Aphasia and stroke therapeutic alliance measure (A-STAM): Development and preliminary psychometric evaluation

Abstract

Purpose: The therapeutic alliance, also known as the therapeutic relationship, may influence treatment process and outcome in aphasia rehabilitation; however, we currently lack a reliable tool to measure this relationship. This study aimed to develop a novel measure of the therapeutic alliance applicable to this population and provide preliminary evidence of the measure’s psychometric properties.

Method: Statements were generated from the: (1) therapeutic alliance literature, (2) qualitative interviews with stakeholders, and (3) Q methodological insights with people with aphasia (PWA) (n = 455). A representative sample of statements was identified from the data set (n = 57) and reviewed by expert panels (professionals and PWA), culminating in a 42-item clinician and patient version of the aphasia and stroke therapeutic alliance measure (A-STAM). Reliability and validity of both the clinician and patient versions of A-STAM were investigated with 34 Clinician-patient dyads engaging in therapy.

Result: Internal consistency and test–retest reliability were excellent for both clinician (α = 92; ICC = 0.93) and patient versions of A-STAM (α = 0.92; ICC = 0.97). In both versions, scores correlated highly with psychotherapeutic measures of therapeutic alliance, indicative of good construct validity (r_s = 0.75; r_s = 0.77).

Conclusion: The findings establish the preliminary reliability and validity of A-STAM and support further investigation into the measure’s psychometric properties in larger samples.

Keywords:

• psychosocial
• psychometrics
• interaction

Ethical approval

Ethical approval was obtained from the Health Research Authority, Research Ethics Committee in the UK, Reference 16 NW 0499, in addition to permissions from research and governance departments at individual National Health Service (NHS) sites, prior to the commencement of the study.

Supplementary material

Supplemental data for this article can be accessed at https://doi.org/10.1080/17549507.2019.1648551

Additional information

Funding

This study was carried out while the first author (M. L.) was in receipt of a Stroke Association Junior Research Training Fellowship (TSA JRTF 2013/02).