. 15-20.
STROKE is the lead cause of disability in
United Kingdom (UK) adults, the third
lead cause of death, and a national and
international research priority. Direct costs to
the National Health Service (NHS) are £3 billion,
with indirect care costs of £2.4 billion.
Half of all stroke units in England have no
access to psychology services and in a recent
survey only two in ten stroke survivors considered
they had received the support they
needed to cope emotionally. There is much
service development work to do.
Neuropsychological (mood and cognition)
stroke consequences are prevalent, complex
and overlapping. This article guides on
assessment formulation and treatment of
Dorstyn, D, Roberts, R, Kneebone, I, Kennedy, P & Lieu, C 2014, 'Systematic review of leisure therapy and its effectiveness in managing functional outcomes in stroke rehabilitation.', Topics in Stroke Rehabilitation, vol. 21, no. 1, pp. 40-51.View/Download from: Publisher's site
BACKGROUND: Evidence suggests that the incorporation of leisure activities in adult stroke rehabilitation can contribute to improved physical, cognitive, and psychological outcomes. However, differences in study design and treatment delivery may affect these findings. Furthermore, the magnitude of therapeutic change associated with leisure therapy is unclear, with few quantitative reviews available. OBJECTIVE: To synthesize and evaluate the empirical evidence examining leisure therapy in stroke rehabilitation. METHODS: Eight independent studies (N = 615 participants) were identified from a comprehensive database search. Study quality was evaluated using the Oxford Levels of Evidence. Pre- and posttreatment data for participants who received leisure therapy, in comparison with peers who received standard care or no treatment, were evaluated by calculating Cohen's d effect sizes and 95% confidence intervals. RESULTS: No studies met the criteria for the highest level of methodological rigor, although all used randomization procedures. Leisure therapy contributed to significant short-term improvements in psychological outcomes, namely quality of life and mood (d range, 2.10 to 0.54), in addition to leisure-specific outcomes, including increased participation in and satisfaction with leisure activities (d range, 0.81 to 1.23). Longer term effects of treatment could not be determined, with one study providing data and reporting nonsignificant effects (d range, -0.07 to 0.17). CONCLUSIONS: There is some evidence that leisure therapy offers an opportunity to enhance short-term treatment gains in community-based stroke rehabilitation. Further controlled research is needed to establish its longer term effects and assist the development of evidence-based guidelines for this treatment.
Kneebone, I, Walker-Samuel, N, Swanston, J & Otto, E 2014, 'Relaxation training after stroke: potential to reduce anxiety.', Disability and Rehabilitation, vol. 36, no. 9, pp. 771-774.View/Download from: Publisher's site
OBJECTIVE: To consider the feasibility of setting up a relaxation group to treat symptoms of post stroke anxiety in an in-patient post-acute setting; and to explore the effectiveness of relaxation training in reducing self-reported tension. METHOD: A relaxation group protocol was developed in consultation with a multidisciplinary team and a user group. Over a period of 24 months, 55 stroke patients attended group autogenic relaxation training on a rehabilitation ward. Attendance ranged between one and eleven sessions. Self-reported tension was assessed pre and post relaxation training using the Tension Rating Circles (TRCs). RESULTS: The TRCs identified a significant reduction in self-reported tension from pre to post training, irrespective of the number of sessions attended; z = -3.656, p < 0.001, r = -0.67, for those who attended multiple sessions, z = -2.758, p < 0.01, r = -0.6 for those who attended a single session. DISCUSSION: The routine use of relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation shows potential. Self-reported tension decreased after attendance at relaxation training. The TRCs proved acceptable to group members, but should be validated against standard anxiety measures. Further exploration of the application of relaxation techniques in clinical practice is desirable. Implications for Rehabilitation Anxiety is prevalent after stroke and likely affects rehabilitation outcomes. Relaxation training is a well proven treatment for anxiety in the non-stroke population. A significant within session reduction in tension, a hallmark symptom of anxiety, was evidenced via group relaxation training delivered in a post-acute, in-patient stroke unit setting. Relaxation training a shows promise as a treatment for anxiety after stroke.
