Stepped psychological care in post-stroke aphasia: Feasibility protocol to evaluate the co- designed “Kalmer” online relaxation intervention

Background : People with stroke are at greater risk of experiencing depression and anxiety. The prevalence of these difficulties in those with the communication disorder aphasia after stroke is even higher. Relaxation training is recommended as part of stepped care for mental health difficulties for those with stroke. The potential impact of the online co-designed Kalmer relaxation intervention and thus its place within stepped care for people with post stroke aphasia is unknown. Methods/design: This study will determine the feasibility and potential efficacy of the Kalmer relaxation intervention on people with post stroke aphasia and who met the cut off on screening instruments for anxiety and/or depression. Primary outcomes will be assessed using two observer rated scales; the Behavioural Outcomes of Anxiety (BOA) and the Stroke Aphasia Depression Questionnaire - 10 item (SADQ-10). A case series design will utilise a multiple baseline procedure. Up to 12 participants will be recruited. Consent procedures modified for those with aphasia will be employed. The Reliable Change Index will be used to determine the interventions impact on anxiety and depressive symptoms. Participants will be followed-up at 3- and 6-month intervals. Discussion : This study represents the first known evaluation of the online co-designed Kalmer relaxation intervention program. The results will have implications for recommending its inclusion as a recommended treatment at Step 2 of mental health care for people with aphasia after stroke.