Quality of Life After Stroke and Aphasia: Stroke Survivors’ and Spouses’ Perspectives. Emma Jane Ford August 2014 Thesis submitted in partial fulfilment of the requirements of Staffordshire and Keele Universities for the jointly awarded degree of Doctorate in Clinical Psychology

Abstract A thesis was completed as part of the author’s Doctorate in Clinical Psychology. Having previously worked in research teams investigating the impact of stroke and aphasia upon individuals and spending two years working therapeutically with people with low mood and post-stroke aphasia, a passion for aiding this client group to achieve a good quality of life was developed. Furthermore, completing this work highlighted the paucity of good quality research including this population, despite having learned from personal experience that it was feasible to do so, given that the appropriate adaptations and considerations were made to accommodate communication difficulties. Subsequently, a need for further research regarding quality of life post-stroke and aphasia was acknowledged. An initial review of the existing literature regarding quality of life post-stroke and aphasia was conducted, to determine what was already known, and what remained to be found. The studies identified for review were subjected to evaluation. The outcome of the review suggested that quality of life was a complex, multifaceted concept, impacted by a number of factors, but that it was not possible to determine for certain what factors were important in achieving a good quality of life, primarily due to the methodological limitations of the studies forming the evidence base. Chiefly, the data collection methods used were seemingly inappropriate for people with communication difficulties. Thus it was proposed that the more aphasia friendly, Q methodology approach was utilised to gather the views of people with post-stroke aphasia about what factors were important to achieve a good quality of life. Six aphasic stroke survivors and five spouses completed a Q sort task, in which they were required to rank a number of statements depicting different factors related to quality of life, in terms of personal importance. Spouses did this task from the perspective of the stroke survivor. Ultimately, two factors were identified: ‘returning to the pre-stroke self’ which represented the stroke survivors of working age, and ‘life beyond stroke, what’s important now?’ which reflected the views of the older, retired participants. The two factors were considered in relation to Erikson’s (1968) psychosocial stages of development model and in terms of stroke recovery models (Holbrook, Quality of Life After Stroke and Aphasia 1982; Kirkevold, 2002). Significant, strong and positive pair-wise correlations between the Q sort outcomes of the stroke survivors’ and their respective spouses’ suggested that spouses could reliably report the stroke survivors’ views regarding quality of life. The importance of the findings in relation to the work of a clinical psychologist was subsequently considered