Speech and Hearing Sciences - Journal Articles

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    UK speech and language therapists’ assessment of children's expressive language, and functional impairment and impact, following the CATALISE publications
    (Wiley, 2023-04) Waine, Hannah; Bates, Sally; Frizelle, Pauline; Oh, Thomasina M.; National Institute for Health Research Applied Research Collaboration South West Peninsula
    Background: In 2016/17, the CATALISE Consortium published the results of a multinational and multidisciplinary Delphi consensus study, representing agreement among professionals about the definition and process of identification of children with Developmental Language Disorder (DLD) (Bishop et al., 2016, 2017). The extent to which the current clinical practice of UK speech and language therapists (SLTs) reflects the CATALISE consensus statements is unknown. Aims: To investigate how UK SLTs’ expressive language assessment practices reflect the CATALISE documents’ emphasis on the functional impairment and impact caused by DLD, by examining: whether multiple sources of assessment information are gathered; how standardised and non-standardised sources are combined in clinical decision-making, and how clinical observation and language sample analysis are utilised. Methods and Procedures: An anonymous, online survey was carried out between August 2019 and January 2020. It was open to UK-based paediatric SLTs who assess children up to age 12 with unexplained difficulties using language. Questions probed different aspects of expressive language assessment which are referred to in the CATALISE consensus statements and supplementary comments, and asked about participants’ familiarity with the CATALISE statements. Responses were analysed using simple descriptive statistics and content analysis. Outcomes and Results: The questionnaire was completed by 104 participants, from all four regions of the United Kingdom, working in a range of clinical settings with different levels of professional experience of DLD. The findings indicate that clinical assessment practices broadly align with the CATALISE statements. Although clinicians carry out standardised assessments more frequently than other types of assessment, they also gather information from other sources and use this alongside standardised test scores to inform clinical decisions. Clinical observation and language sample analysis are commonly utilised to evaluate functional impairment and impact, along with parent/carer/teacher and child report. However, asking about the child's own perspective could be more widely utilised. The findings also highlight a lack of familiarity with the details of the CATALISE documents among two thirds of the participants. Conclusions and Implications: Assessment practices broadly align with the CATALISE statements, but there is a need for greater clarity regarding terminology and the assessment of functional language impairment and impact. This research should prompt discussion in the profession about how to further develop and adopt expressive language assessment practices which reflect the CATALISE consensus and support effective assessment.
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    Developing, monitoring, and reporting of fidelity in aphasia trials: core recommendations from the collaboration of aphasia trialists (CATs) trials for aphasia panel
    (Taylor & Francis, 2022-03-13) Behn, Nicholas; Harrison, Madeleine; Brady, Marian C.; Breitenstein, Caterina; Carragher, Marcella; Fridriksson, Julius; Godecke, Erin; Hillis, Argye; Kelly, Helen; Palmer, Rebecca; Rose, Miranda L.; Thomas, Shirley; Tippett, Donna; Worrall, Linda; Becker, Frank; Hilari, Katerina; National Health and Medical Research Council; Bundesministerium für Bildung und Forschung; German Society for Aphasia Research and Treatment; National Institute on Deafness and Other Communication Disorders; Stroke Association; Tavistock Trust for Aphasia; Edith Cowan University
    Background: Developing, monitoring, and reporting of fidelity are essential and integral components to the design of randomised controlled trials (RCTs) in stroke and aphasia. Treatment fidelity refers to the degree to which an intervention is delivered as intended and is directly related to the quality of the evidence generated by RCTs. Clear documentation of treatment fidelity in trials assists in the evaluation of the clinical implications of potential benefits attributed to the intervention. Consideration of the implementation requirements of a research-based intervention as intended in a clinical context is necessary to achieve similar outcomes for a clinical population. Despite this, treatment fidelity is rarely reported in RCTs of aphasia intervention. Aim: To describe fidelity strategies and develop core recommendations for developing, monitoring, and reporting of fidelity in aphasia intervention RCTs. Scope: Relevant conceptual frameworks were considered. The Behaviour Change Consortium comprehensive framework of fidelity was adopted. It includes five areas: study design, training providers, delivery of treatment, treatment receipt, and treatment enactment. We explored fidelity in RCTs with a range of complex aphasia interventions (e.g., ASK, Big CACTUS, COMPARE, FCET2EC, POLAR, SUPERB, and VERSE) and described how different trial design factors (e.g., phase of trial, explanatory vs. pragmatic, number and location of sites, and number and type of treatment providers) influenced the fidelity strategies chosen. Strategies were mapped onto the five areas of the fidelity framework with a detailed exploration of how fidelity criteria were developed, measured, and monitored throughout each trial. This information was synthesised into a set of core recommendations to guide aphasia researchers towards the adequate measurement, capture, and reporting of fidelity within future aphasia intervention studies. Conclusions/Recommendations: Treatment fidelity should be a core consideration in planning an intervention trial, a concept that goes beyond treatment adherence alone. A range of strategies should be selected depending on the phase and design of the trial being undertaken and appropriate investment of time and costs should be considered.
