Which treatment outcomes are most important to aphasia clinicians and managers? An international e-Delphi consensus study

ABSTRACT

Background: Clinicians have expressed frustration at the lack of strong evidence for aphasia treatments. Inconsistent outcome measurement practices across treatment trials have negatively impacted the quality and strength of evidence for aphasia interventions. Core outcome sets (COSs; minimum sets of outcomes/outcome measures) are increasingly being used to maximise the quality, relevancy, transparency, and efficiency of health treatment research. The current study is the third in a trilogy of stakeholder perspectives to inform the development of a COS for aphasia treatment research.

Aims: To identify essential aphasia treatment outcomes from the perspective of an international sample of clinicians and managers working in aphasia rehabilitation.

Methods & Procedures: A three-round e-Delphi exercise was conducted with aphasia clinicians and managers. In total, 265 clinicians and 53 managers (n = 318) from 25 countries participated in round 1. In round 1, participants responded to the open-ended question, “In your opinion, what are the most important outcomes (results) from aphasia treatment?” Responses were analysed using inductive content analysis. In rounds 2 and 3, 153 and 137 participants respectively rated the importance of each outcome generated in round 1 using a nine-point rating scale. Outcomes reaching predefined consensus criteria were further analysed using the International Classification of Functioning Disability and Health (ICF) coding.

Outcomes & Results: Analysis of round 1 participant responses produced 1709 codes, which were condensed into 90 subcategories, 25 categories, and 4 themes. In rounds 2 and 3, a total of 51 outcomes reached consensus. The two outcomes with the highest levels of consensus both related to communication between the person with aphasia and their family/carers/significant others. Outcomes relating to people with aphasia most frequently linked to the ICF activity/participation component (52%), whilst outcomes relating to family/carers/significant others were evenly divided between the ICF activity/participation component (36%) and environmental factors (36%).

Conclusions: Consensus was reached on 51 essential aphasia treatment outcomes. Very high levels of consensus (97–99%) between clinicians were achieved for outcomes relating to communication between the person with aphasia and their communication partner/s, suggesting that in the clinical environment improved dyadic communicative interaction is an important indicator of treatment success. The high proportion of outcomes linking to the ICF activity/participation component highlights the importance of measuring outcomes beyond impairment, both in clinical and research settings. These findings will be combined with other stakeholder perspectives and a systematic review of outcome measures to develop a COS for aphasia treatment research.

KEYWORDS:

• Outcome measurement
• aphasia
• e-Delphi
• core outcome set
• speech-language pathologist
• ICF

Acknowledgements

We acknowledge the invaluable contribution of the international community of aphasia clinicians and managers who participated in this study. We thank you for your time, your expertise, and for the unique perspectives you have brought to this research. The enthusiasm with which you approached this study was inspiring and very much appreciated.

Disclosure statement

The authors have no other declarations of interest to report.

Additional information

Funding

This work was supported by an Australian Postgraduate Award (APA) scholarship awarded to Sarah J. Wallace.