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Background: The involvement of service users and supporters/advocates in healthcare education and healthcare research has developed an increasingly high profile in recent years, but relatively little is known about collaborations involving people with aphasia and family members. Aims: To reflect on and learn from the experience of collaboration, examining the ways in which the involvement of people with aphasia and family members was carried out over a fifteen-year period in the context of a UK university. Methods and procedures: We have taken a reflective longitudinal case study approach, and used constructs from implementation theory as sensitizing concepts in a cross-sectional analysis of documents in four key activities: the Conversation Partner scheme; Reaching Further Out; Supported Communication to Improve Participation in Rehabilitation; the Aphasia Research Collaboration. We then produced narrative accounts which run through the whole period of the study. Through this process, we as authors also reflected on our own experiences of collaboration. Outcomes and results: Conversation Partners (CP), integrated into the speech and language therapy practice placement, was the basis for almost all subsequent involvement. We deepened and strengthened the scope of the CP collaboration through funded workshops–Reaching Further Out–facilitated by Connect. Increasing the visibility of our collaboration enabled us to attract institutional support to develop our first major research undertaking, where people with aphasia played a key role in highlighting the need for the study, developing and implementing the intervention, taking part in project oversight, and helping disseminate the findings. The Aphasia Research Collaboration began as a partnership between speech and language therapy students and people with aphasia and has continued in various forms. Four narrative threads run through the period of this study: the importance of systems and people being adaptable; the contribution of leadership and commitment to continuity; a commitment to act and learn together; the importance of understanding value. Conclusions: Collaboration between people with aphasia, family members, and academic staff has been a collective accomplishment, where careful attention to learning, negotiation and adjustment have led to sustained involvement. In the future, where collaborations may be increasingly mediated through online technologies, all those involved must ensure that these are supported by robust and inclusive processes.

Purpose: International health and social care policy increasingly draws on stakeholder experiences and opinions. The distinctions between various approaches to researching “insider” perspectives are contentious. This article explores features (e.g. philosophy, ethics, and power dynamics) of qualitative approaches and public and patient involvement (PPI) in communication disorder research and explicates the blurred boundaries between them. Method: We use two case studies involving PPI contributors with aphasia – an Irish mixed methodologies study and a Danish qualitative study - to illustrate PPI in research and thus demonstrate how researchers can bridge the gap between theoretical considerations and research implementation Result: There are important distinctions between PPI in research and qualitative approaches (e.g. origins, roles, and reimbursement) and many blurred boundaries (e.g. inclusion, openness to mutual learning and “insider” perspectives). A key difference is that PPI contributors take an active role at project level and more flexibility in roles is required in PPI research. These flexible and varied roles reflect the shared decision-making powers between lay and professional researchers. Conclusion: PPI can add innovation to qualitative and mixed methods communication disorder research as illustrated in both case studies. However, researchers wishing to include PPI must embrace and respond to the evolving and flexible nature of PPI relationships and processes. Flexibility, negotiation and continuous reflection on methodological approaches, power dynamics, roles and co-created knowledge will impact and transform the field of research in communication disorders.

Background : Definitions reflect the current state of knowledge about a health condition. An agreed definition of aphasia is central to the progression of the science and clinical practice relevant to aphasia.\ud \ud Aim : To establish consensus on a definition of aphasia.\ud \ud Methods & Procedures : A three-round modified e-Delphi study was conducted with aphasia researchers who were members of the Collaboration of Aphasia Trialists (CATs). In round one, participants were provided with a draft definition developed by the Societal Impact and Reintegration Working Group of CATs. Participants were asked whether they agreed with the definition and were asked to comment on any aspects that they perceived to require amendment. Comments were collated and analysed using inductive content analysis. In round two, participants were presented with the collated and de-identified results of the first round and the participants were asked to vote “yes/no” on two contentious aspects of the definition. In round three, agreement on the revised definition was again sought using closed “yes/no” voting. Consensus was defined a priori as at least 70% agreement by 80% of all CATs members. CATs membership fluctuated across the study period and ranged between 131 and 141 members.\ud \ud Outcomes & Results : The proposed definition was Aphasia is a communication disability due to an acquired impairment of language modalities caused by focal brain damage. Aphasia may affect participation and quality of life of the person with aphasia as well as their family and friends. Aphasia masks competence and affects functioning across relationships, life roles and activities, thereby influencing social inclusion, social connectedness, access to information and services, equal rights, and wellbeing in family, community and culture.\ud \ud Two main categories of proposed amendments to the definition were identified: (1) definition of aphasia as a communication disability versus a language impairment; and (2) definition of aphasia as being the result of a focal and/or diffuse lesion. After three rounds of surveys, consensus was unable to be achieved with an almost even split across participants on both amendment issues.\ud \ud Conclusion : Further debate about the use of the term communication disability to describe aphasia and whether aphasia is a result of focal or diffuse lesions is required before consensus is again attempted.