Linley-Adams, B, Morris, R & Kneebone, I 2014, 'The Behavioural Outcomes of Anxiety scale (BOA): a preliminary validation in stroke survivors.', The British journal of clinical psychology, vol. 53, no. 4, pp. 451-467.View/Download from: Publisher's site
OBJECTIVES: To determine the psychometric properties of an observational scale of anxiety. DESIGN: A cross-sectional and longitudinal survey with stroke survivor-carer dyads. METHODS: Eighty-nine dyads recruited in community stroke groups completed: a demographic questionnaire; the Behavioural Outcomes of Anxiety scale (BOA), survivor-rated (survivor BOA) and carer-rated (carer BOA) versions; the anxiety scale of the Hospital Anxiety and Depression Scales (HADS-A), also in carer and survivor versions. Twenty-seven survivors and carers repeated the BOA after 1 week. RESULTS: Correlations between the carer BOA and the survivor HADS-A (r = .55, p < .001) and the survivor BOA (r = .73, p < .001) demonstrated construct validity. Cronbach's alpha for the carer BOA was .81; item statistics did not identify any items for exclusion. The test-retest coefficient at 1 week was 0.83. Receiver operating characteristic analysis against the survivor HADS-A and BOA produced areas under the curve of 0.75 and 0.88, respectively. At a cut-off score of 13/14 sensitivity and specificity against the HADS-A were 0.77 and 0.58, respectively, and 0.86 and 0.68 against the survivor BOA. The impact of stroke on memory was associated with elevated anxiety. Scores for both BOA versions were independent of demographic variables. CONCLUSIONS: The carer BOA has acceptable psychometric properties and is independent of survivor demographic variables such as age. It identifies self-reported cases with acceptable sensitivity and specificity. It has potential for use with persons unable to self-report anxiety. Further validation is recommended, but its continuing use is supported.
Martin, KJ, Lincoln, N & Das Nair, R 2014, 'Group-based memory rehabilitation for people with multiple sclerosis: Subgroup analysis of the remind trial', International Journal of Therapy and Rehabilitation, vol. 21, no. 12, pp. 590-596.View/Download from: Publisher's site
© 2014 MA Healthcare Ltd. Background/Aim: Memory problems are frequently reported in people with multiple sclerosis (MS). These can be debilitating and affect individuals and their families. This subgroup analysis focused on the effectiveness of memory rehabilitation in patients with MS.Methods: Data were extracted from a single-blind randomised controlled trial, the ReMiND trial, which also included participants with traumatic brain injury and stroke. Participants were randomly allocated to compensation or restitution treatment programmes, or a self-help control. The programmes were manual-based and comprised two individual sessions and ten group sessions. Outcome measures included assessments of memory, mood and activities of daily living. A total of 39 patients with MS participated in this study (ten males (26%), 29 females (74%); mean±SD age: 48.3±10.8 years).Results: Comparison of groups showed no significant effect of treatment on memory, but there were significant differences between compensation and restitution on self-report symptoms of emotional distress at both five-(p=0.04) and seven-month (p=0.05) follow-up sessions. The compensation group showed less distress than the restitution group.Conclusions: Individuals with MS who received compensation memory rehabilitation reported significantly less emotional distress than those who received restitution. Further research is needed to explore why self-reported memory problems did not differ between groups.
