Background: Participation of people with aphasia in clinical care and rehabilitation is an area of increasing research interest. Supported communication (SC) training, which aims to enhance the participation of aphasic patients, has been shown to improve conversation partner knowledge and skills. However, there is a lack of evidence for transfer of SC training to practice in post-acute rehabilitation settings. Aims: We aim to develop an understanding of causal mechanisms implicated in the transfer of SC training by examining the nature of the setting, staff perspectives, and the situated character of the action. Methods and Procedures: Twenty-eight staff from a multidisciplinary team were trained in SC. We collected detailed and varied data, including staff experiences of SC training and implementation, and video data of routine practice. Using a critical realist approach, we develop explanatory mechanisms for barriers to and enablers of transfer. Eleven team members (nursing, therapy, and assistant staff) took part in focus groups and interviews at the end of the study; 54 learning logs were collected over a 10-month period. Six aphasic patients and eight staff took part in video-recordings of therapy and care sessions. Outcomes & Results: Three main themes derived from staff experience data are linked to key components of the setting, indicating processes implicated in transfer of training, and impacting on outcomes such as perceptions of quality and staff confidence. Barriers, constraints, and problem-solving approaches in enacting SC were evidenced through patient factors, spaces and events, and time constraints. Staff flexibility and team working were key factors in problem-solving these obstacles. Staff reported responsive use of skills and resources and perceived impact of SC training, with most, but not all, staff reporting benefits, including increased confidence in interactions with aphasic patients. Activity analysis of video data illustrates how some mechanisms may be operating in practice, with evidence of rich use of interactional strategies and resources; a focus by staff on getting the work done; opportunities for patient active participation or emotional support that are realised or not; strategies for aphasia-related trouble and repair sequences. Conclusions: This model of SC training has clear benefits for staff communication practices and confidence, but transfer of training is subject to complex processes. Training should therefore address systems-level practices and be extended for staff who need more advanced skills. The values implicit in SC have the potential to create a culture of access and inclusion, encouraging and supporting active participation of all stroke patients

Although the available evidence is often described as limited, inconsistent or inconclusive, some rehabilitation interventions were cost-effective or showed cost-saving in a variety of disability conditions. Available evidence comes predominantly from high income countries, therefore economic evaluations of health-related rehabilitation are urgently required in less resourced settings.

The questionnaire is concise, easy to complete and simple to analyse, and appears to be a reliable and valid measure of staff perceptions of quality of clinical group supervision. Further studies with larger sample sizes and including other groups of health professionals are needed to confirm the validity and reliability of the CSEQ.

BackgroundChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) can cause profound and prolonged illness and disability, and poses significant problems of uncertainty for healthcare professionals in its diagnosis and management. The aim of this qualitative study was to explore the nature of professional 'best practice' in working with people with CFS/ME.MethodsThe views and experiences of health care practitioners (HCPs) were sought, who had been judged by people with CFS/ME themselves to have been particularly helpful and effective. Qualitative semi-structured interviews following a topic guide were carried out with six health care practitioners. Interviews were audio-recorded, transcribed and subject to thematic analysis.ResultsFive main themes were developed: 1) Diagnosis; 2) Professional perspectives on living with CFS/ME; 3) Interventions for treatment and management; 4) Professional values and support for people with CFS/ME and their families; 5) Health professional roles and working practices. Key findings related to: the diagnostic process, especially the degree of uncertainty which may be shared by primary care physicians and patients alike; the continued denial in some quarters of the existence of CFS/ME as a condition; the variability, complexity, and serious impact of the condition on life and living; the onus on the person with CFS/ME to manage their condition, supported by HCPs; the wealth of often conflicting and confusing information on the condition and options for treatment; and the vital role of extended listening and trustful relationships with patients.ConclusionsWhile professional frustrations were clearly expressed about the variability of services both in primary and specialist care and continuing equivocal attitudes to CFS/ME as a condition, there were also strong positive messages for people with CFS/ME where the right services are in place. Many of the findings from these practitioners seen by their patients as helping them more effectively, accord with the existing literature identifying the particular importance of listening skills, respect and trust for establishing a therapeutic relationship which recognises key features of the patient trajectory and promotes effective person-centred management of this complex condition. These findings indicate the need to build such skills and knowledge more systematically into professional training informed by the experience of specialist services and those living with the condition.

Background: Communication partner training (CPT) is an umbrella term for a complex behavioural intervention for communications partners (CPs) of people with aphasia (PWA) and possibly PWA themselves, with many interacting components, deployed in flexible ways. Recent systematic reviews (Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010; Simmons-Mackie, Raymer, & Cherney, 2016) have highlighted the effectiveness of CPT in addressing the skills of conversation partners and the communicative participation of people with aphasia but have suggested that CPT has been variably delivered, with no clear picture of what the essential elements of CPT are and how CPT is expected to achieve its results through hypothesized mechanisms of change (Coster, 2013). Aim: This paper aims broadly to consider specification of CPT and describes how CPT has been conducted overall and in relation to treatment recipients. Recommendations for CPT and areas for future research are considered. Methods & Procedures: A critical review and narrative synthesis was carried out through: i) the systematic application of the 12-item TIDieR checklist (Hoffmann et al., 2014) to the 56 studies appraised in the Simmons-Mackie et al. (2010; 2016) reviews, providing a quantitative overview of the completeness of CPT intervention reporting; and ii) a qualitative synthesis of the reviewed CPT literature according to TIDieR items. Results: Half of the TIDieR checklist items were reported by 71% or more of the studies, and the rest of the items were reported by 0-63% of studies. TIDieR items relating to the treatment (goal, rationale or theory of essential elements, materials and procedures) and provision (provider, mode, timing, dose) were more frequently reported, however the level of detail provided was often inadequate or incomplete. The interventions were insufficiently specified to enable replication for most of the studies considered. The most infrequently reported items were: name, location, intervention tailoring and modification, and planned and Reporting interventions in communication partner training 3 actual intervention adherence/fidelity. Conclusion: For a better understanding of an intervention, it is necessary to identify and describe potentially central elements and perhaps especially in complex interventions as CPT, where it is likely also more difficult. Whilst the reviewed CPT studies are on average reporting on slightly more than half of the TIDieR items, they are overall insufficiently detailed. Some items appear easier to report on, whereas other items have not been attended to, are too complex in nature to give a full report on, or simply have not been relevant for the individual study to include.