Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Improving Communication Partner Training of Carers of People with Aphasia: Preliminary Results of a Stepped Wedge Implementation Trial (#107)

Kirstine Shrubsole 1 2 , Emma Power 3 , Kris Rogers 3 , Sarah Wallace 1 , Annie McCluskey 4 , Megan Isaacs 1 , Wen Xuan Ong 1
  1. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
  2. Speech Pathology Department, Princess Alexandra Hospital, Brisbane
  3. Graduate School of Health , University of Technology Sydney, Sydney
  4. Sydney School of Health Sciences,, The University of Sydney, Sydney

Background: Carer burden is a significant issue for partners of people with aphasia (1). Although Communication Partner Training (CPT) improves outcomes (2) and is recommended by the Stroke Foundation Living Guidelines (3), fewer than half of speech pathologists provide this training (4). A feasible and effective implementation strategy is required to close this evidence-practice gap.

Aims: To evaluate the feasibility and preliminary effectiveness of a novel implementation package on speech pathologists’ practice in providing CPT to carers of people with aphasia in rehabilitation and community settings.

Methods: Pilot stepped wedged cluster randomised controlled trial conducted with three health services over 12 months (2020-2021). All sites received the intervention: one-hour online module and half-day interactive workshop, resource provision and Site Champion training. Audit data was collected at 4 time-points and analysed with a generalised linear mixed model. Focus groups were conducted post implementation, analysed using qualitative content analysis (5).

Results: Thirty-six clinicians (speech pathologists, allied health assistants) participated; 106 patient files were audited. More carers were offered CPT with implementation (Odds ratio: 1.93), but there was no evidence of an intervention effect on CPT offers (CI: 0.36; 12.5, p-value = 0.84). There were small improvements in carers receiving CPT for two health services following the workshop (8% absolute percent increase), but small patient and site numbers did not allow estimation of intervention effect. Clinicians identified that while they valued and intended to implement CPT routinely, organisational barriers (e.g., workforce instability; COVID-19) and complex patient-carer relationships impacted implementation.

Conclusion: Our implementation package was feasible and may have led to more carers being offered CPT, however effects on CPT provision were unclear due to site-specific factors (e.g. COVID-19; carer readiness) confounding the time period analysis. Our preliminary findings suggest greater organisational support is necessary for clinicians to champion complex changes in CPT practice effectively, and that tiered CPT implementation may be required.

  1. Bakas T, Kroenke K, Plue LD, Perkins SM, Williams LS. Outcomes among family caregivers of aphasic versus non-aphasic stroke survivors. Rehabilitation Nursing. 2006;31(1):33-42.
  2. Simmons-Mackie N, Raymer A, Cherney LR. Communication Partner Training in aphasia: An updated systematic review. Archives of Phys Medicine & Rehabilitation. 2016;97(12):2202-21.
  3. Stroke Foundation. Clinical Guidelines for Stroke Management. Melbourne, Australia. 2017.
  4. Chang H, Power E, Foster A, O' Halloran R. Stroke Communication Partner Training: A national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators. International Journal of Language & Communication Disorders. 2018.
  5. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004 Feb;24(2):105-12. doi: 10.1016/j.nedt.2003.10.001. PMID: 14769454