Purpose: This commentary describes how a grassroot-led partnership initiated by members of the organisations World Federation of NeuroRehabilitation and Collaboration of Aphasia Trialists is addressing the marginalisation of people with aphasia, through education and knowledge exchange related to communication partner training of health professionals. Result: A partnership between academics and healthcare professionals across Austria, Denmark, Egypt, Ireland, Greece, India, Serbia and the United Kingdom was established in 2020. Through bimonthly online sessions in 2021–2022 a Danish communication partner training program was introduced while six teams adapted and translated the training and its materials to their local contexts. Conclusion: A collaborative partnership enabled multiple translations of an existing communication partner training program for healthcare professionals working with people with aphasia to support a sustainable delivery model that is linguistic and culturally sensitive. This commentary paper focusses on Sustainable Development Goal (SDG) 17 and also addresses SDG 10.

Background: An important goal of people living with aphasia, aphasia organizations and professionals who work with aphasia is increased awareness of aphasia by the public. However, surveys of the public awareness of aphasia around the world and over time suggest that public knowledge of aphasia is poor. Aims: The aim of this article is to examine the literature on aphasia awareness and aphasia awareness campaigns, and to propose a strategic research agenda to move awareness building forward. Main Contribution: Aphasia awareness campaigns appear to have had minimal impact on knowledge of aphasia by the general public. Potential problems with aphasia awareness building were identified including a lack of a unified and compelling message across awareness campaigns, lack of coordination across organizations and campaigns, tendency to target audiences already familiar with aphasia, failure to base campaigns on theory and research from disciplines such as marketing, health promotion and communication research, failure to involve people with aphasia, their families and health-care professionals in the co-design of campaigns and no evidence that the impact of campaigns has been evaluated. Conclusions: A strategic research agenda is needed in order to increase the effectiveness, co-design, and co-evaluation of aphasia awareness campaigns worldwide. The authors propose an international effort and comprehensive research agenda to address aphasia awareness.

Coordination of international aphasia research would minimise duplication of effort, support synergistic international activities across languages and multidisciplinary perspectives, and promote high-quality conduct and reporting of aphasia research, thereby increasing the relevance, transparency, and implementation of findings. The Collaboration of Aphasia Trialists (CATs) sought to develop an aphasia research agenda to direct future research activities, based on priorities shared by people with aphasia, family members, and healthcare professionals. Our established international research network spanning 33 countries contributed to this activity. Research literature reporting the priorities of stakeholders was reviewed and synthesized (phase 1). Representatives from Working Groups on Aphasia Assessment & Outcomes, Prognosis & Predictors of Recovery, Effectiveness of Interventions, and Societal Impact & Reintegration participated in a two-day research agenda-setting meeting. The CATs expert panel refined research objectives and identified constituent components of research and methodological developments required to address these research components. The objectives and research components were grouped into overarching themes (phase 2). The resultant list was then circulated to more than 180 CATs members for review, revision, and approval. Consensus on the final aphasia research agenda and roadmap was reached by CATs executive committee (phase 3). The expert panel identified five overarching research themes: (i) evidence-based interventions for people with aphasia, (ii) effective interventions to support those communicating with people with aphasia, (iii) cross-linguistic assessment and core outcomes for aphasia research, (iv) predictors of language recovery, and (v) clinical implementation of research findings. Within these broad themes, 30 research objectives and 91 individual aphasia research components were identified and sequentially ordered. This agenda builds on research priorities identified by people with aphasia and their families, and includes priorities of healthcare professionals and researchers, and will support the rehabilitation and recovery of people with aphasia. Our internationally relevant research agenda promotes rigor in methodology, considers international applicability, synergistic activities, and sharing of resources and expertise. publishedVersion

