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Aphasia Nexus: Connecting Evidence to Practice is a theoretically-based online implementation intervention designed to overcome the barriers related to the implementation of intensive and comprehensive aphasia services. The objective was to establish the feasibility of incorporating Aphasia Nexus within routine clinical practice through an evaluation of: (1) its potential to positively influence the intensity and/or comprehensiveness of aphasia services; (2) the ability of selected outcome measures to capture changes to factors influencing implementation; and (3) the acceptability of the website to on-site speech-language pathologists (SLPs). A single arm pre-post pilot trial was conducted within an Australian health service. The design collected qualitative and quantitative pre-post data in the form of therapy logs, behaviour change questionnaires, and a post-intervention focus group. Data were collected one week prior to, and one week following, a 12 week implementation period where participating SLPs (n = 5) were provided access to the Aphasia Nexus website. Quantitative data revealed improvements in the median time per patient with aphasia from 65 to 115 minutes per week (intensity/dose), an additional 50 minutes per week. SLPs trialled at least one new therapy approach (Attentive Reading and Constrained Summarisation) and service delivery model (group therapy) representing an increase in the comprehensiveness of their services to patients. SLPs perceived a reduction in the barriers associated with the promotion of new aphasia services. Qualitative analysis of focus group discussion revealed that participants considered Aphasia Nexus in the overarching theme of practice efficiency (obtaining the best outcome from the least amount of effort) and the sub-themes of accessible therapy resources and the prioritisation of time. Overall, Aphasia Nexus was considered a useful clinical tool with the potential to positively influence clinical aphasia practice. These results will inform further implementation intervention refinements and will inform the methodology of future research.

Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far-reaching dissemination of current evidence and best-practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings.To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice.A mixed-methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians.A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention.Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian-based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research.What is already known on the subject Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work? Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in-depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia.

Map the landscape of friendship interventions/programs for older adults to guide intervention/program development inclusive of the unique needs of older people with aphasia (PWA).A search query of multiple databases was completed for articles published before 4 January 2021. Studies included all the following: (1) participants aged 55 years or older; (2) addressed an intervention/program designed to prevent social isolation and/or friendship loss; (3) used an outcome variable related to social isolation and/or friendship; and (4) published in a peer-reviewed journal. Title and abstract screening were conducted using Covidence software, which tracked disagreements across the study team. All studies included in the full-text review were identified as relevant by a minimum of two study authors, and a consensus was reached on all full-text reviews. Data were extracted according to (1) theoretical frameworks used; (2) interventionist and discipline; (3) participant characteristics; (4) intervention/program replicability; (5) format of intervention/program; (6) measures used in the intervention/programs; (7) and, reported effects of intervention/programs on individuals.A total of 40 articles with 42 intervention/programs were included and represented 4584 intervention/program participants ranging in age from 40 to 104 years. Intervention/programs involved a wide range of theoretical frameworks (e.g., theories of loneliness, feminist theory, positive psychology). Disciplines such as psychology and exercise science informed intervention/programs. Interventionists included many types of individuals like therapists, volunteers and home health aides. Intervention/programs often lacked adequate description for replication and included individual and group formats, most commonly delievered in the participants homes. Outcomes usually included self-report measures of loneliness, social networks, or well-being, and intervention/programming was primarily educational, activity-based, or networking-based in nature.The intervention/programs reviewed yield important lessons to support innovation in developing friendship intervention/programs for older PWA as most yielded positive results and were acceptable to participants.IMPLICATIONS FOR REHABILITATIONPeople with aphasia want their friendships addressed as part of their rehabilitation; however, the research literature has little guidance in this area.Studies reviewed of friendship intervention/programs for older adults yielded helpful lessons for consideration in developing this type of intervention/programming for people with aphasia.Interprofessional teams made up of rehabilitation professionals should address friendship for people with aphasia in both research and clinical practice.

Goal setting is key to stroke rehabilitation, but access for people with aphasia is challenging. Based on the Goal setting and Action Planning (G-AP) framework, we developed an accessible goal setting resource (Access G-AP).Access G-AP was designed using a three-phase, user-centred design process.Recommended design improvements included reducing text, adding bullet points, and diversifying images. Both participant groups highlighted that Access G-AP should be used collaboratively to support stroke survivor involvement. Staff recommended Access G-AP training and additional resources to support stroke survivors with severe aphasia.Access G-AP was co-developed to support people with aphasia to access and engage in stroke rehabilitation goal setting. Further research is required to establish the feasibility of Access G-AP in clinical practice.IMPLICATIONS FOR REHABILITATIONEvidence-based accessible formatting strategies and an iterative design process can inform the design of accessible goal setting resources.Accessible goal setting materials should be relevant to stroke survivors with aphasia and responsive to their needs.Rehabilitation staff require training and support to use accessible goal setting resources (like Access G-AP) with stroke survivors with aphasia, especially those with severe aphasia.Evaluation of the feasibility of Access G-AP in clinical practice is now required.

