Background and Aims: 
Stroke and aphasia can have a profound impact on people’s lives. Depression is a common sequel of stroke, with rates remaining high even one year after stroke at 33%. It is associated with worse rehabilitation outcomes, increased carer strain, increased healthcare utilisation, and higher mortality. A Cochrane systematic review has indicated that there is currently insufficient evidence for the effectiveness of psychological therapies for treating post-stroke depression. There is a pressing need to systematically evaluate interventions that aim to improve psychosocial wellbeing for people with stroke; and for the vulnerable group of people with aphasia, who are often excluded from stroke studies, in particular. SUPERB will evaluate the feasibility of a study on the clinical and cost-effectiveness of peer befriending for people with aphasia post-stroke. Peer befriending fits within the Stepped Care model, which aims to offer psychological care in a hierarchical approach, offering simpler interventions first (level 1), such as those provided by peers or stroke specialist staff, and progressing to more complex interventions requiring input from clinical psychology or psychiatry (level 3) if required.  We will run an exploratory (phase II) randomised controlled trial (RCT) to:
1. Explore the feasibility of a definitive/phase III RCT on clinical and cost-effectiveness of peer-befriending for people with aphasia post-stroke.
2. Measure psychological and social wellbeing outcomes of participants, significant others, and peer befrienders.
3. Explore the economic consequences of peer befriending versus usual care control.

Methods
Design: Single blind, mixed methods, parallel group phase II RCT comparing peer-befriending vs. usual care, starting at discharge from hospital.  The design has been informed by the MRC framework for complex interventions. The study will deliver on four work packages: development phase; RCT; qualitative study; economic evaluation. Participants (n=60) will be assessed four times up to 12 months post-randomisation

Results
We will assess feasibility of recruitment to a definitive trial (proportion screened who meet criteria; proportion who consent; rate of consent); participant, significant other, peer befriender views on acceptability of procedures (qualitative study); number of missing/incomplete data on outcome measures; attrition rate at follow-up; potential value of conducting main trial using value of information analysis (economic evaluation); description of usual care; treatment fidelity of peer-befriending.  Patient-reported outcomes will include mood, confidence, participation, social support, quality of life.

Discussion and Clinical Implications
Evidence of benefit for level 1 interventions addressing wellbeing may help clinical practice to avert some of the serious psychological consequences post stroke and aphasia, and prevent the need for more complex and costly level 2 and 3 input.  This study will provide such evidence for one-to-one peer befriending; and provide the necessary parameters and information to plan a definitive trial.

Conclusion
Peer befriending is worth exploring as it has the potential, pending on positive outcomes of a definitive trial, to improve service provision for people with stroke and aphasia.

Adjustment post-stroke and aphasia: protocol for the SUpporting well-being through PEeR-Befriending (SUPERB trial)