Patientology traditionally signifies the scientific study of the patients through medical sociological and anthropological perspectives. The last decades have witnessed notable changes in the understanding of what it means to be a patient and what role patients play in healthcare processes, with the rise of concepts such as patient-centered care, patient empowerment, and patient participation. This article develops a reconceptualization of patientology, proposes a model hereof, and exemplifies its use through the application to an illustrative case. Our reconceptualization of patientology considers the patient as the central actor in a network of healthcare actors. Being a patient requires health capital that is comprised of health-relevant aspects of Bourdieusian forms of capitals: economic, social, and cultural capital. The patient role is constructed through the patient’s interaction with a range of healthcare actors such as health professionals, relatives, and other patients. The proposed model allows for understanding health inequalities as based on differences in (cultural) health capital, opening up new avenues of investigating and ameliorating patients’ challenges in health interactions. The model allows for a fresh take on the reciprocity of Parsons social sick role, allowing to clarify both how patients can contribute to their own health and healthcare and where and how health professionals ought to meet their patients.

This paper aims to describe the interactional processes through which a medical professional and a patient collaboratively accomplish filling out answers to a questionnaire. Empirical analysis of three different sequences from a video-recorded doctor-patient interaction in which questions of a questionnaire were answered with a ‘no' reveals three different ways (or methods) in which doctor and patient accomplish this jointly. Applying ethnomethodological conversation analysis (EMCA) as our methodological framework, we conclude that the three interactional practices are fitted in relation to the constraints of the interview that is itself methodically aligned to the practices and organizational structures of the institution, a Danish hospital. Furthermore, we make the case that questionnaires are designed as idealizations of question-answer sequences, and as such do not operate at the same level of detail as the actual question-answer situation. Details that are crucial for the objective of the questionnaire (in this case providing information to a third party) may not be included in the recorded answer. Thus, we argue that in order to understand the informational value of recorded answers in questionnaires, we need to diagnose the interaction in which they were produced, i.e. to critically examine it.

Background: There is growing interest in interventions that promote positive outcomes and well-being for people with aphasia (PWA) and their families, but provision is inconsistent. An asset-based approach, based on the theory of salutogenesis, focuses on what makes you well rather than ill. This approach has been used successfully across a variety of research fields, including health and social care research and practice, and has the potential to provide coherent strategies to support people living successfully with aphasia. Aim: To explore the relevance and potential of an asset-based approach to promoting and sustaining well-being for PWA and their families, across contexts and cultures. Methods & procedures: Exploratory case studies were carried out in the United Kingdom (UK), Norway, Israel, Ireland, and Denmark in a variety of settings. Following an interpretative paradigm, we used qualitative methods including: interviews; appreciative inquiry; group discussions; and participatory action research. 95 PWA and 25 family members were asked to identify assets within themselves and their communities that promote, sustain and maintain well-being, by responding to: “What makes you feel good/well/healthy?” Data were analysed using thematic analysis. Outcomes & results: An asset-based approach proved to be a powerful means for PWA and family members to explore what helps them live well with aphasia. Key themes were identified: (1) personal journey; (2) helping others; (3) connecting to self; (4) connecting to others; (5) recreation; and (6) personal attributes. Self-identification of assets, within the person and their community, and connections to these, helped PWA and their family members to maintain well-being, overcome barriers and regain confidence. Using this approach, focusing on the person’s recognition, activation and mobilisation of assets, could enhance the person’s understanding and restore meaning around the stroke and onset of aphasia. Conclusion: This novel exploratory research demonstrates the relevance and potential across diverse cultural contexts of taking an asset-based approach to promoting and sustaining well-being for PWA and their families. Focusing on maintaining connections to these assets and developing meaning around the event, could prevent some of the negative sequela of stroke. The “patient–professional” relationship must transform into a collaborative partnership, with time and flexibility needed to introduce this approach. Further research should examine how service providers and PWA could develop and operationalise an asset-based approach in clinical and community settings and identify if there is an optimum timing for introducing this approach along the stroke pathway.

