Creating therapeutic relationships through communication: a qualitative metasynthesis from the perspectives of people with communication impairment after stroke

Figures & data

Figure 1. Search strategy and results.

Table 1. Included papers.

Citation	Author	Focus of study	Researcher discipline^a	Setting^b	Participants^c	Methodology and methods
[23]	Berg, Askin, Baladin, Armstrong & Rise (2017)	Explore how people with aphasia experienced participation during goal-setting and clinical decision-making in language rehabilitation	Speech therapy	Aphasia rehabilitation	N = 15 people w aphasia (8 F: 7 M)	Methodology: qualitative data collection: individual interviews data analysis: systematic text condensation
[24]	Boutin-Lester & Gibson (2002)	Understand patient’s perspectives of home-based occupational therapy during stroke rehabilitation	Occupational therapy	Occupational therapy in home-based stroke rehabilitation	N = 5 (4 F:1M) 1 with aphasia	Methodology: Phenomenology Data collection: Individual interviews (2 per participant) Data analysis: Thematic analysis
[35]	Bright, Kayes, McCann & McPherson (2013)	Explore how hope is experienced by people with aphasia during post-acute stroke rehabilitation	Speech therapy	NA	N = 5 people with aphasia (2 F:3M)	Methodology: Interpretive Description Data collection: Individual interviews (3 per participant) Data analysis: Thematic and narrative analysis
[37]	Bright, Kayes, Cummins, Worrall & McPherson (2017)	Explore the interplay between patient and practitioner engagement and disengagement in stroke rehabilitation	Speech therapy	Inpatient and home-based stroke rehabilitation	N = 11, gender not specified Aphasia: 6, apraxia 6; Dysarthria: 3, Cognitive communication: 2	Methodology: Voice centred relational approach Data collection: Individual interviews (5 participants), Observations and interviews over episode of care (4 participants) Data analysis: Listening Guide
[11]	Bright, Kayes, McPherson & Worrall (2018)	Examine how people with communication impairments engage in stroke rehabilitation	Speech therapy	Inpatient and home-based stroke rehabilitation	N = 4 (2 F:2M) Aphasia: 3; Apraxia: 1; Cognitive communication: 2; Dysarthria: 1	Methodology: Voice centred relational approach Data collection: Observations and interviews over episode of care Data analysis: Listening Guide
[39]	Burns, Baylor, Dudgeon, Starks & Yorkston (2015)	Explore perspectives of people with aphasia, family and doctors about communication with doctors	Speech therapy	Outpatient/community medical services	N = 6 (2 F:4M) 5 with post-stroke aphasia	Methodology: Qualitative description Data collection: Interviews (2 per person) Data analysis: Thematic analysis
[33]	Clancy, Povey & Rodham (2018)	Explore experiences of staff-patient communication in inpatient stroke care	Health psychology	Inpatient stroke services	N = 6 people with aphasia (4 F:2M)	Methodology: Critical realist Data collection: Focus group, individual interviews Data analysis: Thematic analysis
[44]	Dickson, Barbour, Brady, Clark & Paton (2008)	Investigate beliefs and experiences of people with dysarthria about their speech disorder and its impacts	Unknown	NA	N = 24 (9 F:15M) Setting: NA	Methodology: Qualitative Data collection: Individual interviews Data analysis: Thematic analysis
[22]	Fourie (2009)	Explore patient perceptions of therapeutic relationships in speech-language therapy	Speech therapy	Speech therapy services	N = 11 (6 F,5M), 3 with stroke Aphasia: 3, Dysarthria: 1	Methodology: Grounded theory Data collection: Interviews Data analysis: Grounded theory approach
[42]	Hersh, Wood & Armstrong (2017)	Explore interactions and therapeutic relationship development during assessments after stroke	Speech therapy	Inpatient speech therapy	N = 3 men with aphasia	Methodology: Qualitative Data collection: Observations and interviews Data analysis: Systemic functional linguistics and Thematic analysis
[40]	Hjelmblink, Bersten, Uvhagen, Kunkel & Holström (2007)	Understand the meaning of rehabilitation for one man with post-stroke aphasia	Unknown	Rehabilitation	N = 1 man with aphasia	Methodology: Phenomenology Data collection: Interview Data analysis: EPP phenomenological approach
[12]	Lawton, Haddock, Conroy, Serrant & Sage (2018)	Understand people’s experiences of constructing and maintaining therapeutic alliances in aphasia rehabilitation	Speech therapy	Aphasia rehabilitation	N = 18 people with aphasia (6 F:12M)	Methodology: Qualitative Data collection: Interviews Data analysis: Thematic analysis
[18]	Lawton, Haddock, Conroy, Serrant & Sage (2019)	Explore which elements of the therapeutic alliance are most valued by people with aphasia	Speech therapy	Aphasia rehabilitation	N = 23 people with aphasia (6 F:17M)	Methodology: Q methodology Qualitative interview data collected during sorting activities
[43]	Mackay (2003)	A sociological exploration of aphasia from the perspective of a person with aphasia	Sociology	Stroke services	Not specified	Theoretical paper
[21]	Nyström (2009)	Explore professional aphasia care from the perspective of people with aphasia	Unknown	Stroke services	N = 9 people with aphasia(4F:5M)	Methodology: Phenomenology Data collection: Interviews Data analysis: Phenomenological approach
[45]	Stans, Dalemans, de Witte & Beurskens (2013)	Explore experiences of communication in long-term care	Occupational therapy	Long term care	N = 14 (5 F, 9 M) 5 people with post-stroke aphasia	Methodology: Critical incident approach Data collection: Interviews Data analysis: Critical incident analysis
[36]	Tomkins, Siyambalapitiya & Worrall (2013)	Explore factors influencing satisfaction and dissatisfaction with healthcare for people with aphasia	Speech therapy	Healthcare	N = 50 people with aphasia (26 F, 24 M)	Methodology: Descriptive phenomenology Data collection: Interviews Data analysis: Content analysis
[5]	Worrall, Davidson, Hersh, Ferguson, Howe & Sherratt (2010)	Examining evidence for relationship-centred care in aphasia rehabilitation in longitudinal study of insider experiences of aphasia	Speech therapy	Aphasia rehabilitation	N = 50 people with aphasia (26 F, 24 M)	Methodology: Qualitative descriptive Data collection: Interviews Data analysis: Content analysis
[41]	Young, Gomersall & Bowen (2013)	Explore people’s experiences of a trial comparing speech therapy and visitors	Social work	Speech therapy	N = 22 (9 F:13M) Aphasia: 17; Dysarthria: 10	Methodology: Qualitative study embedded within an RCT Data collection: Interviews Data analysis: Thematic content analysis