Hull, SL, Kneebone, II & Farquharson, L 2013, 'Anxiety, Depression, and Fall-Related Psychological Concerns in Community-Dwelling Older People', AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY, vol. 21, no. 12, pp. 1287-1291.View/Download from: Publisher's site
Kneebone, I, Stone, N, Robertson, S & Walker-Samuel, N 2013, 'Screening for Depression After Stroke: Occupational Therapists' Performance to Protocols', OCCUPATIONAL THERAPY IN MENTAL HEALTH, vol. 29, no. 2, pp. 106-113.View/Download from: Publisher's site
Kneebone, II & Jeffries, FW 2013, 'Treating anxiety after stroke using cognitive-behaviour therapy: Two cases', NEUROPSYCHOLOGICAL REHABILITATION, vol. 23, no. 6, pp. 798-810.View/Download from: Publisher's site
McGurk, R & Kneebone, II 2013, 'The problems faced by informal carers to people with aphasia after stroke: A literature review', APHASIOLOGY, vol. 27, no. 7, pp. 765-783.View/Download from: Publisher's site
Phillips, J, Kneebone, II & Taverner, B 2013, 'Breaking bad news in stroke rehabilitation: a consultation with a community stroke team', DISABILITY AND REHABILITATION, vol. 35, no. 8, pp. 694-701.View/Download from: Publisher's site
Kneebone, II, Hull, SL, McGurk, R & Cropley, M 2012, 'Reliability and Validity of the Neurorehabilitation Experience Questionnaire for Inpatients', NEUROREHABILITATION AND NEURAL REPAIR, vol. 26, no. 7, pp. 834-841.View/Download from: Publisher's site
Kneebone, II, Neffgen, LM & Pettyfer, SL 2012, 'Screening for depression and anxiety after stroke: developing protocols for use in the community', DISABILITY AND REHABILITATION, vol. 34, no. 13, pp. 1114-1120.View/Download from: Publisher's site
McGurk, R, Kneebone, II & ten Cate, IMP 2011, '"Sometimes we get it wrong but we keep on trying": A cross-sectional study of coping with communication problems by informal carers of stroke survivors with aphasia', APHASIOLOGY, vol. 25, no. 12, pp. 1507-1522.View/Download from: Publisher's site
Wain, H, Kneebone, II & Cropley, M 2011, 'Attributional Intervention for Depression in Two People with Multiple Sclerosis (MS): Single Case Design', BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY, vol. 39, no. 1, pp. 115-121.View/Download from: Publisher's site
Kneebone, I, Baker, J & O'Malley, H 2010, 'Screening for depression after stroke: Developing protocols for the occupational therapist', British Journal of Occupational Therapy, vol. 73, no. 2, pp. 71-76.View/Download from: Publisher's site
Depression after stroke is common and can have a substantial effect on rehabilitation outcome. Despite this, the routine screening that has been recommended is only taking place around half the time. Occupational therapists have training that well positions them to provide screening. In a local stroke unit, the psychology and occupational therapy departments worked together, considering relevant research, clinical considerations (such as identifying suicidal ideas) and practical issues (such as ease of administration and patient compliance) to determine screening protocols that could be enacted by occupational therapists. Two protocols were developed, one for people under 65 years of age and one for people aged 65 years or older. © The College of Occupational Therapists Ltd.
Kneebone, II, Hurn, JS, Raisbeck, E, Cropley, M, Khoshnaw, H & Milton, JE 2010, 'The validity of goal achievement as an outcome measure in physical rehabilitation day hospitals for older people', International Journal of Disability, Development and Education, vol. 57, no. 2, pp. 145-153.View/Download from: Publisher's site
Physical rehabilitation day hospitals are widely used community-based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored goals be used to assess outcomes. This study considered whether such goal achievement demonstrated validity with respect to a standardised measure. The association between goal achievement and change in Nottingham Health Profile-Part 1 (NHP-1) scores was considered for 102 people attending four physical rehabilitation day hospitals. The predicted significant positive relationship between the percentage of goals achieved by participants and NHP-1 scores was not found. This remained evident when functional goals were considered separately to medical goals. Further subsidiary analyses identified a complex relationship between goal achievement and NHP-1 change scores. For those with higher change scores, there was a significant negative association between NHP-1 change and goal achievement; while for those with lower (or negative) change scores, there was a significant positive association. A curve estimate regression confirmed a highly significant quadratic (curvilinear) relationship. Possible reasons for this finding might include the timing and nature of the goals set, the potential complication of some participants having cognitive impairment, as well as the use of the NHP-1 as a comparison measure. At this time it is recommended that goal achievement only be used alongside other measures of day hospital outcome. © 2010 Taylor & Francis.