Background There is an increasing amount of research that investigates the needs and wishes of people with aphasia and their relatives with regards to improving the accessibility of communication with healthcare professionals (HCP). An important way to improve this is by training HCP to use supportive conversation techniques and tools. Objectives This study aimed to inform the development of such a training, by adding to previous findings in the literature regarding the experiences, needs and wishes of people with aphasia and their relatives. We were interested in their experiences with the accessibility of communication and support from HCP and how they believed this can be improved. Methods An exploratory qualitative research design was chosen. Data was collected through qualitative semi-structured interviews with 20 people with aphasia and 12 relatives. The time post stroke ranged from 3 months to 41 years. Results Four themes described the data. According to people with aphasia and relatives (1) information transfer in healthcare settings and (2) the use of supported conversation techniques by HCP are inadequate, (3) there is a lack of shared decision-making in healthcare settings, and (4) support, guidance, counseling and education is mainly targeted at the person with aphasia. Conclusions People with aphasia and relatives reported a variety of positive and negative experiences in all themes. Even though guidelines and interventions have been developed to improve healthcare for people with aphasia and their relatives, we found that people still encounter substantial challenges in access to- and provision of information, shared decision-making, support and communication with HCP. The findings in this study provide some important recommendations for improvement, including the improvement of transfer of information, shared decision-making and individual support for the relatives.

Background: Communication partner training (CPT) of health professionals (HP) is recommended in several international guidelines for stroke and aphasia. The effectiveness of CPT is well established, but research and evaluation is needed for implementation of CPT in different healthcare settings. The Health Professionals and Aphasia Questionnaire (HPAQ) was developed to make available a valid and reliable outcome measure, which is feasible for use with HP working in practice settings with people with aphasia as well as in research. Aims: The aim was to investigate the test–retest reliability and underlying psychometric properties of the HPAQ when administered four weeks apart to HP in neurorehabilitation.Methods and Procedures: Participants were recruited from a CPT implementation study in Denmark. Health professionals with con- tact with patients with aphasia were assigned to CPT courses and asked to fill the questionnaire four weeks before and on the day of their scheduled course. In all, 270 HP responded to the HPAQ. The internal consistency, test–retest reliability, structural validity, and floor and ceiling effects of the HPAQ questions were investigated using descriptive statistics, intraclass correlation coefficient (ICC), Cronbach’s alpha, and factor analysis.Outcomes and Results: The overall test–retest reliability of HPAQ was excellent (ICC = 0.86); and ICC of the individual questions ranged between 0.80 and 0.48. Minor ceiling or flooring effects in answering questions were present. The factor analysis revealed three underlying factors. The first and strongest was a CPT-related knowledge and skill factor represented in all questions except for question 10. The second component was associated with questions probing environmental factors. Test–retest reliability was excellent for the score developed with variables used in these factors. A third factor was associated with expecting or being prepared for making an extra effort when communicating with patients with aphasia. Test–retest reliability for the variables explaining this factor was good. Regarding professions, nurses have the highest ICC on the overall HPAQ, whereas physio and occupational therapists have the lowest. The overall HPAQ showed excellent or good reliability for all healthcare professionals with six or more years of experience, and fair reliability for respondents with fewer years of experience. Conclusions: The HPAQ has good reliability and is suitable as an outcome measure in CPT studies aimed at different health profes- sionals working in practice settings with people with aphasia. Background: Communication partner training (CPT) of health professionals (HP) is recommended in several international guidelines for stroke and aphasia. The effectiveness of CPT is well established, but research and evaluation is needed for implementation of CPT in different healthcare settings. The Health Professionals and Aphasia Questionnaire (HPAQ) was developed to make available a valid and reliable outcome measure, which is feasible for use with HP working in practice settings with people with aphasia as well as in research. Aims: The aim was to investigate the test–retest reliability and underlying psychometric properties of the HPAQ when administered four weeks apart to HP in neurorehabilitation.Methods and Procedures: Participants were recruited from a CPT implementation study in Denmark. Health professionals with con- tact with patients with aphasia were assigned to CPT courses and asked to fill the questionnaire four weeks before and on the day of their scheduled course. In all, 270 HP responded to the HPAQ. The internal consistency, test–retest reliability, structural validity, and floor and ceiling effects of the HPAQ questions were investigated using descriptive statistics, intraclass correlation coefficient (ICC), Cronbach’s alpha, and factor analysis.Outcomes and Results: The overall test–retest reliability of HPAQ was excellent (ICC = 0.86); and ICC of the individual questions ranged between 0.80 and 0.48. Minor ceiling or flooring effects in answering questions were present. The factor analysis revealed three underlying factors. The first and strongest was a CPT-related knowledge and skill factor represented in all questions except for question 10. The second component was associated with questions probing environmental factors. Test–retest reliability was excellent for the score developed with variables used in these factors. A third factor was associated with expecting or being prepared for making an extra effort when communicating with patients with aphasia. Test–retest reliability for the variables explaining this factor was good. Regarding professions, nurses have the highest ICC on the overall HPAQ, whereas physio and occupational therapists have the lowest. The overall HPAQ showed excellent or good reliability for all healthcare professionals with six or more years of experience, and fair reliability for respondents with fewer years of experience. Conclusions: The HPAQ has good reliability and is suitable as an outcome measure in CPT studies aimed at different health profes- sionals working in practice settings with people with aphasia.

