Using an Implementation Framework to Survey Outcome Measurement and Treatment Practices in Aphasia

Abstract

Purpose: Best practices in the field of aphasia rehabilitation increasingly acknowledge a whole-person approach that values interventions aimed at reducing impairments, while also recognizing the impact of aphasia on participation and quality of life. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aimed to examine whether current clinical practices along levels of service provision reflect this whole-person, multifaceted approach. Method: Speech-language pathologists (SLPs) in the United States who provide intervention to people with aphasia across the continuum of care completed this cross-sectional online survey. Current outcome measurement and treatment practices were evaluated within the Living With Aphasia: Framework for Outcome Measurement via multiple-choice and open-text response questions. Data were analyzed descriptively and using ordinal logistic regression models to compare clinical practices along levels of service provision. Results: Data from 90 SLPs revealed that language and cognitive skills are assessed with equal consistency across clinical settings; however, functional communication, participation, and quality of life domains are prioritized in settings providing care to clients within the community. Psychological well-being is rarely assessed within clinical practice along most of the rehabilitation process and prioritized within the university clinic setting when clients are in the chronic stage of recovery. Conclusions: Clinical practices related to a multifaceted approach to aphasia intervention are variable across levels of service provision. Further exploration of barriers and facilitators to multifaceted aphasia care along the domains of the CFIR is needed to provide an informed approach to implementing change.

‘It's been an extraordinary journey’: Experience of engagement from the perspectives of people with post‐stroke aphasia

“…However, it is necessary to recognize that client and provider interactions (and thus engagement) do not exist within a vacuum but are embedded in and influenced by the broader healthcare system. Healthcare policy and incentive structures can influence clinical workflow and culture within rehabilitation settings and may not be in concordance with individual client needs and priorities (Tierney‐Hendricks et al., 2021). Therefore, there may be organizational level barriers that hinder a clinician's ability to be: a friend, invested, adaptable, a co‐creator, encouraging and dependable.…”

Intensive and comprehensive aphasia therapy—a survey of the definitions, practices and views of speech and language therapists in the United Kingdom

“…Variation in provision based on workplace setting is a key variable (Manning et al, 2020) with more intensive therapy provided in the inpatient rehabilitation setting than other settings (Verna et al, 2009) and more barriers to meeting aphasia guideline recommendations experienced by those in acute versus rehabilitation (Shrubsole et al, 2019b). A US survey of 90 SLTs found functional communication was a more common therapy target in the community setting (Tierney-Hendricks et al, 2022). Taylor et al (2015) found that institutional goals played a role in therapy intensity (e.g., there was a focus in some settings on discharge planning and reducing length of stay rather than providing intensive rehabilitation), see also Putman et al (2007).…”

Aphasia outcome measurement in clinical practice: An international survey

“…While clinical practice guidelines emphasise the importance of measuring outcomes, there remains great variability in how this practice is operationalised in clinical settings. Addressing this variability is challenging due to limited understanding of the factors that drive clinician practice (Arnold et al, 2020;Simmons-Mackie et al, 2005;Tierney-Hendricks et al, 2022).…”

“…Studies investigating aphasia outcome measurement practice reveal considerable variability (Arnold et al, 2020;Kiran et al, 2018;Simmons-Mackie et al, 2005;Tierney-Hendricks et al, 2022). Most recently, Tierney-Hendricks and colleagues (2022) used a crosssectional survey to explore the outcome measurement and treatment practices of speechlanguage pathologists who work with people with aphasia in the United States.…”