Gratton, S & Kneebone, I 2009, 'Assessing the psychological needs of patients on a GP-managed, step up, step down ward in a community hospital', Clinical Psychology Forum, no. 199, pp. 33-37.
Assessment established high levels of anxiety, depression, cognitive impairment and low confidence in activities of daily living (ADLs) in a service mainly utilised by older people. Staff identified the need for support in managing challenging behavior and assessing decision making capacity.
Kneebone, II & Hull, SL 2009, 'Cognitive behaviour therapy for post-traumatic stress symptoms in the context of hydrocephalus: A single case', Neuropsychological Rehabilitation, vol. 19, no. 1, pp. 86-97.View/Download from: Publisher's site
There is limited information about anxiety disorders occurring in the context of the challenging condition of hydrocephalus. This paper describes the treatment, via trauma-focused cognitive behaviour therapy (TFCBT), of post-traumatic stress symptoms arising on account of hydrocephalus in a 23-year-old man. Specific components of the intervention included exposure, cognitive disputation, and relaxation training. The 20-session intervention appeared effective with decreases in anxiety (on the Hospital Anxiety and Depression Scale) and event impact (on the Impact of Events Scale) from clinical to sub-clinical levels. The main contributor to change appeared to be the exposure element of the treatment. The benefits of the intervention were maintained at one-, three-, and six-month follow-up. © 2008 Psychology Press.
Healey, AK, Kneebone, II, Carroll, M & Anderson, SJ 2008, 'A preliminary investigation of the reliability and validity of the Brief Assessment Schedule Depression Cards and the Beck Depression Inventory-Fast Screen to screen for depression in older stroke survivors', International Journal of Geriatric Psychiatry, vol. 23, no. 5, pp. 531-536.View/Download from: Publisher's site
Objective: To conduct an initial assessment of the reliability and validity of the Brief Assessment Schedule Depression Cards (BASDEC) and the Beck Depression Inventory-Fast Screen (BDI-FS) to screen for depression in older stroke survivors. Methods: Participants from four inpatient rehabilitation units completed the BASDEC and the BDI-FS together with the Hospital Anxiety and Depression Scale (HADS) for comparison. The Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID) was then completed with all participants to ascertain a criterion depression diagnosis. The BASDEC and BDI-FS were subsequently completed for a second time. Results: Forty-nine stroke survivors (M = 78.80, SD = 6.79 years) were included. The BASDEC and BDI-FS demonstrated acceptable internal consistency and test-retest reliability. The BASDEC (cut-off ≥7) resulted in a sensitivity of 1.0 and specificity of 0.95 for detecting major depression whereas the BDI-FS (cut-off ≥4) had a sensitivity of 0.71 and specificity of 0.74. When participants with minor depression were included in analyses, sensitivity lowered to 0.69 (specificity = 0.97) for the BASDEC and 0.62 (specificity = 0.78) for the BDI-FS. Conclusions: The BASDEC and BDI-FS were found to have acceptable reliability. The BASDEC demonstrated some advantage in criterion validity over the BDI-FS at the examined cut-offs. Copyright © 2007 John Wiley & Sons, Ltd.
