The top ten: best practice recommendations for aphasia

ABSTRACT

Background: The move from nationally focused health services towards healthcare globalisation is apparent with the hope that healthcare services will ultimately follow similar quality standards and guidelines throughout the world. Aphasia United, an organisation representing a broad range of professionals and others interested in improving the lives of those with aphasia, undertook a project to gain consensus on best practices to guide aphasia rehabilitation across multiple countries.

Aims: To develop and gain multinational consensus on an initial set of best practice recommendations for aphasia.

Methods & Procedures: The project entailed three phases: (1) crafting a draft set of recommendations for aphasia management drawing from research evidence and stroke guidelines, (2) obtaining consensus on recommendations from healthcare experts across multiple countries and (3) creating a strategic plan to facilitate dissemination, revision, further development and uptake of best practices. This article reports on the first two phases of this process. Phase 1 entailed reviewing existing research reviews, national clinical guidelines for stroke and/or aphasia and evidence websites to identify recommendations based on high-quality evidence. Nine national stroke and/or aphasia guidelines were identified to serve as the primary source documents. A qualitative theme analysis was used to extract recommendations from these documents. An auditing reviewer examined the source documents and extracts to ensure that results were consistent with sources. Finally, the recommendations were circulated to an expert panel for input. Phase 2 involved a multiple stage consensus process: (1) discussion of draft recommendations by an expanded panel of experts, (2) cycles of revision by an expert working group, (3) an online survey soliciting agreement from a broader panel of experts and (4) an open-ended online survey soliciting consensus from professionals across multiple countries.

Outcomes & Results: The cycles of revision and the final consensus of 500 aphasia experts across multiple countries resulted in 10 best practice recommendations for aphasia including screening, assessment, intervention and discharge recommendations.

Conclusions: The top 10 recommendations achieved very strong consensus among participants. These results provide an initial set of recommendations that might serve as a basis for translating evidence into practice to improve aphasia services. Future efforts should be directed at determining barriers to implementation. In addition, individual countries or groups (whether represented in the consensus process or not) will necessarily need to consider the applicability of recommendations to their own cultural and ethnic traditions and national practices.

KEYWORDS:

• Clinical practice guidelines
• consensus development
• aphasia
• rehabilitation
• therapy

Acknowledgements

The authors wish to acknowledge the following for their contributions to the best practices recommendations: the Aphasia United Advisory Group & Best Practices Working Group, Aphasia United Secretariat, Adi Lifshitz Ben Basat, Karianne Berg, Carola deBeer, Lisbeth Frolund, Ritienne Grima, Tarja Kukkonen, Ilknur Mavis, Ilias Papathanasiou, Sabiha Parveen, Anastasia Raymer, Virginia Reay and Mariko Yoshino. We also acknowledge the 500 aphasia clinicians and researchers who joined the final consensus survey.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Aphasia United operates entirely with volunteers including an administrative Secretariat, a multinational advisory committee and several working groups that implement projects consistent with the organisational aim of improving advocacy, services and research for people living with aphasia. The Aphasia United Advisory Committee serves as a conduit to a particular region or organisation(s) to help Aphasia United achieve goals. Smaller working groups address specific projects identified by the Advisory Committee and Secretariat.

2. Stroke clinical guidelines included in the G-I-N library include Australia, Belgium, Brazil, Canada, Europe, Finland, France, Germany, Malaysia, The Netherlands, Spain, Ukraine, UK and the United States. These guidelines cover a variety of different management domains and do not necessarily include aphasia recommendations.