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    Measuring communication as a core outcome in aphasia trials: Results of the ROMA‐2 international core outcome set development meeting
    (Wiley, 2022-12-30) Wallace, Sarah J.; Worrall, Linda; Rose, Tanya A.; Alyahya, Reem S. W.; Babbitt, Edna; Beeke, Suzanne; de Beer, Carola; Bose, Arpita; Bowen, Audrey; Brady, Marian C.; Breitenstein, Caterina; Bruehl, Stefanie; Bryant, Lucy; Cheng, Bonnie B. Y.; Cherney, Leora R.; Conroy, Paul; Copland, David A.; Croteau, Claire; Cruice, Madeline; Dipper, Lucy; Hilari, Katerina; Howe, Tami; Kelly, Helen; Kiran, Swathi; Laska, Ann‐Charlotte; Marshall, Jane; Murray, Laura L.; Patterson, Janet; Pearl, Gill; Jana Quinting; Rochon, Elizabeth; Rose, Miranda L.; Rubi‐Fessen, Ilona; Sage, Karen; Simmons‐Mackie, Nina; Visch‐Brink, Evy; Volkmer, Anna; Webster, Janet; Whitworth, Anne; Le Dorze, Guylaine; National Health and Medical Research Council; University of Manchester; National Institute for Health and Care Research; Stroke Association
    Background: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia—ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. Aim: To establish consensus on a communication OMI for inclusion in the ROMA COS. Methods & Procedures: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. Outcomes & Results: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living—3 (CADL-3). TST received 72% (n = 21) of ‘yes’ votes and the CADL-3 received 28% (n = 8) of ‘yes’ votes. Conclusions & Implications: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research.
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    ICT usage in aphasia rehabilitation – beliefs, biases, and influencing factors from the perspectives of speech and language therapists
    (Taylor & Francis, 2022-02-07) Kearns, Áine; Kelly, Helen; Health Research Board
    Background: The use of digital technology is promoted as an efficient route for the delivery of intensive speech and language therapy in aphasia rehabilitation. Research has begun to explore the views of people with aphasia (PwA) in relation to Information and Communication Technology (ICT) usage in the management of aphasia but there is less consideration of the prescribers’ views, i.e., speech and language therapists (SLTs). Aims: We aimed to explore SLTs’ views of ICT use in aphasia management and identify factors that influence their decisions to accept and integrate ICT in aphasia rehabilitation. In addition, we considered the findings in the context of the Unified Theory of Acceptance and Use of Technology (Venkatesh, Morris, Davis & Davis, 2003). Methods & Procedures: Speech and language therapists (n = 15) from a range of clinical and geographical settings in the Republic of Ireland were invited to participate in one of four focus groups. Focus group discussions were facilitated by an SLT researcher and were audio-recorded and transcribed. Analysis was completed following Braun and Clarke’s six phases of thematic analysis (Braun and Clarke, 2006). Outcomes & Results: Four key themes were identified; i. Infrastructure, Resources, and Support, ii. SLT beliefs, biases and influencers, iii. Function & Fit, and iv. ICT and Living Successfully with Aphasia. The SLTs discussed a wide range of factors that influence their decisions to introduce ICT in aphasia rehabilitation, which related to the person with aphasia, the SLT, the broad rehabilitation environment, and the ICT programme features. In addition, several barriers and facilitators associated with ICT-delivered aphasia rehabilitation were highlighted. Conclusion: This research highlights a range of issues for SLTs in relation to the use of ICT in aphasia rehabilitation within an Irish context. The potential benefits of using ICT devices in rehabilitation and in functional everyday communication were discussed. However, SLTs also identified many barriers that prevent easy implementation of this mode of rehabilitation.
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    Learning to swallow together: Medical and speech and language therapy student interprofessional learning about dysphagia
    (IOS Press, 2021-11-09) Kelly, Helen; Cronin, Maireád; Hynes, Helen; Duxbury, Sarah; Twomey, Orlaith; Irish Network of Healthcare Educators (INHED)
    BACKGROUND: Interprofessional education (IPE) is considered to be a necessary step in preparing the healthcare workforce for collaborative patient care. Dysphagia, a complex health condition, requires collaboration between disciplines such as medicine (MED) and speech and language therapy (SLT). Therefore, both disciplines must have a shared understanding of dysphagia management within the context of interprofessional care. OBJECTIVE: This study investigated MED and SLT students’ shared learning about dysphagia management following an IPE workshop. The student experience of IPE was also explored. METHODS: Fifty students participated in one 3-hour classroom-based IPE dysphagia workshop which was appraised through a questionnaire completed immediately before and following the workshop. Within- and Between-Group analysis evaluated change in knowledge about dysphagia management. Comments related to student learning experiences were examined using a qualitative description approach. RESULTS: 98%of students (24 MED; 25 SLT) completed pre- and post-workshop questionnaires. Wilcoxon Signed-Rank tests indicated statistically significant post-workshop growth in knowledge of symptoms (p < 0.001) and medical conditions (p < 0.001) related to dysphagia. Students reported increased confidence in their ability to identify dysphagia (p < 0.001). Greater understanding of interprofessional roles was observed post-workshop, notably nursing (p < 0.05), pharmacy (p < 0.05), occupational therapy (p < 0.05) and physiotherapy (p < 0.001). While recognised as beneficial to shared learning and appreciation of different discipline perspectives, both cohorts found IPE challenging. CONCLUSIONS: Classroom-based IPE is an appropriate approach for shared learning about complex health conditions which require interprofessional care. Including patient-facing activities would further enhance student learning. While students found IPE challenging, they identified several benefits related to their professional development.