Complexity in measuring outcomes after communication partner training: alignment between goals of intervention and methods of evaluation

Figures & data

Table 1. Examples of differences between CPT approaches, and between methods of outcome evaluation.

Methods of Intervention		Methods of evaluation and measurement
What domain of change is the intervention focused on: knowledge, behaviour or feelings/attitudes? What are the included procedures, activities and tasks?	WHAT	What is measured to evaluate change: Constructs reflecting knowledge, behaviour or feelings/attitude? Which ICF domains are evaluated: body function, activity/participation, environmental or personal factors?
Who are the targeted participants: The dyad, only the CP, a family member, volunteer or healthcare staff?	WHO	Who is being assessed: CP, PWA or dyad? Who is assessing: PWA or CP giving self-reports, an “objective” other, for example, the SLT providing intervention, or a trained and blinded assessor?
How is intervention delivered: individually, in dyads, in groups? How long is the period of intervention, and how intensive?	HOW	Type of data explored: video-recorded interaction, interview, rating scale, or questionnaire data? Methods of analysing data: qualitative, quantitative, mixed? Psychometric properties of methods: Reliability, validity, sensitivity, feasibility?
What is the context or setting for the intervention: home, clinical setting, university/college, other?	WHERE	What is the social context for obtaining the outcome data: home, clinical setting, experimental, other?
What is the main objective of the intervention and its stated intermediate goals?	WHY	What is the purpose of evaluation: goal setting, baseline, outcome measurement?

Figure 1. Visual model inspired by Coster (2013) of a hypothetical type of anomia intervention, where therapy focuses on confrontation naming tasks. The projected proximal outcomes are likely to be effects relating to word retrieval in confrontation naming (full arrow). Possible effects relating to word finding in conversation would be dependent on generalization and seem to be more distal to the tasks and activities of the intervention (dotted arrow).

Figure 2. Visual model of a hypothetical type of CPT, which exclusively targets the CP. The projected proximal outcomes are likely to be effects relating to the communication partner (full arrow) or his or her interaction with the PWA (dashed arrow), whereas effects relating to the PWA seem to be more distal to the tasks and activities of the intervention (dotted arrow).

Table 2. Two different types of CPT approaches describing well-aligned main objectives, intermediate goals, activities and tasks in intervention and possible proximal and distal outcomes to measure.

CPT approach	Main objective	Intermediate goals	Activities and tasks in intervention	Outcomes suggested as proximal or distal
Dyad-focused CPT: Training dyads in the development of individually adapted communicative strategies	To facilitate communication in specific dyads	Increased knowledge about communication in aphasia. Increased use in the dyad of communicative behaviours which facilitates the interactional flow and reduction of barriers in the dyad’s everyday communication	Teaching about aphasia and conversational interaction. Use of own video-recorded interactions and coaching to gain insights and adaptation of specific communicative behaviours	Proximal: Knowledge about communication in aphasia including own barrier and facilitative behaviours; change in targeted behaviours in CP and/or PWA Distal: Change in the dyad’s feelings/attitudes about the quality of their communication
Generic CPT: Teaching healthcare staff to use supportive techniques and materials in healthcare contexts	To enable PWA to participate in planning and assessment of healthcare	Increased knowledge about communication and aphasia and behavioural increase in the appropriate use of generic supportive techniques in conversations with different PWAs	Teaching about aphasia and training through role play in use of generic strategies to support conversations with different PWAs in healthcare contexts	Proximal: CP’s knowledge about communication in aphasia; CP’s behaviour and skill in use of different supportive techniques Distal: Increased communicative participation (behaviour) of PWA, or PWAs’ feelings of inclusion and participation in the healthcare setting; change in CP’s feelings/attitudes about communicating with PWAs

Coster, W. J. (2013). Making the best match: Selecting outcome measures for clinical trials and outcome studies. The American Journal of Occupational Therapy, 67(2), 162–170. doi:10.5014/ajot.2013.006015

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