Background: Communication partner training (CPT) is an umbrella term for a complex behavioural intervention for communications partners (CPs) of people with aphasia (PWA) and possibly PWA themselves, with many interacting components, deployed in flexible ways. Recent systematic reviews (Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010; Simmons-Mackie, Raymer, & Cherney, 2016) have highlighted the effectiveness of CPT in addressing the skills of conversation partners and the communicative participation of people with aphasia but have suggested that CPT has been variably delivered, with no clear picture of what the essential elements of CPT are and how CPT is expected to achieve its results through hypothesised mechanisms of change (Coster, 2013).\ud \ud Aim: This paper aims broadly to consider specification of CPT and describes how CPT has been conducted overall and in relation to treatment recipients. Recommendations for CPT and areas for future research are considered.\ud \ud Methods & Procedures: A critical review and narrative synthesis was carried out through: (i) the systematic application of the 12-item TIDieR checklist (Hoffmann et al., 2014) to the 56 studies appraised in the Simmons-Mackie et al. (2010, 2016)) reviews, providing a quantitative overview of the completeness of CPT intervention reporting; and (ii) a qualitative synthesis of the reviewed CPT literature according to TIDieR items.\ud \ud Outcomes & Results: Half of the TIDieR checklist items were reported by 71% or more of the studies, and the rest of the items were reported by 0–63% of studies. TIDieR items relating to the treatment (goal, rationale or theory of essential elements, materials and procedures) and provision (provider, mode, timing, dose) were more frequently reported; however, the level of detail provided was often inadequate or incomplete. The interventions were insufficiently specified to enable replication for most of the studies considered. The most infrequently reported items were: name, location, intervention tailoring and modification, and planned and actual intervention adherence/fidelity.\ud \ud Conclusion: For a better understanding of an intervention, it is necessary to identify and describe potentially central elements and perhaps especially in complex interventions as CPT, where it is likely also more difficult. Whilst the reviewed CPT studies are on average reporting on slightly more than half of the TIDieR items, they are overall insufficiently detailed. Some items appear easier to report on, whereas other items have not been attended to, are too complex in nature to give a full report on, or simply have not been relevant for the individual study to include.

Background: Communication partner training (CPT) is the term used for a variety of complex behavioural interventions with many interacting components, deployed in flexible ways, for communications ...

Background: In the context of the growing evidence, communication partner training (CPT) for frequent communication partners of people with aphasia is a recommended intervention in the best practic...