Background and Aims:Engagement is increasingly recognised as important for maximising rehabilitation outcome following stroke. However, engagement can be challenging when neurological impairment impacts a persons’ ability to activate the regulatory processes necessary for engagement and in the context of a changed self. We explored engagement in stroke rehabilitation from the perspective of people with stroke with a primary focus on identifying key processes that appeared important to engagement in stroke rehabilitation.Design and Methods:This study drew on Interpretive Description methodology. Maximum variation and theoretical sampling were used to capture diversity in the sample and access a depth and breadth of perspectives. Data collection included semi-structured interviews with people with stroke (n = 19). Data were analysed through a collaborative and iterative process drawing on range of analytical tools including coding, memoing, diagramming and group discussions.Findings:Our findings highlight that engagement is a complex, nuanced, responsive, flexible and inherently two-way process.Developing connectionsappeared central to engagement with connections taking various forms. The most fundamental was the therapeutic connection between the person with stroke and their practitioner as it provided the foundation on which to build other connections. Connection was made possible through five collaborative processes:Knowing, Entrusting, Adapting, Investing and Reciprocating.Conclusions:Engagement is a social and relational process enabled through an inherently person-centred approach and active and ongoing reflexivity – highlighting the importance of a humanising approach to care where aspects of self, care and emotion are evident, for both the person with stroke and their practitioner.

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. WHAT THIS PAPER ADDS: What is already known on this subject International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well-being. Before this study, OMIs for the constructs of communication and patient-reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work? The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post-stroke aphasia within phases I–IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices.

PurposeA core outcome set (COS; an agreed minimum set of outcomes) was developed to address the heterogeneous measurement of outcomes in poststroke aphasia treatment research. Successful implementation of a COS requires change in individual and collective research behavior. We used the Theoretical Domains Framework (TDF) to understand the factors influencing researchers' use and nonuse of the Research Outcome Measurement in Aphasia (ROMA) COS.MethodAphasia trialists and highly published treatment researchers were identified from the Cochrane review of speech and language therapy for aphasia following stroke and through database searches. Participants completed a theory-informed online survey that explored factors influencing COS use. Data were analyzed using descriptive statistics and qualitative content analysis.ResultsSixty-four aphasia researchers from 13 countries participated. Most participants (81%) were aware of the ROMA COS, and participants identified more facilitators than barriers to its use. The TDF domain with the highest agreement (i.e., facilitator) was “knowledge” (84% agree/strongly agree). Participants had knowledge of the measures included in the ROMA COS, their associated benefits, and the existing recommendations. The TDF domains with the least agreement (i.e., barriers) were “reinforcement” (34% agree/strongly agree); “social influences” (41% agree/strongly agree); “memory, attention, and decision processes” (45% agree/strongly agree); and “behavioral regulation” (49% agree/strongly agree). Hence, participants identified a lack of external incentives, collegial encouragement, and monitoring systems as barriers to using the ROMA COS. The suitability and availability of individual measurement instruments, as well as burden associated with collecting the COS, were also identified as reasons for nonuse.ConclusionsOverall, participants were aware of the benefits of using the ROMA COS and believed that its implementation would improve research quality; however, incentives for routine implementation were reported to be lacking. Findings will guide future revisions of the ROMA COS and the development of theoretically informed implementation strategies.Supplemental Materialhttps://doi.org/10.23641/asha.16528524

Background: Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia. Aims: To determine whether a tailored intervention program (Action Success Knowledge; ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12 month end point at cluster and individual participant level. Methods: A multi-site, pragmatic, two-level single blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and caregivers were recruited within 6 months post-stroke who scored ≤12 on the Stroke Aphasic Depression Questionnaire Hospital Version-10 at screening. Each arm received manualised intervention over 6-8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset. Results: Twenty clusters (health regions) were randomised. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n=231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm respectively receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modelling under the intention to treat protocol showed a significant difference on the Stroke and Aphasia Questionnaire-21 (SADQ-21 N=122, 17 clusters) in favour of the attention control (β: −2.74, 95% CI: −4.76, −0.73, p=0.008). Individual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful. Conclusion: ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members. Funding acknowledgement: National Health and Medical Research grant APP1060673 Trial registration: Australian Clinical Trials ACTRN12614000979651

PURPOSE: To describe the process and outcome of a user and theory informed online intervention for speech pathologists targeting the implementation of intensive and comprehensive aphasia services. METHODS: The design process followed the eight steps outlined by the Behaviour Change Wheel and incorporated the principles of Integrated Knowledge Translation (IKT). Eight speech pathology researchers and clinicians from four countries (Australia, Canada, the United Kingdom and Ireland) contributed to three focus groups via videoconference. RESULTS: The online platform, Aphasia Nexus: Connecting Evidence to Practice, provides resources, guidance and support for speech pathologists seeking to improve the intensity and comprehensiveness of their aphasia service. A collaborative and iterative design process facilitated the creation of an intervention envisioned by participants. CONCLUSIONS: The website contains both interactive elements and resource links which have been arranged under the three headings of resources, action and support. The inclusion of multi-national researchers and clinicians benefitted a design process to make implementation more likely.IMPLICATIONS FOR REHABILITATIONTheoretically informed implementation interventions aim to change the everyday clinical practice of health workers.An online platform has been developed to support speech pathologists' implementation of intensive and comprehensive aphasia services.A collaborative design process can be beneficial in creating an intervention that is relevant to research-users and is more likely to be implemented.

