Gloucestershire Evidence & Research Repository

Background: How do practitioners in service settings respond to communication support needs of people with intellectual disabilities? Conversation Analysis (CA) uses recordings of everyday encounters to understand the challenges practitioners face. Method: Following specialist guidance on systematically reviewing CA research, we reviewed 65 CA research articles examining staff communication in healthcare, education, social care and the police. Results: We identified five themes in the synthesis. Two were categories of interactional practices (Questions and Answers; Decision-Making), one examined non-verbal communication (Embodied and Non-Verbal Communication) and two considered contributions of other material and human agents (Communication Aids and Supports; Involvement of Companions). In each theme, we saw examples of competency-enhancing and competency-inhibiting practices. Conclusions: Practitioners face interactional dilemmas: (1) Orienting to the Person's Self-determination versus Getting the Job Done; (2) Adapting Communication versus Downplaying Difference. Future research should build on this review to develop and evaluate communication training for staff. Plain language summary Need for communication support: People with intellectual disabilities often need communication support in order to present their views, make decisions and engage in activities, but there is not much research that shows how this support is delivered by practitioners in real life. Using Conversation Analysis research to understand everyday interactions: We reviewed existing research that used a method called Conversation Analysis (CA) to understand how ordinary ways that staff ask questions, offer choices, use communication aids and respond to body language strongly shape whether people with intellectual disabilities are heard, understood and treated as competent decision‐makers. Support can both help and hinder: The research demonstrated that strategies intended to help—such as simplifying language, guiding decisions or speaking on someone's behalf—can unintentionally limit autonomy and participation if they prioritise efficiency or control over listening and choice. Implications for practice and research: Practitioners can improve their practice by being aware of the implications of offering support in different ways. This review provides information that can underpin evidence‐based communication training at a level of detail beyond what is currently available.

Background: Eye movement desensitisation and reprocessing (EMDR) is a guideline-recommended treatment for post-traumatic stress disorder (PTSD), but evidence in survivors of critical illness remains limited. We assessed the feasibility, acceptability, and safety of EMDR for critical care survivors with clinically significant post-traumatic stress symptoms, and generated exploratory clinical outcome estimates to inform a future definitive trial. Methods: We conducted a mixed-methods, randomised, single-blind, parallel group-controlled, feasibility trial at three UK National Health Service hospitals. Adults (≥18 years) with an intensive care stay >24 h were approached before hospital discharge and followed within an observational cohort. At 2-3 months, participants were screened for post-traumatic stress symptoms (Impact of Event Scale-Revised); those scoring ≥22 were invited and randomly assigned (1:1) to EMDR plus treatment as usual (TAU) or TAU. EMDR comprised up to 16 sessions delivered face-to-face or online by accredited therapists. Primary outcomes were feasibility (recruitment, retention, intervention uptake, fidelity) and safety. Symptoms were assessed using Clinician-administered PTSD Scale for Diagnostic and Statistical Manual-5 (CAPS-5) at 3 and 12 months. Analyses followed intention-to-treat principles. The trial was registered on ClinicalTrials.gov (NCT05591625) and is closed to recruitment. Findings: Between Feb 20, 2023, and May 13, 2024, 160 patients were recruited to the observational cohort; 40 were randomised, with 20 allocated to EMDR plus TAU and 20 to TAU. Median age was 59.5 years (IQR 52.0-66.0); 21 participants (53%) were female and 19 (48%) were male. At 12 months, 39 (98%, 95% CI 86.8-99.9) of 40 randomised participants completed CAPS-5 follow-up. In the EMDR plus TAU group, 18 (90%, 95% CI 68.3-98.8) of 20 participants initiated treatment; mean sessions attended was 10.4 (SD 7.0), and 15 (75%) of 20 completed a full therapeutic course. Mean CAPS-5 score change was -15.6 (SD 12.5) in the EMDR plus TAU group and -1.6 (SD 11.8) in the TAU group, giving an exploratory unadjusted between-group difference of -14.1 points (95% CI -22.0 to -6.2). No treatment-related serious adverse events were identified. Interpretation: A staged trial pathway of symptom screening, clinician-rated PTSD assessment, randomisation, and EMDR delivery was feasible and broadly acceptable in survivors of critical illness with clinically significant post-traumatic stress symptoms. Exploratory clinician-rated PTSD outcome estimates were hypothesis-generating and support progression to a definitive multicentre trial, but should not be interpreted as evidence of treatment effectiveness. Funding: Andrew Bates was funded by National Institute for Health and Care Research Clinical Doctoral Research fellowship (grant number: NIHR302160). Keywords: Critical illness; Eye movement desensitization reprocessing; Feasibility studies; Intensive care units; Post-traumatic; Stress disorders; Survivors.