Clinical borderlands manifest themselves through encounters between people deemed to be in need of health care and health care providers (Mattingly, 2010). This article addresses the problem of inherent asymmetry in the clinical discourse between clinical providers, such as speech-language pathologists (SLPs), and persons with aphasia. Speech-language pathologists, communicating as experts, tend to dominate the discourse regarding the course of treatment, particularly with clients with aphasia who may lack the necessary communicative skills to participate in decision making. Such patterns of communication were apparent in a study reported here that involved thematic analysis of the views of 12 SLPs regarding involving people with aphasia in shared decision making and in analysis of 33 video recordings of these 12 SLPs and 28 people with aphasia during clinical interactions. Although the SLPs stated that they wanted to involve their clients in decision making and took steps to do so, the discourse sample analysis revealed that the SLPs controlled the interaction through their initiations, topic selection, and presentation of limited choices. Alternatives for supporting greater decision-making participation among people with aphasia with their clinicians are discussed.

Purpose: To identify important treatment outcomes from the perspective of people with aphasia and their families using the ICF as a frame of reference.Methods: The nominal group technique was used with people with aphasia and their family members in seven countries to identify and rank important treatment outcomes from aphasia rehabilitation. People with aphasia identified outcomes for themselves; and family members identified outcomes for themselves and for the person with aphasia. Outcomes were analysed using qualitative content analysis and ICF linking.Results: A total of 39 people with aphasia and 29 family members participated in one of 16 nominal groups. Inductive qualitative content analysis revealed the following six themes: (1) Improved communication; (2) Increased life participation; (3) Changed attitudes through increased awareness and education about aphasia; (4) Recovered normality; (5) Improved physical and emotional well-being; and (6) Improved health (and support) services. Prioritized outcomes for both participant groups linked to all ICF components; primary activity/participation (39%) and body functions (36%) for people with aphasia, and activity/participation (49%) and environmental factors (28%) for family members. Outcomes prioritized by family members relating to the person with aphasia, primarily linked to body functions (60%).Conclusions: People with aphasia and their families identified treatment outcomes which span all components of the ICF. This has implications for research outcome measurement and clinical service provision which currently focuses on the measurement of body function outcomes. The wide range of desired outcomes generated by both people with aphasia and their family members, highlights the importance of collaborative goal setting within a family-centred approach to rehabilitation. These results will be combined with other stakeholder perspectives to establish a core outcome set for aphasia treatment research.Implications for Rehabilitation• Important outcomes for people with aphasia and their families span all components of the ICF.• The relevancy and translation of research findings may be increased by measuring and reporting research outcomes which are important to people living with aphasia.• The results of this study indicate that important treatment outcomes for people living with aphasia most frequently link to the activity/participation and body function components of the ICF.• The outcomes identified in this study suggest a broad role for clinicians working in aphasia rehabilitation. The categories of identified outcomes may be used clinically as a starting point in goal-setting discussions with clients and their families. Purpose: To identify important treatment outcomes from the perspective of people with aphasia and their families using the ICF as a frame of reference.Methods: The nominal group technique was used with people with aphasia and their family members in seven countries to identify and rank important treatment outcomes from aphasia rehabilitation. People with aphasia identified outcomes for themselves; and family members identified outcomes for themselves and for the person with aphasia. Outcomes were analysed using qualitative content analysis and ICF linking.Results: A total of 39 people with aphasia and 29 family members participated in one of 16 nominal groups. Inductive qualitative content analysis revealed the following six themes: (1) Improved communication; (2) Increased life participation; (3) Changed attitudes through increased awareness and education about aphasia; (4) Recovered normality; (5) Improved physical and emotional well-being; and (6) Improved health (and support) services. Prioritized outcomes for both participant groups linked to all ICF components; primary activity/participation (39%) and body functions (36%) for people with aphasia, and activity/participation (49%) and environmental factors (28%) for family members. Outcomes prioritized by family members relating to the person with aphasia, primarily linked to body functions (60%).Conclusions: People with aphasia and their families identified treatment outcomes which span all components of the ICF. This has implications for research outcome measurement and clinical service provision which currently focuses on the measurement of body function outcomes. The wide range of desired outcomes generated by both people with aphasia and their family members, highlights the importance of collaborative goal setting within a family-centred approach to rehabilitation. These results will be combined with other stakeholder perspectives to establish a core outcome set for aphasia treatment research.Implications for Rehabilitation• Important outcomes for people with aphasia and their families span all components of the ICF.• The relevancy and translation of research findings may be increased by measuring and reporting research outcomes which are important to people living with aphasia.• The results of this study indicate that important treatment outcomes for people living with aphasia most frequently link to the activity/participation and body function components of the ICF.• The outcomes identified in this study suggest a broad role for clinicians working in aphasia rehabilitation. The categories of identified outcomes may be used clinically as a starting point in goal-setting discussions with clients and their families.

