Making aphasia implementation stick: ensuring the sustainability of implementation

ABSTRACT

Background: Evidence-practice gaps exist in aphasia rehabilitation across the continuum of care. The principles of implementation science have been utilised in recent research to reduce evidence-practice gaps and demonstrate improvements in clinical practice. However, the sustainability of these changes are unknown. Sustained outcomes are critical to establishing whether practice improvements have been maintained with clear ongoing health impacts for clients. Without sustained outcomes there is potential waste of time and resources in an already burdened health system.

Aims: In this tutorial paper, we provide a brief introduction to clinical sustainability models and outline evidence for sustainability of outcomes in aphasia implementation research to date.

Methods: We utilised a recent review of aphasia implementation studies to critically evaluate the sustainability of implementation research. Each included article was analysed with reference to (i) sustainability processes and measures, and (ii) important stages in designing, monitoring, and revising behaviour change. Two examples of aphasia implementation research are then presented to illustrate potential methods to enhance intermediate and long term sustainability.

Results: None of the six reviewed studies contained a specific sustainability plan, and none included outcome measurement beyond 6 months post-intervention. While behaviour change approaches were utilised, no study implemented an iterative behaviour change strategy beyond one implementation cycle to address to ongoing or new implementation barriers.

Discussion and Conclusions: Aphasia implementation research has not targeted implementation sustainability beyond a single ‘revolution’ of the implementation cycle. Future implementation efforts in aphasia require focus on a more continuous, iterative implementation process with reference to models of implementation that promote sustainability. We provide recommendations for ways to enhance sustainability research and practice.

KEYWORDS:

• Implementation science
• evidence-based practice
• aphasia
• sustainability
• behaviour-change intervention

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Emma Power http://orcid.org/0000-0002-2638-0406

Lucy Bryant http://orcid.org/0000-0001-8497-7406

Kirstine Shrubsole http://orcid.org/0000-0002-7805-2447