Department of Veterans Affairs' contributions to treatment outcomes research in aphasia

Abstract

Background: Since at least 1948, Veterans Administration (VA) clinicians have been reporting the outcomes of treatment administered to mend aphasia. These range from retrospective clinical observations to controlled, multicentre clinical trials. While the rigour of research varies among reports, the body of work is considerable.

Aims: The purpose of this paper is to review VA contributions to treatment outcomes research in aphasia.

Methods & Procedures: Examples of VA aphasia treatment outcomes research were selected from a corpus of over 100 reports. Each was classified in the traditional, five‐phase, treatment outcomes research model, and each was rated by a levels of evidence scale.

Outcomes & Results: VA aphasia treatment outcomes research, like the bulk of aphasia treatment outcomes research, is patchy. There is little evidence of systematic progression through the traditional, five‐phase, treatment outcomes research model. It is also difficult to classify and to assign a level of evidence to many investigations. There is no VA aphasia treatment outcomes research on the effectiveness of the few treatments that have been demonstrated to be efficacious. Nevertheless, the amount of VA aphasia treatment outcomes research is massive, and its contribution to what can be said about the influence of treatment on aphasia is considerable.

Conclusions: For almost 60 years the VA has been contributing to treatment outcomes research in aphasia. No other single healthcare system can match the volume of this research. Lack of a systematic research programme may limit precise conclusions, but it does not diminish the significant contributions.

Keywords:

• Aphasia
• Treatment
• Outcomes research

Notes

We are indebted to the excellent reviews provided by the members of the 1st VA taskforce on treatment outcomes in aphasia—Stephanie Danials, Carol Starch, and Lynn Maher—and the 2nd VA taskforce—Michael de Riesthal, Amber Hollingsworth, Kathrien B. Ross, William H. Irwin, and Neila J. Donovan. Any errors in the present paper result from our failure to use their considerable contributions wisely.