Efficacy of a strategy-based intervention on text-level reading comprehension in persons with aphasia: a study protocol for a repeated measures study

Thumbeck, Sarah-Maria; Schmid, Philipp; Chesneau, Sophie; Domahs, Frank

doi:10.1136/bmjopen-2020-048126

Cited by 4 publications

(19 citation statements)

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“…The intervention consisted of teaching reading strategies that focused on the situational model, macrostructure, microstructure and surface structure. The strategies (use of advance organizers, summarization and re-reading, asking questions and providing answers, using referential links and elaboration) were applied in 14 faceto-face sessions, of 60 min each, plus homework, according to a treatment protocol provided in Thumbeck et al (2021).…”

Section: Methodsmentioning

confidence: 99%

“…In addition to these principles, we analysed first psychometric properties based on data from an intervention study described in Thumbeck et al. (2021). Figure 1 presents an overview of the realized workflow for translation and adaptation as well as the subsequent analysis of psychometric properties.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, we based our translation and adaptation procedures on the steps outlined in Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures (Wild et al, 2005) which include two independent forward translations, a back translation and pilot testing. In addition to these principles, we analysed first psychometric properties based on data from an intervention study described in Thumbeck et al (2021). Figure 1 presents an overview of the realized workflow for translation and adaptation as well as the subsequent analysis of psychometric properties.…”

Section: Translation and Adaptation Proceduresmentioning

confidence: 99%

“…For the retention of psychometric properties, it is therefore recommended to conduct further testing of the adapted version (Beaton et al., 2000). We analysed data collected during a repeated measures intervention study targeting text level reading comprehension (Thumbeck et al., 2021). In addition to the analyses of psychometric properties, we investigated the relationship between the self‐reported outcome of the questionnaire and performance‐based outcomes on text level reading comprehension (accuracy and reading time).…”

Section: Data Collectionmentioning

confidence: 99%

“…Thus, in goal‐setting, it is very important to consider both self‐reported and performance‐based assessments (Webster et al., 2022). In preparation for an intervention study on text‐level reading comprehension in PWA (Thumbeck et al., 2021), we searched for self‐reported outcome measurement instruments for reading in aphasia. Individual perceptions of reading in aphasia can be collected with different methods such as interviews (e.g., Kjellén et al., 2017; Webster et al., 2018), questionnaires (e.g., Knollman‐Porter et al., 2015) or participant observations (e.g., Lynch et al., 2013).…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire—German version

Thumbeck

Webster

Domahs

2023

Intl J Lang & Comm Disor

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BackgroundReading comprehension is frequently impaired in persons with aphasia (PWA). For goal‐setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person‐centred tool to find out the individual perception of reading functions, reading‐related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German.AimsTo translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version.Methods & ProceduresBased on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self‐reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German‐speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations.Outcomes & ResultsOur data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy‐induced change. We found moderate correlations between outcomes of the questionnaire and text‐level reading speed.Conclusions & ImplicationsThe German version of the CARA reading questionnaire could be helpful in intervention planning and goal‐setting with German‐speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self‐reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments.WHAT THIS PAPER ADDSWhat is already known on the subject Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal‐setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person‐centred English language questionnaire for this purpose. So far, there is no equivalent tool in German.What this paper adds to the existing knowledge In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German‐speaking PWA. We demonstrated that the German version is accessible for German‐speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self‐reported change. Outcomes of the questionnaire correlate with text level reading speed.What are the potential or actual clinical implications of this work? The German version of the questionnaire could be a valuable self‐reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Translation and Adaptation Proceduresmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire—German version

Thumbeck

Webster

Domahs

2023

Intl J Lang & Comm Disor

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“Competing Noises”: How Background Noise Impacts the Communication Experiences of People With Mild-to-Moderate Aphasia

Harmon,

Hegewald,

Dromey

2024

Am J Speech Lang Pathol

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Purpose: The aim of this study was to explore the subjective experiences of people with aphasia when communicating in the presence of various types of background noise. We hypothesized that (a) people with aphasia would report greater perceived effort and stress than controls when talking in noise, (b) perceived effort and stress would be greater in noise than silence, and (c) people with aphasia would describe more negative reactions to communicating in noise than controls. Method: Eleven people with aphasia and 11 age- and gender-matched controls retold stories in a baseline silent condition and five background noise conditions (pink noise, cocktail party, monologue, one-sided phone call, and conversation) and rated their perceived effort and stress after each story. Participants then described their experience in a semistructured interview. Perceived effort and stress ratings were analyzed statistically using quantitative methods. Interview data were analyzed qualitatively. Results: Quantitative findings showed that people with aphasia reported significantly greater perceived effort and stress than controls. Across groups, phone call, conversation, and monologue conditions were perceived as either more effortful or stressful than the silent baseline condition. Although both participant groups discussed cognitive and emotional challenges and strategies related to talking in noise, qualitative findings showed distinct difficulties for people with aphasia. Specifically, unlike controls, participants with aphasia mentioned difficulty ignoring background noise, decreased processing speed, fatigue, negative emotional reactions, deliberately focusing, slowing down/taking breaks, and consciously regulating their emotions. Conclusions: Although aphasia therapy often occurs in quiet clinic environments, everyday communication does not. The increased perceived difficulty that people with aphasia have for coping with background noise should be acknowledged, and training should be designed to prepare people with aphasia to communicate in noisy environments. Supplemental Material: https://doi.org/10.23641/asha.27893445