Wain, HR, Kneebone, II & Billings, J 2008, 'Patient Experience of Neurologic Rehabilitation: A Qualitative Investigation', Archives of Physical Medicine and Rehabilitation, vol. 89, no. 7, pp. 1366-1371.View/Download from: Publisher's site
Wain HR, Kneebone II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Objective: To understand the experiences of patients who had undergone neurologic rehabilitation. Design: An interpretative phenomenological analysis of semistructured interviews. Setting: Neurologic rehabilitation unit. Participants: A purposive convenience sample of 8 past patients. Interventions: Not applicable. Main Outcome Measure: Participants' reports of neurologic rehabilitation obtained via in-depth semistructured interviews. Results: Participants predominantly described positive experiences of rehabilitation. The superordinate theme person-centeredness was developed, which included 4 key themes: ownership, personal value, holistic approach, and therapeutic atmosphere. These reflected patients' perceptions of choice and control and feelings of personal respect and self-worth. These appeared to be promoted through the multidimensional benefits of the unit (eg, the understanding and friendly nature of staff and other patients, physical improvements, psychologic gains) as well as the unit's informal, relaxed environment. When present, these factors created a positive rehabilitation experience; when absent, a negative experience. Conclusions: These findings support those from other literature, which has identified person-centered care as a core element of successful rehabilitation and linked its absence to dissatisfaction with health care. This research has increased our understanding of patients' experience of neurologic rehabilitation, and could inform the development of a patient-centered assessment instrument for neurologic rehabilitation. © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.
Hull, S, Hartigan, N & Kneebone, I 2007, 'Is bingo a psychological intervention? Developing a support group for stroke survivors and carers', Clinical Psychology Forum, no. 180, pp. 27-29.
This article describes the development of a stroke support group for stroke survivors and carers based on user consultation.
Palmer, S & Kneebone, I 2007, 'An investigation of day hospital outcome measures', International Journal of Therapy and Rehabilitation, vol. 14, no. 8, pp. 372-377.View/Download from: Publisher's site
© 2007, MA Healthcare Ltd. All rights reserved. It is important to evaluate services in order to establish best practice, allocate limited resources, and strive towards clinical excellence. This study explored outcome measures for medical rehabilitation day hospitals for older people, where a broad range of needs are addressed. The aim was to identify alternatives to the current measure in use across four day hospitals, as it was considered by staff that this measure was not consistently reflecting observed and clinically significant changes.Consultation with day hospital staff clarified the outcomes they hoped to capture in a measure, and their concerns about current measures. Literature review identified potential alternatives, one of which was piloted; the CANE-S (Camberwell Assessment of Need-Short Form). The CANE-S was selected for pilot owing to it being specifically designed for use within services for older people, with established reliability and validity.Pilot results indicated that the CANE-S was not a suitable measure for all of the four day hospitals because it did not offer the brevity and distinctiveness required by all. Recommendations for further evaluation are discussed.
Depression is common among people with multiple sclerosis (MS). Research suggests that treatments for depression are effective in this population, though few patients appear to access these treatments. Our objectives were to consider whether persons with MS and significant depressive symptoms, prompted to seek treatment by letter, did so, what professionals they consulted, and the benefits of any treatment obtained. A total of 495 individuals with MS (401 female; 94 male), aged 22-65 years (mean: 45.8 years), were surveyed in three phases at yearly intervals. Significant depressive symptoms were found over the three phases (50-60.2%). Despite a high prevalence of depressive symptoms, few participants sought treatment, even though prompted to do so. Where treatment was sought, general practitioners remained the principal group consulted. Contrary to previous reports of the efficacy of treatment in clinical trials, no strong supportfor this was found. Future research needs to consider why the majority of people with MS do not seek treatment for depression, and why interventions, which are not clinical trials, seem to lack effectiveness. © 2007 SAGE Publications.