Background: Social isolation and loneliness are often present after aphasia and lead to negative health, social, and physical outcomes. Maintaining social connections after aphasia has been identif...

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age ( Conclusions: Earlier intervention for poststroke aphasia was crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke.

In clinical practice and in research, aphasia measurement instruments are used for many reasons: to screen and diagnose, to identify deficits and strengths, and to measure outcomes. A proliferation...

Background Concomitant aphasia and depression after stroke is highly prevalent, but there is a lack of psychological care in stroke rehabilitation for people with aphasia and family members. Evidence-based frameworks such as stepped psychological care may be viable, but the barriers and facilitators to translating this framework into aphasia rehabilitation practice are unknown. Aim The aim of this study was to identify, from the perspective of stroke health professionals, the barriers and facilitators to implementing stepped psychological care for depression after post-stroke aphasia. Method Five semi-structured focus groups of stroke health professionals were conducted (n = 39) across the stroke care continuum. Verbatim transcripts were analyzed using Interpretive Description. Results Barriers and facilitators were identified within three core themes: knowledge, skills, and attitudes have the most impact on implementing stepped psychological care; the physical environment impacts on managing depression and communication disability for people with aphasia; and the support and leadership of the health organization influence change in any implementation of a stepped psychological care approach. Barriers included: no experience with stepped psychological care; limited understanding of aphasia and communication support; lack of adequate physical space and resources; lack of psychologists. Facilitators included: specialist training; enhancement of physical spaces; communication tools; leadership; funding; specialized staff. Conclusion Addressing the identified barriers and facilitators to stepped psychological care will improve the viability of implementing this evidence-based framework after post-stroke aphasia. Change may be driven through specialist training for health professionals in communication support; mood assessment and treatments; modification of physical space; and accessible resources.

Notable positive change arising from the struggle with a major crisis (known as posttraumatic growth – PTG) has been reported following war, accidents and life-threatening illnesses. Whilst negativ...

To describe the development and determine the diagnostic accuracy of the Brisbane Evidence-Based Language Test in detecting aphasia. Consecutive acute stroke admissions ( = 100; mean = 66.49y) participated in a single (assessor) blinded cross-sectional study. Index assessment was the ∼45 min Brisbane Evidence-Based Language Test. The Brisbane Evidence-Based Language Test is further divided into four 15-25 min Short Tests: two Foundation Tests (severe impairment), Standard (moderate) and High Level Test (mild). Independent reference standard included the Language Screening Test, Aphasia Screening Test, Comprehensive Aphasia Test and/or Measure for Cognitive-Linguistic Abilities, treating team diagnosis and aphasia referral post-ward discharge. Brisbane Evidence-Based Language Test cut-off score of ≤157 demonstrated 80.8% (LR+ =10.9) sensitivity and 92.6% (LR- =0.21) specificity. All Short Tests reported specificities of ≥92.6%. Foundation Tests I (cut-off ≤61) and II (cut-off ≤51) reported lower sensitivity (≥57.5%) given their focus on severe conditions. The Standard (cut-off ≤90) and High Level Test (cut-off ≤78) reported sensitivities of ≥72.6%. The Brisbane Evidence-Based Language Test is a sensitive assessment of aphasia. Diagnostically, the High Level Test recorded the highest psychometric capabilities of the Short Tests, equivalent to the full Brisbane Evidence-Based Language Test. The test is available for download from brisbanetest.org.Implications for rehabilitationAphasia is a debilitating condition and accurate identification of language disorders is important in healthcare.Language assessment is complex and the accuracy of assessment procedures is dependent upon a variety of factors.The Brisbane Evidence-Based Language Test is a new evidence-based language test specifically designed to adapt to varying patient need, clinical contexts and co-occurring conditions.In this cross-sectional validation study, the Brisbane Evidence-Based Language Test was found to be a sensitive measure for identifying aphasia in stroke.

To examine the inter-rater reliability, intra-rater reliability, internal consistency and practice effects associated with a new test, the Brisbane Evidence-Based Language Test. Reliability estimates were obtained in a repeated-measures design through analysis of clinician video ratings of stroke participants completing the Brisbane Evidence-Based Language Test. Inter-rater reliability was determined by comparing 15 independent clinicians' scores of 15 randomly selected videos. Intra-rater reliability was determined by comparing two clinicians' scores of 35 videos when re-scored after a two-week interval. Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect inter-rater reliability (0.995; 95% confidence interval: 0.990-0.998), intra-rater reliability (0.994; 95% confidence interval: 0.989-0.997) and internal consistency (Cronbach's α = 0.940 (95% confidence interval: 0.920-1.0)). Almost perfect correlations (0.998; 95% confidence interval: 0.995-0.999) between face-to-face and video ratings were obtained. The Brisbane Evidence-Based Language Test demonstrates almost perfect inter-rater reliability, intra-rater reliability and internal consistency. High correlation coefficients and narrow confidence intervals demonstrated minimal practice effects with scoring or influence of years of clinical experience on test scores. Almost perfect correlations between face-to-face and video scoring methods indicate these reliability estimates have direct application to everyday practice. The test is available from brisbanetest.org.Implications for RehabilitationThe Brisbane Evidence-Based Language Test is a new measure for the assessment of acquired language disorders.The Brisbane Evidence-Based Language Test demonstrated almost perfect inter-rater reliability, intra-rater reliability and internal consistency.High reliability estimates and narrow confidence intervals indicated that test ratings vary minimally when administered by clinicians of different experience levels, or different levels of familiarity with the new measure.The test is a reliable measure of language performance for use in clinical practice and research.

