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Title: Validation of behavioural outcomes of anxiety (BOA) questionnaire in stroke survivors with aphasia
Author: Eccles, Alicia
ISNI:       0000 0004 5351 526X
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2015
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Aims: Anxiety disorders and aphasia are common following stroke. This study investigated the psychometric properties of the Behavioural Outcomes of Anxiety scale (BOA) in a sample of aphasic stroke survivors. The BOA relies upon the observations of a carer to rate the anxiety of the stroke survivor. The Generalised Anxiety Disorder-7 measure (GAD-7) is a brief screen for general anxiety which has not been investigated in stroke. A secondary aim of this study was to evaluate the performance of an observational version of the GAD-7 for aphasic stroke survivors. Design: Cross-sectional questionnaires, with repeated measures and a relaxation intervention for a subsample. Correlational and ROC analysis to assess psychometric properties, repeated measures MANOVA to assess the outcome of the intervention. Method: One hundred and eleven stroke survivor-carer dyads were recruited through voluntary sector organisations. All survivors completed a visual self-report anxiety screen, the Tension Rating Circles (TRCs), and the Frenchay Aphasia Severity Test (FAST). Carers completed the BOA and adapted versions of the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and GAD-7. A sub-group of 29 survivor-carer dyads repeated the measures two weeks later to assess test-retest reliability. Within this sub-group, stroke survivors were randomly allocated to a relaxation training or control group. Results: 41.4% of these aphasic stroke survivors were identified as anxious which is higher than prevalence rates in general stroke samples. The BOA and the GAD-7 correlated significantly with each other and with all the other measures of anxiety. When using the HADS-A (≥7) as a criterion standard against the BOA, the area under the ROC curve (AUC) was 0.90 (excellent range of accuracy). A cut-off score on the BOA >16 achieved recommended levels of sensitivity (0.85) and specificity (0.85). For the GAD-7, using the same criterion standard, the AUC (0.94) also fell within the excellent range of accuracy, and was significantly greater than an AUC of 0.50. Optimal cut-off for identifying anxiety was a score of >4 (sensitivity: 0.91, specificity: 0.83). Significantly greater reductions in the BOA scores occurred in survivors who completed relaxation training than in the controls, providing evidence of construct validity. The BOA and the GAD-7 both showed good test-retest reliability of 0.91 and 0.67 respectively. Feedback from carers revealed that the BOA was easy and quick to use and prompted further reflection on the emotional status of the survivors. Conclusions: The carer-completed BOA appears to be a valid and reliable screen for anxiety in stroke survivors with aphasia. Preliminary support for the validity of the GAD-7 is provided and further studies are warranted. Clinical and theoretical implications of the study findings are discussed and recommendations for future research are outlined.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available