Development of an evidence-based aphasia therapy implementation tool: an international survey of speech pathologists’ access to and use of aphasia therapy resources

Figures & data

Table 1. Reported country of respondents (n=176).

Country	%	n
Australia	24%	43
Canada	2%	3
Chile	1%	1
Germany	4%	7
Iceland	1%	1
India	1%	1
Ireland	1%	1
Italy	1%	1
Kenya	1%	2
New Zealand	2%	3
Nigeria	1%	1
Norway	11%	19
South Africa	1%	1
Sweden	1%	2
Switzerland	1%	2
Turkey	2%	3
United Kingdom of Great Britain and Northern Ireland	20%	36
United Republic of Tanzania	1%	1
United States of America	26%	45
Not specified	2%	3

Table 2. Highest professional qualification obtained (n=176).

Qualification	%	n
Bachelor’s degree	11%	19
Bachelor’s degree with Honours	13%	23
Clinical Doctorate	1%	2
Graduate certificate/diploma	3%	6
Master of Philosophy (MPhil)	3%	5
Doctor of Philosophy (PhD)	18%	32
Postgraduate Master’s degree	50%	88
Not specified	1%	1

Table 3. Reported number of years post qualifications obtained and years of aphasia clinical experience (n=176).

	Years post qualifications		Aphasia clinical experience
Clinical experience	%	n	%	n
Less than 1 year	3%	5	2%	4
1-3 years	13%	22	16%	29
4-5 years	10%	17	9%	16
6-10 years	20%	36	20%	36
11-15 years	21%	37	22%	38
16-20 years	7%	13	6%	11
20+ years	25%	44	23%	40
Not specified	1%	2	1%	2

Table 4. Reported primary clinical setting of respondents (n=176).

Primary clinical setting	%	n
Hospital - Acute service	14%	24
Hospital - Inpatient rehabilitation service	19%	34
Community rehabilitation - Day hospital, outpatient rehabilitation service, community centre or home-based care	27%	48
University clinic	16%	28
Private practice	14%	24
Residential aged care facility/Skilled nursing facility	1%	2
Aphasia center	1%	1
Community health organisation	1%	2
University research programme	2%	3
Voluntary sector	1%	2
Other	4%	7
Not specified	1%	1

Table 5. Speech pathologists’ reported use of therapy approaches for aphasia rehabilitation.

Therapy approach	Count	% of respondents
Semantic therapy	154	88%
Multimodal therapy	125	71%
Functional & pragmatic therapy	121	69%
Phonological therapy	110	63%
Conversational partner training	107	61%
Verbal therapy	89	51%
Sentence processing therapy	76	43%
Melodic Intonation Therapy (MIT)	31	18%
Constraint Induced Aphasia Therapy (CIAT)	25	14%

Note: Each respondent could list as many therapy approaches as they wished.

Table 6. Speech pathologists’ reported methods for obtaining information regarding new developments in speech pathology for the management of aphasia.

Mode	Count	% of respondents
External professional development courses, seminars or conferences	145	82%
Research literature	130	74%
Special interest groups	88	50%
Through your current workplace/department	82	47%
Search engines (e.g., Google^©)	59	34%
From students undertaking clinical placements with you	33	19%
Other
Social Media (e.g., Twitter, Instagram, Facebook)	12	7%
Aphasia Research Centres & Interest Groups (Aphasia CRE, QARC, British Aphasiology Society, Aphasia Bank Group)	8	5%
Speech pathology professional bodies (e.g., Speech Pathology Australia, RCSLT, ASHA)	5	3%
Podcasts (e.g., Med SLP, speech uncensored)	4	2%
Aphasia Access	3	2%
Websites (e.g., Tactus)	3	2%
Professional colleagues	2	1%
Participation in research	2	1%
Private speech pathology services (e.g., Honeycomb Speech Therapy Activity Studio)	1	1%
SpeechBITE	1	1%
Patients/Clients	1	1%
Collaboration of Aphasia Trialists	1	1%

Key: Aphasia CRE = Centre for Research Excellence in Aphasia Rehabilitation and Recovery, QARC = Queensland Aphasia Research Centre, ASHA = American Speech-Language-Hearing Association, RCSLT = Royal College of Speech and Language Therapists

Note: Each respondent could list as many methods as they wished.