Background: Guidelines to support accessible goal setting with stroke survivors with aphasia are lacking.Aims: This review aimed to (i) determine the communication barriers and facilitators relevan...

Prognostication is a complex clinical task that involves forming a prediction about recovery and communicating prognostic information to patients and families. In aphasia, recovery is difficult to predict and evidence-based guidance on prognosis delivery is lacking. Questions about aphasia prognosis commonly arise, but it is unknown how speech pathologists formulate and deliver information about expected recovery. An understanding of current practice in prognostication is needed to develop evidence-based guidelines for this process, and is necessary in order to ensure successful future implementation of recommended practice regarding prognosis delivery.To identify the factors speech pathologists consider important when responding to questions about aphasia prognosis; to examine how they respond in different scenarios; and to evaluate their current attitudes towards aphasia prognostication.A total of 54 speech pathologists participated in an online survey featuring hypothetical aphasia prognosis delivery scenarios, short-response questions and ratings. Open responses were analysed thematically. Multiple-choice responses were analysed using descriptive statistics and non-parametric tests.Speech pathologists regarded factors relating to the nature and severity of post-stroke deficits, an individual's level of motivation and the availability of social support as most important for forming an aphasia prognosis. When delivering prognostic information, considerations of the recipient's emotional well-being, hope and expectations, and comprehension of information were regarded as most important. Speech pathologists' prognosis responses varied in content and manner of communication. The content of the responses included predictions of recovery and information about various attributes and activities contributing to recovery. Prognostic information was most frequently communicated through qualitative probability expressions, general statements and uncertainty-based expressions. A need for more professional support in aphasia prognostication was indicated.There is variation in the way speech pathologists respond to questions about aphasia prognosis, and it is unknown how these conversations affect people with aphasia and their significant others. Further research to understand speech pathologists' clinical reasoning and professional support needs, and the perspectives of people living with aphasia, may help to develop an evidence-based approach to prognostication in aphasia. What this paper adds What is already known on this subject Questions about aphasia prognosis are difficult to answer. Current methods for predicting aphasia recovery are yet to demonstrate the reliability and individual specificity required for clinical application. At present, there is no evidence-based guidance or support for prognosis delivery in aphasia. What this study adds to existing knowledge There is variation in the way speech pathologists predict aphasia recovery, the prognostic information they deliver and the manner in which they communicate prognoses. Current approaches to aphasia prognostication are reliant on experience and professional judgement, and speech pathologists desire more support for undertaking this task. What are the potential or actual clinical implications of this work? Speech pathologists lack a consistent approach to aphasia prognostication and desire more support in this task. The present findings offer insight into clinician attitudes and practice, and provide a direction for future research to establish best-practice guidelines for this complex and demanding area of aphasia management.

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.\ud \ud \ud \ud AIM To describe fidelity strategies and develop core recommendations for developing, monitoring, and reporting of fidelity in aphasia intervention RCTs.\ud \ud \ud \ud 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.\ud \ud \ud \ud 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.

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.

Stroke 53(3), 956-967 (2022). doi:10.1161/STROKEAHA.121.035216, Published by Lippincott Williams & Wilkins, Philadelphia, Pa.

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.

Purpose: Influential value-driven approaches to aphasia rehabilitation have been proposed previously, but have emphasised how service providers need to deliver their services. The aim of this article is to extract a set of values or habits that define effective aphasia therapists, from a 16-year programme of research that has sought to capture the perspectives of people with aphasia, their family and speech-language pathologists. Method: The findings of 58 studies published by members of our team which have sought the views of people with aphasia (38 studies), speech-language pathologists (11 studies) and family members (5 studies), and those which compared all stakeholder's perspectives (2 studies), were synthesised into seven themes. Presented as habits, these were subsequently described in the same manner as the popular "Seven Habits of Highly Effective People". Result: The seven habits of highly effective aphasia therapists described by people with aphasia and their family were (1) Prioritise relationships; (2) Find a rope team; (3) Begin with the end in mind; (4) Practise SMARTER therapy; (5) Leave no person behind; (6) Look behind the mask and (7) Find a voice. Conclusion: While there are similarities to other value-based approaches to aphasia rehabilitation, these seven habits are detailed using our published research that has privileged the voices of people with aphasia. The seven habits therefore reflect what people with aphasia view as the features of highly effective aphasia therapists. The next steps are to identify how to evaluate evidence-based practices in these areas and ensure their implementation into practice. Effective aphasia therapists are at the heart of effective aphasia rehabilitation.