Background: Goal achievement has been considered to be an important measure of outcome by clinicians working with patients in physical and neurological rehabilitation settings. This systematic review was undertaken to examine the reliability, validity and sensitivity of goal setting and goal attainment scaling approaches when used with working age and older people. Aims and objectives: To review the reliability, validity and sensitivity of both goal setting and goal attainment scaling when employed as an outcome measure within a physical and neurological working age and older person rehabilitation environment, by examining the research literature covering the 36 years since goal-setting theory was proposed. Methods: Data sources included a computer-aided literature search of published studies examining the reliability, validity and sensitivity of goal setting/goal attainment scaling, with further references sourced from articles obtained through this process. Main findings: There is strong evidence for the reliability, validity and sensitivity of goal attainment scaling. Empirical support was found for the validity of goal setting but research demonstrating its reliability and sensitivity is limited. Conclusions: Goal attainment scaling appears to be a sound measure for use in physical rehabilitation settings with working age and older people. Further work needs to be carried out with goal setting to establish its reliability and sensitivity as a measurement tool. © 2006 SAGE Publications.
Kneebone, II & Al-Daftary, S 2006, 'Flooding treatment of phobia to having her feet touched by physiotherapists, in a young woman with Down's syndrome and a traumatic brain injury', Neuropsychological Rehabilitation, vol. 16, no. 2, pp. 230-236.View/Download from: Publisher's site
This case study describes the treatment of a 32-year-old woman with Down's syndrome and a recent head injury, for phobia to treatment of her feet by physiotherapists. The phobia had the potential to severely limit rehabilitation progress in terms of the client regaining the ability to stand, assist with transfers (including to and from a car), and walk. A single session, in vivo, flooding intervention was used. The treatment resulted in a substantial change in tolerance of physiotherapists' touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident. Benefits were maintained at multiple follow-ups. The results of the case study extend the evidence for the utility of such behavioural interventions to people with complex disability and unusual phobias in neurological rehabilitation systems. © 2006 Psychology Press Ltd.
Kneebone, I 2005, 'How to be a scientist-practitioner ', Clinical Psychology, no. 48, p. 2.
Guerrier, S & Kneebone, I 2004, 'Pilot evaluation of an inpatient neurological rehabilitation programme', International Journal of Therapy and Rehabilitation, vol. 11, no. 2, pp. 51-55.View/Download from: Publisher's site
© 2004, MA Healthcare Limited. All rights reserved. Evaluation systems for rehabilitation services are required so that financial providers, service users and those involved in service delivery can assess their efficacy. This article reports on a pilot study to assess a community hospital inpatient rehabilitation unit service, in terms of client change from admission to discharge, using routinely administered measures: the Functional Assessment Measure and the Northwick Park Dependency Scale. Cases considered were acute admissions, predominantly clients with neurological diagnoses. The measurements taken demonstrated a positive change in all areas assessed for the majority of clients. A minority of clients showed no change. It is recommended that future evaluations incorporate goal-achievement measures, in order to assess whether the unit's services have helped clients to reach their specific goals, and consider clients' views of the service. It is also suggested that the financial impact of the service should receive attention and that variation coding might help to identify the reasons why some clients might not benefit from the programme.
Kneebone, II & Dunmore, E 2004, 'Attributional style and symptoms of depression in persons with multiple sclerosis', International Journal of Behavioral Medicine, vol. 11, no. 2, pp. 110-115.View/Download from: Publisher's site
This study was designed to assess hypotheses derived from the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), specifically that negative attributional style would be associated with depressive symptoms and that negative life events would interact with negative attributional style to explain depressive symptoms in a sample of persons with multiple sclerosis (MS). The research was cross sectional in design. Data was collected via survey from 495 persons with MS. Attributional style was positively associated with depressive symptoms across the whole sample. The proposition that negative life events would interact with negative attributional style to explain depressive symptoms was also supported, although only for global attributional style. Longitudinal studies would assist in determining the causal direction proposed by the hopelessness theory of depression in this population. It is also appropriate that clinicians consider attributional style in persons with MS whom they are treating for depression.