a Professional discipline of the first author is detailed if identifiable from the paper or from the author’s current academic webpage.

b Setting refers to the profession or service that is the focus of inquiry, if specified.

c If the study gathered data from multiple sources (e.g. patients, clinicians), we only given details of the patient participants as the metasynthesis only utilised their data.

Berg K, Askim T, Balandin S, et al. Experiences of participation in goal setting for people with stroke-induced aphasia in Norway. A qualitative study. Disabil Rehabil. 2017;39(11):1122–1130.

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Boutin-Lester P, Gibson RW. Patients' perceptions of home health occupational therapy. Aust Occup Ther J. 2002;49(3):146–154.

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Bright FAS, Kayes NM, McCann CM, et al. Hope in people with aphasia. Aphasiology. 2013;27(1):41–58.

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Bright FAS, Kayes NM, Cummins C, et al. Co-constructing engagement in stroke rehabilitation: a qualitative study exploring how practitioner engagement can influence patient engagement. Clin Rehabil. 2017;31(10):1396–1405.

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Bright FAS, Kayes NM, McPherson KM, et al. Engaging people experiencing communication disability in stroke rehabilitation: a qualitative study. Int J Lang Commun Disord. 2018;53(5):981–994.

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Burns M, Baylor C, Dudgeon BJ, et al. Asking the stakeholders: perspectives of individuals with aphasia, their family members, and physicians regarding communication in medical interactions. Am J Speech Lang Pathol. 2015;24(3):341–357.

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Clancy L, Povey R, Rodham K. "Living in a foreign country": experiences of staff-patient communication in inpatient stroke settings for people with post-stroke aphasia and those supporting them. Disabil Rehabil. 2020;42(3):324–334.

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Dickson S, Barbour RS, Brady M, et al. Patients' experiences of disruptions associated with post-stroke dysarthria. Int J Lang Commun Disord. 2008;43(2):135–153.

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Fourie RJ. Qualitative study of the therapeutic relationship in speech and language therapy: perspectives of adults with acquired communication and swallowing disorders. Int J Lang Commun Disord. 2009;44(6):979–999.

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Hersh D, Wood P, Armstrong E. Informal aphasia assessment, interaction and the development of the therapeutic relationship in the early period after stroke. Aphasiology. 2018;32(8):876–901.

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Hjelmblink F, Bernsten CB, Uvhagen H, et al. Understanding the meaning of rehabilitation to an aphasic patient through phenomenological analysis – a case study. Int J Qual Stud Health Well-Being. 2007;2(2):93–100.

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Lawton M, Haddock G, Conroy P, et al. People with aphasia’s perception of the therapeutic alliance in aphasia rehabilitation post stroke: a thematic analysis. Aphasiology. 2018;32(12):1321–1397.

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Lawton M, Haddock G, Conroy P, et al. People with aphasia's perspectives of the therapeutic alliance during speech-language intervention: a Q methodological approach. Int J Speech Lang Pathol. 2020;22(1):59–69.

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Mackay R. Tell them who i was’[1]: the social construction of aphasia. Disabil Soc. 2003;18(6):811–826.

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Nyström M. Professional aphasia care trusting the patient's competence while facing existential issues. J Clin Nurs. 2009;18(17):2503–2510.

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Stans SEA, Dalemans R, de Witte L, et al. Challenges in the communication between 'communication vulnerable' people and their social environment: an exploratory qualitative study. Patient Educ Couns. 2013;92(3):302–312.

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Tomkins B, Siyambalapitiya S, Worrall L. What do people with aphasia think about their health care? Factors influencing satisfaction and dissatisfaction. Aphasiology. 2013;27(8):972–991.

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Worrall L, Davidson B, Hersh D, et al. The evidence for relationship-centred practice in aphasia rehabilitation. JIRCD. 2011;1(2):277–300.

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Young A, Gomersall T, Bowen A. Trial participants' experiences of early enhanced speech and language therapy after stroke compared with employed visitor support: a qualitative study nested within a randomized controlled trial. Clin Rehabil. 2013;27(2):174–182.

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