Background: People with post-stroke aphasia commonly experience mental health conditions, with depression having a high prevalence. An understanding of current practice may inform ways to improve psychological care for people with aphasia.Aim: To explore current practice for managing depression after post-stroke aphasia from the perspective of stroke health professionals.Method: Five semi-structured focus groups were conducted with 39 stroke health professionals across the care continuum. Focus groups were transcribed verbatim and analyzed using the method of Interpretive Description.Results: Analysis of verbatim transcripts revealed four core themes: (1) concomitant aphasia and depression after stroke is a challenging area of rehabilitation, (2) mood difficulties and depression are not always a high stroke rehabilitation priority, (3) approaches to identification and management are ad hoc, and (4) stroke health professionals are trying to bridge the gap between clients' psychological care needs and limited services. Sub-themes were also identified.Conclusion: This study demonstrates that health professionals are challenged by and limited in managing depression after post-stroke aphasia. Health professionals have the opportunity to improve services through the translation of evidence-based interventions. The integration of mental health care into stroke rehabilitation may be achieved through policy development, leadership and specialist training.Implications for rehabilitationPeople with aphasia need routine mood screening using aphasia-specific clinical tools and communication support.Stroke health professionals report a need for communication partner training to facilitate mental healthcare for people with aphasia.Family members need to be involved in aphasia rehabilitation to gain psychological care for themselves and the person with aphasia.

Objective:To determine accessibility of the primary healthcare system for patients with stroke recently discharged from hospital.Methods:This project mapped retrospective patient location data and the location of primary healthcare services in the same region. Patient location data were from all patients with stroke (N = 1595: January 2011–January 2017) discharged from one metropolitan hospital to the local Primary Health Network. Geographic Information System technology was used to map the patient discharge locations and the spatial distribution of primary healthcare services (general practitioner, pharmacy, allied health) across the region. Road network data were used to measure the level of access from each patient’s discharge location to the services.Results:Access to primary healthcare services was variable. Areas with larger proportions of patients with stroke did not necessarily have good service access. With an increase in travel time, the number of services accessible to patients also increased. However, the spatial variation of access to services remained largely unchanged.Conclusion:Access to primary healthcare services for patients with stroke varies spatially, with a trend towards relatively low levels of accessibility for many patients. There is an urgent need for future planning to consider geographical access to primary healthcare services for patients with stroke.

Background: Aphasia services are currently faced by increasing evidence for therapy of greater intensity and comprehensiveness. Intensive Comprehensive Aphasia Programs (ICAPs) combine these elements in an evidence-based, time-limited group program. The incorporation of new service delivery models in routine clinical practice is, however, likely to pose challenges for both the service provider and administering clinicians. This program of research aims to identify these challenges from the perspective of aphasia clinicians from six countries and will seek to trial potential solutions. Continual advancements in global communication technologies suggest that solutions will be easily shared and accessed across multiple countries.\ud \ud Aims: To identify the perceived and experienced barriers and facilitators to the implementation of 1) intensive aphasia services, 2) comprehensive aphasia services, and 3) ICAPs, from aphasia clinicians across six countries.\ud \ud Methods and procedures: A qualitative enquiry approach included data from six focus groups (n = 34 participants) in Australia, New Zealand, Canada, United States of America (USA), United Kingdom (UK), and Ireland. A thematic analysis of focus group data was informed by the Theoretical Domains Framework (TDF).\ud \ud Outcomes and results: Five prominent theoretical domains from the TDF influenced the implementation of all three aphasia service types across participating countries: environmental context and resources, beliefs about consequences, social/professional role and identity, skills, and knowledge. Four overarching themes assisted the identification and explanation of the key barriers and facilitators: 1. Collaboration, joint initiatives and partnerships, 2. Advocacy, the promotion of aphasia services and evidence-based practice, 3. Innovation, the ability to problem solve challenges, and 4. Culture, the influence of underlying values.\ud \ud Conclusions: The results of this study will inform the development of a theoretically informed intervention to improve health services’ adherence to aphasia best practice recommendations.

© 2018 The Authors Background: Patients with communication disability, associated with impairments of speech, language, or voice, have a three-fold increased risk of adverse events in hospital. However, little research yet examines the causal relationship between communication disability and risk for specific adverse events in hospital. Objective: To examine the impact of a patient's communication disability on their falls risk in hospital. Methods: This systematic review examined 61 studies on falls of adult hospital patients with communication disability, and patients at high risk of communication disability, to determine whether or not communication disability increased risk for falls, and the nature of and reasons for any increased risk. Results: In total, 46 of the included studies (75%) reported on participants with communication disability, and the remainder included patients with health conditions placing them at high risk for communication disability. Two thirds of the studies examining falls risk identified communication disability as contributing to falls. Commonly, patients with communication disability were actively excluded from participation; measures of communication or cognition were not reported; and reasons for any increased risk of falls were not discussed. Conclusions: There is some evidence that communication disability is associated with increased risk of falls. However, the role of communication disability in falls is under-researched, and reasons for the increased risk remain unclear. Practical applications: Including patients with communication disability in falls research is necessary to determine reasons for their increased risk of adverse events in hospital. Their inclusion might be helped by the involvement of speech-language pathologists in falls research teams.