Table 7. Factors influencing speech pathologists’ selection of a therapy approach or technique for aphasia rehabilitation.

Answer	Count	% of respondents
Scientific evidence base to support the therapy approach or technique	141	80%
Ease of administration of therapy approach or technique (e.g., amount of preparation time required, specific resources needed)	112	64%
Access and availability within your workplace	102	58%
Level of knowledge and familiarity with the therapy approach or technique	93	53%
Cost of therapy approach or technique	43	24%
Reimbursement for a particular intervention	8	5%
Other
Fit with patient’s clinical presentation (language, cognitive and medical factors) and goals for intervention	7	4%
Patient’s personal preference and task engagement	4	2%
Fit with service model (group intervention, volunteer-facilitated, conversation-based, not impairment-level, ability to be delivered online, time availability)	3	2%
Clear description of the treatment in the literature including key components and mechanisms of therapy	1	1%
Gap in SLPs knowledge/skill base	1	1%
Fit or ability to adapt for local population (i.e., CALD)	1	1%
Word of mouth from other clinicians/anecdotal success	1	1%

Note: CALD = Culturally and Linguistically Diverse.

Table 8. Speech pathologists’ access of resources to support the implementation of aphasia therapy.

Having found an approach to aphasia therapy that you want to implement, what resources do you access and where from?
Answer	Count	% of respondents
Online resources from search engines (e.g., Google^© images)	128	73%
Personally salient stimuli (e.g., from person with aphasia)	124	70%
Existing resources within your workplace or department	124	70%
Aphasia therapy software (e.g., computer programs and apps)	112	64%
Commercial aphasia therapy resources (e.g., workbooks and activity sheets)	108	61%
Other
Develop my own resources	11	6%
Textbooks and research literature	1	1%
Podcasts or webinars	1	1%
Student created resources	1	1%
International professional colleagues	1	1%

Table 9. Conventional content analysis of speech pathologist perspectives on the development of the Aphasia Therapy Finder.

Category	Subcategory	Example	Behaviour Change Domain of the Theoretical Domains Framework^a
Potential benefits of the ATF	ATF may support the translation of evidence-based practice	“Sounds ideal and badly needed as there is such divergence of approach that an evidence-based repository would be hugely helpful.”	Beliefs about consequences
	Useful for training students and new graduate speech pathologists	“Seems like a very practical and useful project. Many new graduates report - they have heard of these techniques - but are unclear of ‘how’ to perform them.”	Beliefs about consequences
Equity of Access	Cost and payment model	“Cost is a big limiting factor for any therapy approaches. Indicating what is free or not would be important”	Environmental context and resources
	Access for clinicians in developing countries	“It will be good to have access to the Aphasia Therapy Finder however, therapists from developing countries may not be able to afford it just like other treatment packages … it will be good to have a waiver for SLPs from developing countries”	Environmental context and resources
Clinical Considerations	Recency of evidence included in the repository	“To continue to be useful (and evidence based) the resource would need constant updating.”	Knowledge
	Comprehensive range of therapy approaches included	“Needs to cover interventions across all aspects of the ICF, feel it is easy for it to be still impairment focused … needs to be regularly updated, relevant etc.”	Knowledge
	Access to culturally appropriate information and resources	“Please also consider the cultural relevance of some therapies as most/ all published materials are white- centric and high-income country biased. For this and other reasons, most materials need to be personalised and this is time consuming for the SLT. Would welcome information on cultural biases for each type of approach.”	Environmental context and resources Beliefs about consequences
Usability	Time efficient	“I think it would be an amazing resource for very busy clinicians to have this all in one place with the leg work of finding the papers/evidence done for us.”	Environmental context and resources Beliefs about consequences
	Direct access to therapy resources	“As a clinician recently moved from the hospital system to private practise it is vital to have easy access to evidence-based therapy resources for aphasia to ensure quality care.”	Environmental context and resources Beliefs about consequences Skills
	Incorporation of videos to demonstrate therapy techniques	“Videos would be amazing, I think confidence and time is a major that is a barrier for many when implementing new approaches. It takes time to read an article and figure out how to implement with trial and error. If PWA and experts were agreeable to share videos of intervention I think it would go a long way to improving the quality of service SPs provide.”	Beliefs about consequences Skills