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Efficacy of reading strategies on text‐level reading comprehension in people with post‐stroke chronic aphasia: A repeated measures study

Thumbeck,

Schmid,

Chesneau

et al. 2023

Intl J Lang & Comm Disor

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BackgroundPeople with aphasia (PWA) frequently experience difficulties in understanding longer written content such as paragraphs or books. Reading strategies are a promising approach to treat text‐level reading comprehension deficits in PWA. Nevertheless, empirical evidence for their efficacy remains rare.AimsThe primary objective of this study was to analyse the efficacy of a strategy‐based intervention on text‐level reading comprehension in PWA. Secondary objectives were to compare the effects of two strategy‐based intervention components and to explore potential moderator effects.Methods & ProceduresA protocol was published prior to data acquisition. In a repeated measures trial, 26 German participants with chronic, post‐stroke aphasia participated in a waiting period without aphasia treatment (control condition) followed by a strategy‐based intervention called ‘Strategiebasierte Textverständnis‐Therapie bei Aphasie’ (StraTexT, 14 face‐to‐face‐sessions, twice per week, 60 min each). Two strategy combinations, Intervention Micro targeting microstructure and Intervention Macro targeting macrostructure, were applied to newspaper and magazine articles. Participants were randomly allocated to two parallel groups that received these strategy combinations in interchanged sequences. Assessments were implemented before and after each period as well as 3 and 6 months after the intervention. The primary outcome measure was text‐level reading comprehension measured with the total score of a German version of the Test de Compréhension de Textes (TCT‐D). Secondary outcome measures addressed the self‐reported perception of reading abilities, reading activities and feelings about reading (German version of the Comprehensive Assessment of Reading in Aphasia CARA reading questionnaire) as well as selected cognitive functions.Outcomes & ResultsThe per‐protocol‐analysis included data from 22 participants. We found significant small improvements up to 6 months post‐intervention compared to pre‐intervention in the TCT‐D Total (d = 0.35–0.46) as well as medium to large improvements in the CARA questionnaire (d = 0.68–0.96). Up to 3 months after the intervention, treatment‐induced improvements in the TCT‐D Total were significantly larger than change without treatment during the control condition. There was no evidence of moderator effects. Furthermore, we found improvements in several cognitive functions.Conclusions & ImplicationsReading strategies can lead to long‐term improvements in text‐level reading comprehension and in self‐reported reading abilities, feelings about reading and reading activities in aphasia. In regular clinical settings, it seems reasonable to implement both Intervention Micro and Intervention Macro. It remains important to investigate participant characteristics that contribute to treatment success.WHAT THIS PAPER ADDSWhat is already known on the subject Systematic reviews and multiple case studies suggest that reading strategies are a promising approach to treat text‐level reading comprehension in aphasia. The efficacy of reading strategies has been demonstrated for different populations. However, to date no group study has evaluated the efficacy of reading strategies on text‐level reading comprehension in people with aphasia.What this study adds This study provides the first group‐level evidence about the efficacy of a systematic strategy‐based intervention in 22 people with post‐stroke chronic aphasia. During 14 treatment sessions, participants applied four reading strategies to newspaper and magazine articles within two intervention components called Intervention Micro and Intervention Macro (two strategies per intervention component). We found improvements in text‐level reading comprehension for at least 3 months post‐intervention, as well as effects on selected cognitive functions and self‐reported reading abilities, thoughts and feelings about reading and the ability to engage in reading activities.What are the clinical implications of this work? The strategies and materials evaluated in this study could be used in clinical practice with people with aphasia. In order to replicate treatment effects in clinical practice, we suggest applying the strategy combination with the same protocol features (e.g., frequency, duration, homework, product orientation) as in this study, implementing Intervention Micro and Intervention Macro sequentially in either order. As treatment response was not equal in all individuals, it seems important to investigate individual features that contribute to treatment success.

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Efficacy of a strategy-based intervention on text-level reading comprehension in persons with aphasia: a study protocol for a repeated measures study

Cited by 4 publications

References 38 publications

Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire—German version

Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire—German version

“Competing Noises”: How Background Noise Impacts the Communication Experiences of People With Mild-to-Moderate Aphasia

Efficacy of reading strategies on text‐level reading comprehension in people with post‐stroke chronic aphasia: A repeated measures study

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