Background: Evidence-practice gaps have been identified in the implementation of post-stroke aphasia guideline recommendations. To address this, an implementation intervention tailored to local bar...

More than 50 years of research has demonstrated the profound effect that aphasia has on people with the condition and their family members. In the International Classification of Functioning, Disability and Health, the World Health Organization described the impact of an individual's health condition on a significant other as "third-party disability." Recent research has described how third-party disability can occur in family members of people with aphasia post-stroke. Despite the extensive history and ongoing relevance of these findings, family-centered rehabilitation has been slow to integrate into clinical practice and policy. The aims of this article are (1) to provide an overview of third-party disability in family members of people with aphasia; (2) to consider how third-party disability can be addressed through family-centered care and to identify some of the barriers to family-centered care; and (3) to describe The Family Aphasia Measure of Life Impact (FAMLI), a tool for measuring third-party functioning and disability in family members of people with aphasia, identifying family rehabilitation needs, and measuring outcomes of family-centered care.

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: People with aphasia are at high risk of depression with the majority fulfilling depression diagnostic criteria up to one year post-stroke. There is a lack of psychological care to prevent and treat depression and address the communication disability associated with aphasia. Translating a framework of stepped psychological care after stroke may potentially address treatment gaps and improve rehabilitation outcomes. This multidisciplinary framework is usually composed of level 1 to 4 interventions that match the person’s level of need and severity of symptoms. However, the perspectives of people with aphasia regarding stepped psychological care, mood changes, depression and current practice is extremely limited in the research evidence. Aims: To describe, from the perspective of people with aphasia: a) the experience of mood changes, depression and current practice after post-stroke aphasia; and b) preferences within a stepped psychological care approach. Method & Procedures: Ten people with aphasia participated in two semi-structured interviews each, within a maximal variation sample (severity of aphasia, presence or not of possible depression, transition phase of care). Video data from the 20 interviews were transcribed for speech and non-speech communication and analysed using Interpretive Description. Outcomes & Results: All participants self-reported mostly negative mood changes after aphasia whether they were identified as depressed or not on the SADQ10. Three core themes were derived: 1) the onset of stroke and aphasia is a traumatic event resulting in mood difficulties and depression; 2) people with aphasia are trying to work through communication and mood difficulties with limited psychological support and services in stroke rehabilitation; 3) positivity, supported communication and access to individually tailored therapy would be essential to people with aphasia through stepped psychological care. 10 sub-themes were also identified. Conclusions: This study demonstrates that the onset of post-stroke aphasia is traumatic with negative mood changes impacting ability to participate in stroke rehabilitation. Within this context, it was evident that all participants experienced mood changes but had not participated in stepped psychological care in stroke rehabilitation. Some had experienced elements of psychological care. Stepped psychological care is recommended for people with aphasia.

Background: Effective implementation strategies to improve speech and language therapists’ (SLTs) aphasia management practices are needed. Australian SLTs working in the acute setting have reported inconsistent implementation of post-stroke aphasia guideline recommendations. Therefore, implementation efforts to address these gaps are necessary. However, little is known about the effectiveness of behaviour-change strategies in SLTs providing acute aphasia management. Aims: This study designed and tested the feasibility, acceptability and potential effectiveness of a tailored implementation strategy to improve acute SLTs’ uptake of evidence in two areas of practice: aphasia-friendly information provision; and collaborative goal setting. Methods & Procedures: A pilot cluster randomized controlled trial design was used (retrospective trial registration number ACTRN12618000170224). Four acute SLT teams were randomly assigned to receive either Intervention A (targeted at improving information provision) or Intervention B (targeted at improving collaborative goal setting), and were blinded to their allocation. Interventions were tailored to address known barriers and included a face-to-face workshop incorporating behaviour-change techniques. Outcomes addressed the research questions of feasibility (e.g., treatment fidelity and retention of participants), acceptability (e.g., post-study focus groups) and potential effectiveness (e.g., medical record audits and behaviour construct surveys). The quantitative data were recorded at baseline and 3–6-month follow-up, allowing for change scores to be calculated. Outcomes & Results: All four clusters completed the study, with 37 SLTs participating. The majority of participants were female (36/37 = 97.3%), entry-level clinicians (15/37 = 40.5%), with a mean age of 30 years. Medical record data from 107 patients were included (post-intervention n = 61; information provision intervention n = 36, goal-setting intervention n = 25). Overall, there was a significant improvement in the target behaviour for Intervention A (mean improvement 52.78%, p = 0.001), but a small non-significant change in the target behaviour for Intervention B (8.46%, p = 0.406). There were potentially significant changes seen in several, but not all, of the domains targeted by the interventions (e.g., Knowledge (p = 0.014), Beliefs about Capabilities (p = 0.032), and Environmental Context and Resources (p = 0.000) for Intervention A). Conclusions & Implications: This study showed that a tailored implementation intervention targeting acute SLTs’ aphasia management practices was feasible to deliver and acceptable for most participants. In addition, the interventions were potentially effective, particularly for the information provision behaviour targeted by Intervention A. It was possible partially to explain the mechanisms of behaviour change that occurred during the study.