Note. Categories and subcategories were generated based on researcher interpretation. ATF = Aphasia Therapy Finder. ^a Michie et al. (2005).

Appendix 1. Specific aphasia therapy types and other forms of aphasia treatment used by speech pathologists in aphasia rehabilitation. In addition to the above therapy approaches, please list any specific therapy types that you commonly use in aphasia rehabilitation.

Therapy technique	Count	% of respondents
Verb Network Strengthening Treatment (VNeST)	22	13%
Semantic Feature Analysis (SFA)	19	11%
Anomia therapy (including repetition, word finding, cueing hierarchies, errorless treatments)	9	5%
Script training	8	5%
Augmentative and Alternative Communication (AAC)	7	4%
Copy and Recall Therapy (CART)	7	4%
Phonological Component Analysis (PCA)	7	4%
Discourse Treatment (including NARNIA, narrative Intervention, Cooperative Narrative Recall Therapy, Integrated discourse therapy)	6	3%
Functional, goal-directed therapy	6	3%
Life Participation Approach to Aphasia (LPPA)	6	3%
Oral Reading for Language in Aphasia (ORLA)	6	3%
Cognitive neuropsychological treatment (word retrieval, auditory processing, reading, spelling, sentence processing)	5	3%
Promoting Aphasic’s Communicative Effectiveness (PACE)	5	3%
Supported conversations in aphasia SCA/Better conversations with aphasia	5	3%
Anagram and Copy Treatment (ACT)	4	2%
Articulation approaches: e.g., integral stimulation	4	2%
Multiple Oral Reading (MOR)	4	2%
Psychological support: Advocacy, counselling	4	2%
Response Elaboration Technique (RET)	4	2%
Attentive Reading Constrained Summarisation/ARCS-W	3	2%
Cognitive Linguistic Treatment	2	1%
Computer therapy apps (StepbyStep, Listen-in)	2	1%
Mapping therapy	2	1%
Memory and attention treatments (e.g., Attention Process Training)	2	1%
MODality-Activation (MODAK)	2	1%
Multidisciplinary intervention	2	1%
Metacognitive approaches	2	1%
Treatment of Underlying Forms (TUF)	2	1%
Sentence Production Program for Aphasia (SPPA)	2	1%
Abstract Semantic Associative Network Training (AbSANT)	1	1%
Aphasia Education	1	1%
Asset-based Community Development (ABCD) for aphasia	1	1%
Biographic Narrative Intervention	1	1%
Combined Aphasia and Apraxia of Speech Treatment (CAAST)	1	1%
Communication partner training	1	1%
Constraint Induced Language Therapy (CILT)	1	1%
Gesture-based therapy	1	1%
Group therapy	1	1%
Melodic Intonation Therapy (MIT)	1	1%
Self-management approaches	1	1%
Speech Entrainment Therapy (SET)	1	1%
Strategy-based reading comprehension approaches	1	1%
Tactile kinaesthetic treatment - pure alexia	1	1%

Note: Additional responses were received from 173 of 176 respondents. Respondents were able to provide free text responses to this prompt. Not all responses are considered a specific therapy type (e.g., group therapy), but remain listed here for completeness.

Michie, S., et al. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. Quality and Safety in Health Care. 14(1): 26–33.

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