This article demonstrates how a person with aphasia (PWA) and a speech and language therapist (SLT) collaboratively arrive at a common understanding of the PWAs assessments of his progress in speech and communication. This is done as part of a mandatory outcome evaluation of aphasia therapy. Interactional adaptive strategies known from Supported Conversation for Adults with Aphasia (SCA) are used. By making use of conversation analysis we analyse an assessment sequence initiated with an open question and a sequence initiated with several closed questions and pen and paper. The analyses confirm that adaptive strategies may lead to communication characterized by less interactional trouble, i.e. ‘repair’. The analyses also point at how question formatting and sequential organization may be used to guide, model and transform the PWA’s answers. Building on previous research as well as participants’ displayed understandings in the interaction we discuss perspectives of using SCA strategies in institutional interaction involving PWA.

Resumen basado en el de la publicación Título, resumen y palabras clave también en inglés y español La Práctica Basada en la Evidencia (PBE) hace referencia a un modelo común para la toma de decisiones clínicas. El modelo tiene su origen en la medicina, pero actualmente también se aplica en logopedia. La PBE se basa en 3 (en ocasiones, 4) fuentes: la evidencia científica externa, las preferencias/valores del usuario, la experiencia clínica del profesional y, en algunos modelos, el contexto. Desde este enfoque, la toma de decisiones clínicas se realiza reuniendo y tomando en consideración la información o evidencia disponible desde cada una de estas fuentes. Fundamentándose en la literatura, la experiencia clínica y formativa y los recursos disponibles en línea, se describen los antecedentes de la PBE, así como la experiencia clínica y los valores del usuario, pero poniendo el foco de interés en proporcionar asesoramiento práctico sobre la búsqueda, el acceso y la evaluación de la evidencia científica externa, con el fin de hacer más accesible este modelo de toma de decisiones para el logopeda. ESP

Background Measuring or evaluating outcomes is a common activity for many speech–language therapists (SLTs). A major focus has been on external forces claiming outcome evaluation to optimize quality and the use of resources without integrating the viewpoints of SLTs. Aims To identify the purpose of outcome evaluation by letting SLTs identify not only the actual demands for outcome evaluation, but also the role of outcome evaluation in aphasia therapy in the clinic. Methods & Procedures Twelve SLTs participated in semi-structured interviews to identify the demands they met for outcome evaluation as well as the role the outcome evaluation had in their work with people with aphasia. The interviews were transcribed verbatim and analysed by means of qualitative thematic analysis. Outcomes & Results Six themes corresponding with the aims of this study were identified. These show that the SLTs initially evaluated outcomes because of external demands and interests. However, they also describe the process as a necessary activity inherent to therapy and state that they would not want to be without it. The outcome evaluation is seen as an interactive process between SLTs, clients and possibly significant others. Not only it is seen as a product in which outcome and/or client satisfaction is documented, but also it is described as a dynamic process that benefits the clients, significant others, the therapy and the SLTs themselves in various ways. This role of outcome evaluation ranges from enhancement of insight and promotion of acceptance for the clients and significant others to planning the next step in therapy or in life with aphasia after therapy. In all of which the clients play a significant role, since their active participation is sought throughout the sessions. Conclusion & Implications The results suggest an interesting relationship between treatment policy and treatment practice, where an initial administrative initiative to conduct outcome evaluation is adopted by the SLTs and made into a meaningful part of therapy in which the clients play a significant role.