Purpose. To critically review the research based on Lazarus and Folkman's (1984) stress and coping model, in respect to the coping of those caring for persons with dementia in the community, in an attempt to establish its implications for interventions aimed at improving caregiver adjustment. Method. Published material on the coping of caregivers of persons with dementia was identified through computerized literature searches (Med-line, Psych-Info) to December 1999, employing search terms including Alzheimer's disease, dementia, caregiving, caregiver burden, adaptation, psychological, coping, and stress. Studies were chosen to be considered in detail, based on the reviewer's opinion that they would contribute to an understanding of the current state of the research and its clinical implications. This material was then critically reviewed against the tenets of Lazarus and Folkman's (1984) model. Results. Sixteen studies were selected to be included in the review, 12 cross-sectional and 4 longitudinal. Seven of the studies did not incorporate coping measures specific to caregiving and/or assess coping in respect of specific caregiver problems. Nine of the studies did do this. The research suggests that a general tendency towards problem-solving and acceptance styles of coping is likely to be advantageous to caregivers of people with dementia. Conclusions. Despite this finding, it is concluded that the ability of the research to inform the clinician is severely limited. It is proposed that while longitudinal studies considered specific caregiver problems which incorporate coping measures specific to the caregiving task may improve understanding, a substantial revision of methodology and perspective may be required to produce findings that are likely to influence practice.
Kneebone, II, Dunmore, EC & Evans, E 2003, 'Symptoms of depression in older adults with multiple sclerosis (MS): Comparison with a matched sample of younger adults', Aging and Mental Health, vol. 7, no. 3, pp. 182-185.View/Download from: Publisher's site
The study considered for the first time depression in older adults with multiple sclerosis (MS). Depression symptom scores of 27 persons aged over 65 years who were part of a large study of persons with MS (n = 529), were compared with those of a matched sample of younger adults from the same study. The association between cognitive (attitudinal) variables known to explain significant variance in depressive symptoms in younger adults with MS was then considered in the older adult sample. Consistent with findings from studies with general community samples, older adults with MS reported significantly fewer depressive symptoms than younger adults with MS. The relationship between cognitive variables and depressive symptoms found previously in younger adults was also evident for the older adults. Multiple sclerosis related helplessness was found to be significantly higher in older as opposed to younger adults with MS, the opposite of what was predicted given the differences between the groups in depression scores. Differences in the cognitive variables do not appear to explain the differences between older and younger adults with MS in terms of depressive symptoms. This finding offers support for the view that a decrease in emotional responsiveness may explain differences in depressive symptoms between younger and older adults with MS, rather than this being the result of differences in emotional control exerted via cognitive means.
Childs, L & Kneebone, II 2002, 'Falls, fear of falling and psychological management', International Journal of Therapy and Rehabilitation, vol. 9, no. 6, pp. 225-231.View/Download from: Publisher's site
© MA Healthcare Limited 2014. Many people fall and/or have a fear of falling. This paper outlines clinical approaches to working with adults, particularly older people, in this category. It proposes a modified model for intervention for falls and fear of falling, and provides guidelines for how to intervene in falls prevention groups in which some participants may not have a fear of falling.
Kneebone, I 2002, 'Clinical research ', Psychologist, vol. 15, no. 8, p. 395.
Purpose. To evaluate existing research literature on psychological interventions to manage post-stroke depression (PSD). Method. First, the particular nature of post-stroke depression (PSD) was established. Then, relevant published material was identified through computerized literature searches (to May 1999) and via the first author's clinical experience in the area. This material was critically reviewed against recommended standards for the empirical validation of treatment effectiveness. Results. Methodological limitations in existing research prevent a conclusion as any one psychological intervention has empirical support for its effectiveness. However, cognitive behaviour therapy in particular was identified as worthy of further investigation. Conclusions. It is recommended that future research investigates treatments for PSD appropriate for those with cognitive impairment and communication difficulties, younger versus older stroke victims and those in institutional settings. Studies should also consider the necessity of specialist assessment strategies and allow for possible subtypes of PSD for which psychological treatments might be differentially effective.
Kneebone, I 1999, 'Gloom in the sun? ', Clinical Psychology Forum, no. 124, p. 3.