Engagement is commonly considered important in stroke rehabilitation, with some arguing it is essential for positive patient outcomes. An emerging body of research indicates the practitioner influences engagement through their ways of relating, communicating and working with the patient. People experiencing communication disability may face particular challenges with engagement as a practitioner's communication and interactional patterns may limit their ability to engage. To understand how rehabilitation practitioners worked to engage people experiencing communication disability throughout the course of rehabilitation. A qualitative study using the Voice Centred Relational Approach. Longitudinal observational and interview data were gathered from 28 practitioners and three people experiencing communication disability in inpatient and community stroke rehabilitation services. Data were analyzed using the Listening Guide. Engagement was a relational practice on the part of the rehabilitation practitioner. It was underpinned by a relational philosophy and characterized by three core processes: embedding relational work throughout rehabilitation; getting to know the patient and working in ways valued by the patient; and communicating using relational dialogue and supported conversation. Practitioners wove these together with their technical, disciplinary-based work and rehabilitation tasks. Patient engagement was constructed through relationships and strongly influenced by the practitioners' way of thinking about and enacting practice, challenging the idea that engagement is solely an intrinsic patient state and behaviour. The findings raise questions about which aspects of rehabilitation work and communication are most valuable when working to engage people experiencing communication disability. Viewing engagement as a relational practice and understanding the different ways this is enacted may support practitioners to reflect on their understandings of engagement, their patient's engagement, their ways of working, and the frames and philosophies that surround and influence their practice.

Background: Group participation has been demonstrated to have a range of benefits for people with chronic aphasia yet the strength of empirical findings is limited by the under-representation of pe...

Participation in a group environment is an inherently complex undertaking for people with aphasia. It involves engaging in multi-person interactions with other people who may have a range of communication strengths and strategies at their disposal. The potential challenges of community aphasia-group participation and practice has had limited attention in the research literature. Evidence from group users have primarily been drawn from the perspective of long-term members or those participating in highly specific and time-bound groups. There is a need to explore the experiences of a broader sample, including people who have left groups, to improve our understanding of structures, processes as well as leadership behaviours that may facilitate positive group participation experiences. To examine the potential factors operating within the group environment that contribute to positive and negative participation experiences. Twenty-two people with aphasia participated in semi-structured interviews about their experiences of community aphasia groups. People who maintained long-term membership as well as those who had left groups were sampled. An interpretative phenomenological framework was employed to examine the data collected. Seven factors emerged as central to participation experiences and contributed to the ability of people with aphasia to integrate and engage in the group space. These factors included: (1) balanced interactional patterns; (2) an open and non-hierarchical group environment; (3) communication awareness and education amongst members; (4) meaningful activity; (5) ritual and structure; (6) composition and group size; and (7) group leadership. People with aphasia perceive community aphasia-group participation to be beneficial to their ability to live well with aphasia. However, a range of challenges to successful participation are also evident. Inputs such as peer-to-peer communication strategies, shared roles and responsibilities, and consultation with regard to group objectives and processes provide group members with the opportunity to become active contributors, demonstrate competence and have influence over the group. When inputs are poorly implemented or absent, people with aphasia are at risk of feeling disabled and marginalized by the group experience.

Community aphasia groups represent a formalised opportunity for social participation. The potential barriers and facilitators to accessing and maintaining group participation remain poorly understood. The aim of this study was to explore environmental and personal factors contributing to community aphasia group participation.A framework analysis (FA) was used to analyse the semi-structured interview data from 22 current and past members of community aphasia groups.People with aphasia weigh up the benefits of group participation in the context of a range of personal and environmental factors. These include personal coping mechanisms, perceptions of existing social support as well as the practicalities of accessing the group.Understanding factors that contribute to participation experiences is critical to ensure that, people with aphasia are well supported to access and engage in community aphasia groups. This study found that people may be more able to participate when they are accepting of the chronic nature of the aphasia, when they identify tangible benefits to participation, and when they have easy access to the group. This suggests a role for speech pathologists to recognise critical periods of need and support people with aphasia and their significant others to access and engage in group services. Implications for Rehabilitation Critical stages exist when people with aphasia may feel more ready and able to participate in community aphasia groups. These critical stages include an acceptance of the chronic nature of aphasia, as well as a desire to make positive change. There is a need for clinicians to minimise barriers to participation early in the therapeutic relationship. Proliferation of community aphasia groups will function to alleviate environmental barriers associated with poor public awareness of groups and group accessibility.

In their lead article, Dietz and Boyle (This issue) consider the evolution of discourse outcome measurement in aphasia rehabilitation, positing an urgent need for standardisation. We are undeniable...

Background: Community aphasia groups have consistently been highlighted as a viable and effective means of supporting people with chronic aphasia to live full lives. The multi-person nature of the ...

PURPOSE: Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework. METHOD: Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library. RESULTS: Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia. CONCLUSIONS: This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.