Objective: This study reports on Danish speech and language therapists' knowledge and understanding of quality of life (QoL) in aphasia, including therapists' views on education and training in relation to preparedness for working on QoL, use of measures, and barriers to applying QoL in practice. Methods: Fourteen Danish clinicians completed a 48-item online questionnaire regarding their views, perspectives and practices that included multiple-choice questions, rating scales, and boxes permitting free text responses. Descriptive statistics were used to characterize the numerical data, and content analysis was applied to text responses. Results: The clinicians interpreted QoL as subjective well-being and participation and explored it with most clients and relatives using informal methods, primarily conversation, for the purposes of identifying relevant goals to direct treatment. Clinicians perceived a need for greater theoretical, practical, and experiential knowledge regarding QoL. They also identified a need for translated QoL instruments and training in these measures in practice. Conclusion: Despite a reported lack of knowledge about and tools for measuring QoL, Danish clinicians are applying QoL issues in their practice and perceive these issues as valuable and important in assessment and therapy. The findings have clear implications for tool development and workforce education.

Outcomes of aphasia therapy in Denmark are documented in evaluation sessions in which both the person with aphasia and the speech-language therapist take part. The participants negotiate agreements on the results of therapy. By means of conversation analysis, we study how such agreements on therapy outcome are reached interactionally. The sequential analysis of 34 video recordings focuses on a recurrent method for reaching agreements in these outcome evaluation sessions. In and through a special sequence of conversational assessment it is claimed that the person with aphasia has certain communicative skills. Such claims are systematically substantiated by invoking examples of the person with aphasia performing this skill either outside or inside the therapeutic setting. Substantiation can be seen as a form of validation of the claim and thereby a basis is set for agreement. The findings suggest that in this type of evaluation the requirements of producing a valid account in which the person with aphasia has been heard are being met.KEYWORDS: OUTCOME EVALUATION; AGREEMENT; APHASIA THERAPY; ASSESSMENT; CONVERSATION ANALYSIS; EPISTEMIC RIGHTS(ProQuest: ... denotes formulae omitted.)1. IntroductionMeasures or evaluations of outcomes are commonly seen during and after aphasia therapy (Simmons-Mackie et al., 2005; Verna et al., 2009). Outcome measures are generally associated with formal tests or questionnaires. Simmons-Mackie et al. (2005) divide their findings of tools and methods for outcome measures into the categories cognitive/linguistic, functional, subjective/ qualitative and vague/other. The first two are most frequently reported in studies, and make use of formal tests or specified procedures that have varying degrees of reliability and/or validity. Although this holds true for some described tools in the category subjective/qualitative too, this category as well as the category of vague/other mainly include more individualized approaches such as observations, qualitative speech analysis, and assessment of goal attainment. Natural speech and interaction is the basic element in these methods: either it is the object studied through observations or an actual tool for assessment (e.g. in the person with aphasia's (PWA) report of his/her own competencies). The evaluation sessions, which are less constrained by formal requirements, and are carried out by means of interaction, may thus pose a problem with regard to consistency: Are they at all structured, can they be compared, and, thus, can anything at all be said about their quality? The very terms denoting these methods (subjective/qualitative, and vague/other) may suggest that such sessions are unsystematic. Furthermore, an interactional approach to outcome evaluation may pose challenges to the evaluator (most often the SLT) who has to attain a PWA's true feelings about therapy while at the same time directing and guiding the conversation.This study reports on outcome evaluations that are carried out by means of interaction. Although such sessions may vary widely with regard to what is talked about and how it is talked about, all of them contain sequences in which communicative performance by the PWA is assessed by the participants interactively. These assessment sequences have a clear interactional organization, and can be described as exemplars of outcome evaluations which are systematic and orderly.The present study focuses on outcome evaluation as an interactional achievement by addressing the structural organization of assessment sequences. Drawing on conversation analysis (CA) (Hutchby and Woofitt, 2008; Psathas, 1995; Schegloff et al., 2002; Steensig and Asmuss, 2003) the study presents in-depth analyses of how such assessment sequences are accomplished by the participants. As we will show, the interactional organization of assessment sequences in this setting resembles, but is not identical to, the organization of assessment sequences in everyday conversation as has been described by Pomerantz (1984). …