Do measures of language impairment predict patient‐reported communication difficulty and distress as measured by the Burden of Stroke Scale (BOSS)?

This work was supported by the VHA Department of Rehabilitation Research and Development Merit Review Program (Project # C2386R), and the VA Pittsburgh Healthcare System's Geriatric Research Education and Clinical Center (GRECC).

The authors wish to acknowledge the contributions of Burden of Stroke Scale (BOSS) Phase 2 Field Trial collaborators, Katherine Ross PhD, VAMC Phoenix, and Julie Wambaugh PhD, VAMC Salt Lake City, the assistance of their respective study team members, Steve Larson MA, Rosalea Cameron MA, and Christina Nessler MA, and the assistance of Mary Ann Oakley and Amy Goda.

Abstract

Background: Patient‐reported measures of communication difficulty and communication‐related distress may be used to obtain efficient and valid indices of the functional consequences of aphasia and its treatment on the daily lives of many community‐dwelling stroke survivors. However, they have not been employed to evaluate treatment outcomes or to examine hypotheses specifying their relationship to commonly employed measures of speech and language impairment in persons with aphasia.

This work was supported by the VHA Department of Rehabilitation Research and Development Merit Review Program (Project # C2386R), and the VA Pittsburgh Healthcare System's Geriatric Research Education and Clinical Center (GRECC).

The authors wish to acknowledge the contributions of Burden of Stroke Scale (BOSS) Phase 2 Field Trial collaborators, Katherine Ross PhD, VAMC Phoenix, and Julie Wambaugh PhD, VAMC Salt Lake City, the assistance of their respective study team members, Steve Larson MA, Rosalea Cameron MA, and Christina Nessler MA, and the assistance of Mary Ann Oakley and Amy Goda.

Aims: This study examined whether the Shortened Porch Index of Communicative Abilities, (SPICA) (Disimoni, Keith, & Darley, 1980), 55‐item Revised Token Test (55‐item RTT) (Arvedson, McNeil, & West, 1986), and BDAE Severity Rating Scale (Goodglass, Kaplan, & Barressi, 2001) scores obtained at 3 months post‐onset (MPO) predicted patient‐reported communication difficulty and distress as measured by the Burden of Stroke Scale (BOSS) (Doyle et al., 2004) at 12 MPO.

Methods & Procedures: A sample of 37 adults with mild to moderate aphasia (M SPICA %ile  =  70.4) were identified from a larger sample (n  =  178) of community‐dwelling stroke survivors who participated in a longitudinal investigation designed to examine the psychometric properties of the BOSS. Speech and language data obtained from the sub‐sample of participants with aphasia were retrospectively examined in two sequential regression models in which the 3‐MPO test scores served as the predictor variables of interest, and 12‐MPO BOSS Communication Difficulty and Communication Distress Scores served as dependent variables.

Results: Among the speech and language measures examined, only 3‐month BDAE Severity Ratings contributed significantly to the prediction of 12‐month patient‐reported communication difficulty and distress as measured by the BOSS.

Conclusions: The findings suggest that performance‐based measures of speech and language impairment such as the SPICA and 55‐item RTT may not accurately predict the day‐to‐day communication difficulty and distress experienced by community‐dwelling stroke survivors with mild to moderate aphasia. Replication of these findings in a prospectively designed study employing a larger more representative sample, and more comprehensive assessment instruments is needed to substantiate the relationship between performance‐based measures of language impairment and patient‐reported communication difficulty and distress in adults with aphasia.

Notes

This work was supported by the VHA Department of Rehabilitation Research and Development Merit Review Program (Project # C2386R), and the VA Pittsburgh Healthcare System's Geriatric Research Education and Clinical Center (GRECC).

The authors wish to acknowledge the contributions of Burden of Stroke Scale (BOSS) Phase 2 Field Trial collaborators, Katherine Ross PhD, VAMC Phoenix, and Julie Wambaugh PhD, VAMC Salt Lake City, the assistance of their respective study team members, Steve Larson MA, Rosalea Cameron MA, and Christina Nessler MA, and the assistance of Mary Ann Oakley and Amy Goda.

1. Operationalised as (a) living in a private residence alone, (b) living in a private residence with a spouse, partner, or family member, or (c) living in a residential assisted‐living community.

2. All study SLPs completed a face‐to‐face, 40‐hour PICA training course conducted by MRM, and viewed a videotaped instruction module for administering and scoring the RTT. All SLPs demonstrated 80% or greater point‐to‐point reliability with the respective external standards for these instruments prior to data collection.