Background: Speech pathologists work to optimise communication and reduce the emotional and social impact of communication disability in patients with aphasia but need evidence-based interventions to effectively do so.Objective: This phase 1 study aims to evaluate an Australian speech-pathology-led intervention called the Aphasia Action, Success, and Knowledge (Aphasia ASK) programme for patients with aphasia early post stroke.Methods: A convergent parallel mixed-methods design was utilised. The intervention included up to six individual face-to-face sessions with seven participants with aphasia and their nominated family member(s). Quantitative outcomes assessing mood, quality of life, and communication confidence were conducted for the participants with aphasia. Follow-up interviews were conducted with both participants with aphasia and family members to determine their perceptions of the programme.Results: Significant improvements were found in communication confidence and mood after treatment and the gains were maintained at 3-month follow-up. Participants with aphasia and their family members reported a good level of satisfaction with the programme.Conclusions: Findings suggest the Aphasia ASK programme is a suitable intervention with positive initial outcomes for people with aphasia. A larger scale evaluation with a greater variety of participants is now required. An Australian cluster randomised control trial is planned.

Background: Guidelines recommend that all non–ST-segment elevation acute coronary syndrome (NSTEACS) patients with high-risk features receive a coronary angiogram. We hypothesised that the widely reported gender disparity in the use of angiography might be the result of women more frequently being stratified into the lower-risk category. Objectives: The aim of the study was to review studies reporting risk stratification of NSTEACS patients by gender, compare risk profiles, and assess impact on use of coronary angiography. Methods: PubMed, Scopus, and EMBASE databases were searched on June 17, 2014, using MeSH terms/subheadings and/or key words with no further limits. The search revealed 1230 articles, of which 25 met our objective. Results: Among the 28 risk-stratified populations described in the 25 articles, women were more likely to be stratified as high-risk in 13 studies; men were more likely to be stratified as high-risk in 3 studies. After meta-analyses, women had a 23% higher odds of being stratified as high-risk than did men (P = .001). Lower-risk patients were more likely to receive an angiogram in 15 study populations. Conclusions: Contrary to our hypothesis, this review showed that women with NSTEACS are more likely than men to be considered high-risk when stratified using a range of risk assessment methods. Lower rates of angiography in women form part of a broader treatment-risk paradox, which may involve gender bias in the selection of patients for invasive therapy.

BACKGROUND: Literature suggests an ongoing gender disparity in the use of coronary angiography and subsequent interventions among patients with acute coronary syndrome (ACS). OBJECTIVES: The study aimed to examine gender differences in the use of coronary interventions amongst patients with acute coronary syndrome (ACS) admitted to a major metropolitan hospital in Melbourne during the period 2009-2012. METHODS: We undertook a retrospective analysis of a hospital database of 2096 ACS patients. ACS included unstable angina (UA), ST-segment-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). RESULTS: The mean age of the patients was 64.3 years and 624 (30%) were women. Half of them were diagnosed as NSTEMI, 23% as STEMI and 25% as UA. Compared to men, women were older at admission, less likely to be diagnosed with STEMI and less likely to smoke. No gender difference was observed for severe co-morbidities or use of coronary angiography. Women diagnosed with STEMI were 39% less likely to receive an angioplasty stent (adjusted odds ratio 0.61, 95% confidence intervals 0.39-0.96) and 66% less likely to receive grafts (adjusted OR 0.34, 95% CIs 0.13-0.93). Women diagnosed with NSTEMI were 44% less likely to receive grafts (adjusted OR 0.56, 95% CIs 0.37-0.83). Younger women aged 35-49 years were less likely to receive an angioplasty stent, and older women >50 years were less likely to receive grafts. CONCLUSIONS: Adherence to guideline based treatment will help to ensure knowledge translation from guideline to practice. Further research investigating symptom presentation, use of non-invasive tests and medical management of ACS by gender may further explain gender difference for coronary interventions.

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Background: There are evidence-practice gaps in all areas of aphasia management across the continuum of care. Despite the recognition that effective implementation strategies are needed to improve the consistency of speech pathologists’ aphasia management practices, there have been few studies investigating this important issue. Therefore, little is known about the effectiveness of implementation strategies in the field of aphasiology. In light of the developing field of knowledge translation, it is important to review the aphasia implementation literature to highlight current trends, draw together findings, and determine future implementation research needs. Aims: To critically review, summarise, and discuss the implementation literature in the field of aphasiology to date, in order to guide clinical aphasiologists to work towards closing the evidence-practice gaps in aphasia management. Main contribution: A review of the literature in this developing area of expertise in the field of aphasiology, with examples of practical applications. Conclusions: Only six implementation studies have been published in aphasia (related to conversation partner training, discourse analysis, information provision, and collaborative goal-setting practices), showing there is a need for capacity building in this area. Therefore, we are not yet able to state what interventions are effective in which context, nor fully understand how behaviour change occurs for clinicians providing aphasia management. Implications for speech-language pathologists are discussed. An overarching call to action is the need for clinicians and researchers to work together to drive future implementation efforts that can succeed in closing the aphasia management evidence-practice gaps.