The development and validation of mood scales suitable for use with stroke patients with aphasia

Barrows, Paul David (2016) The development and validation of mood scales suitable for use with stroke patients with aphasia. PhD thesis, University of Nottingham.

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About a third of stroke survivors have some degree of depression. Depression has a significant impact on recovery after stroke, and identification is important so it can be treated. A common symptom of stroke is aphasia, where comprehension or expression of language is significantly impaired. Communication problems following stroke have been shown to be a major predictor of depression after stroke, yet these problems often make assessment of mood using conventional, language-based measures difficult or impossible.

Though some non-verbal, self report mood measures exist, their utility is limited and evidence base lacking. The aim of this study was to design, create and validate a non-verbal mood assessment instrument suitable both as a general outcome measure and as a screening measure for depression in stroke patients with aphasia. A series of four judgement experiments were conducted based on 22 photographic sittings, and a series of scales were developed. The resulting prototype instrument Dynamic Visual Analogue Mood Scales (D-VAMS) is a tablet/computer-based instrument consisting of seven bipolar scales comprising images of human faces whose expressions are modulated by sliders.

The instrument was then validated in a sample of 46 stroke survivors recruited from online, from stroke clubs and via NHS rehabilitation services. Good construct validity was demonstrated by high correlations between word and face versions of the seven D-VAMS scales (r=.73 to r=.79), however discriminant validity was poor, with substantial cross-correlations between scores for all of the face scales (r=.58 to r=.88). Internal consistency of D-VAMS was very high, with a Cronbach’s α of 0.95. A Principal Components Analysis revealed one factor accounting for 80% of the variance, corresponding to pleasantness or unpleasantness of mood.

Excellent criterion validity was evidenced by strong correlations between D-VAMS and Hospital Anxiety and Depression Scale (HADS) depression subscale (HADS-D) scores (r=.73). Excellent test-retest reliability (r=.89), and high sensitivity and specificity against HADS-D cut-offs of 4–7 were also found.

The findings suggest that the D-VAMS is a valid, brief measure of pleasantness of mood in a range of 0–100 which is suitable for use as a general outcome measure for stroke survivors with aphasia, and which may serve as an indirect, simplified measure of depression. Though D-VAMS may also be useful as a screening measure for depression following stroke, further validation is needed to examine how it performs in people during the acute stage after stroke. Some supervision may be required for people unfamiliar with using a tablet or PC interface.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Thomas, S.
Lincoln, N.B.
Keywords: Stroke, Aphasia, Mood, Depression, Nonverbal assessment
Subjects: W Medicine and related subjects (NLM Classification) > WL Nervous system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 37568
Depositing User: Barrows, Paul
Date Deposited: 22 Feb 2017 15:37
Last Modified: 21 Oct 2017 02:16

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