© 1999, MA Healthcare Ltd. All rights reserved. Depression is common after stroke and can have a significant impact on rehabilitation outcome. Non-mental health therapists can play an important role in reducing the effects of depression. This article provides guidelines on assessment and management for the non-specialist, based on relevant psychological models, empirical investigation and clinical experience.
Kneebone, I & Harrop, A 1996, 'Patient confidence in return home: Development of a measurement instrument', Australian Occupational Therapy Journal, vol. 43, no. 1, pp. 19-23.
The paper reviews the issues relevant to the training of Australian clinical psychologists to work with older adults. On the basis of the review, current levels of teaching in clinical masters programs are judged to be inadequate. Possible reasons for this state of affairs are canvassed and suggestions made to address the deficiency. A major recommendation is that courses on older adults should be considered a core area of study for the future; teaching about ageing is the new challenge for Australian clinical psychology.
The present study tested the hypothesis that involving the partners of headache sufferers in a group cognitive-behavioural stress-coping intervention for chronic headaches would enhance treatment outcome. A treatment program in which partners were involved (PI) was compared with a standard treatment program in which partners were not included (NPI) and a no-treatment control condition (NTC). The NPI condition was effective compared to the NTC condition, but there was less evidence that the PI condition was effective. No significant differences were found between the PI and NPI conditions at posttreatment or follow-up. These results are considered in terms of the usefulness of involving partners in group headache-treatment and the manner of their involvement. In addition, the possibility that partner involvement may actually detract from treatment effectiveness is discussed in terms of its impact on motivation and personal responsibility for change. © 1992, Cambridge University Press. All rights reserved.
Clunne, SJ, Ryan, BJ, Hill, AJ, Brandenburg, C & Kneebone, I, 'Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review (Preprint)'.View/Download from: Publisher's site
Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia.
The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia.
A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia.
A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any...
Kneebone, I & Smith, E 2016, 'Assessment and psychological interventions for depression comorbid with cardiovascular disease' in Cardiovascular Diseases and Depression Treatment and Prevention in Psychocardiology, Springer, Germany, pp. 351-364.View/Download from: Publisher's site
This comprehensive book outlines the complex and bidirectional relationship between various types of depression and cerebro- and cardiovascular diseases.
Background and Aims: Pain is a universal phenomenon, but it is also inherently private and subjective – there is no objective test for its existence. Sufferers rely primarily on language to render their pain public, to describe and qualify their pain experience. It has been suggested that pain language may thus provide the best tool to assess and measure pain (1). The McGill Pain Questionnaire (MPQ; 2) paved the way for incorporating language into pain research. However, more recent research has gone further and explored aspects of pain language such as metaphors (3) and linguistic and grammatical patterns (4). The objective of this study was to explore the ways in which those with chronic pain use language to speak about and describe their pain experience.
Methods: Three focus groups were conducted with a total of 16 participants (age range = 22 – 74 years, mean age = 46.6 years) who were attending an outpatient chronic pain management program (average pain duration = 6.6 years). Participants were asked to describe aspects of their pain experience such as how their pain feels and how pain affects their lives. These focus groups were audiotaped, transcribed verbatim, and analysed via thematic analysis.
Results: The key themes and subthemes identified were: Isolation (Invisibility of Pain, Difficulty of Pain Expression, Suffering Alone, Separation from Others, Shame), Physical Sensations of Pain (Size and Weight, Strange Sensations, Temperature, Piercing, Aching, Making Pain Relatable), Pain Personified (As an Adversary, As External to Self), Pain as Overwhelming (Unrelenting Nature of Pain, Loss and Ruin), and Coping with Pain (Holding on and Moving Forward, Finding Positives). Across themes, participants utilised metaphorical language and spoke of their pain in an externalizing fashion, personifying it as an adversary and as outside of their self. The physical, sensory aspects of pain were subsumed by a personal narrative of pain and its effect on the sufferer...
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