Clinicians’ views and practices in quality of life in aphasia rehabilitation: a preliminary study

ABSTRACT

Background: Quality of life (QOL) is important to people with aphasia and their family members and is influenced by a range of factors within the scope of practice for speech and language therapy. Interestingly though, clinicians largely assess patients’/clients’ QOL informally through discussion, and rarely measure QOL as an outcome from aphasia rehabilitation. Research is needed to understand why there is relatively little consideration of QOL in clinical practice and little use of formal assessments.

Aims: This study explores aphasia clinicians’ views and reported practices regarding QOL as a concept and its assessment.

Methods & Procedures: Nineteen practising speech and language therapists working in rehabilitation with adult clients with neurogenic communication disorders volunteered and completed the study. They completed an online survey of 48 questions with a range of response options, including free text. Descriptive and inferential statistics were used for count and categorical data, and content analysis for text responses.

Outcomes & Results: These clinicians felt initially unprepared for practice, and had limited awareness, knowledge and confidence in using QOL assessments, but nonetheless thought QOL was important in clinical management. They considered QOL as being individualized, pertaining to life satisfaction and enjoyment, and additionally considered it as communication, participation in activities, education, and emotional support. The majority used informal methods, although some formal assessment use was reported. Many perceived barriers related to lack of resources (physical, staff, and time). Clinicians also reported scope of practice issues with the broader multidisciplinary rehabilitation team and specifically clinical psychology.

Conclusions: Training and access to existing available QOL assessments are clear implications from this study. Further research is needed to assess the extent to which these findings are representative of the broader aphasia clinician community in England.

KEYWORDS:

• Quality of life
• wellbeing
• clinical expertise
• aphasia
• speech and language therapist

Acknowledgements

We are grateful to Professor Karen Sage, at the time employed at the University of Manchester, for her support in recruitment to this research via the Manchester Aphasia Group.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Wellbeing is considered a related concept of QOL. Admittedly, this outcome was lesser in priority than other outcomes specifically improved communication and increased life participation (Wallace et al., 2017b).

2. This is in the context of 65/70 respondents using impairment-based language assessments.

3. Participants are Western, Educated and from Industrialized, Rich and Democratic countries.

4. The five participants (Table 1) who reported working acute settings (and additionally worked in sub-acute settings) also worked in inpatient rehabilitation, an inclusion criteria for the study.

5. One outlier was noted (n=169 clients) and was removed from the analysis.

6. Participants had been qualified across the entire range from 0-20yrs, so no link evident.

7. Training for professionals to listen and respond to patients and carers who are distressed or concerned.

8. Two participants were in community/residential care setting with one specifically referring to swallowing issues for clients with dementia.

9. A further two participants reported using the CAT but were not specific that this implied the Disability Questionnaire component of the assessment.

10. This can also be considered Capacity reflecting a lack of clinicians’ knowledge as some measures can be used to capture treatment effects.