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Background: People with an acquired brain injury (ABI) find it challenging to use social media due to changes in their cognition and communication skills. Using social media can provide opportunities for positive connection, but there is a lack of interventions specifically designed to support safe and successful social media use after ABI., Aims: To investigate the outcomes of completing a social media skills intervention and identify barriers and facilitators for future implementation., Methods & Procedures: The study used a mixed-methods, pre-post-intervention design. A total of 17 adults with an ABI were recruited. Participants completed an intervention that included a short self-guided course about social media skills (social-ABI-lity course), and then participated in a private, moderated Facebook group over a 12-week period (social-ABI-lity Facebook group). Data were collected over this period through observation of group activity and weekly surveys. They were also collected on social media use and quality of life at pre-intervention, post-intervention and after 3 months. Participants provided feedback on the experience of participating in the programme via a post-intervention interview., Outcomes & Results: At post-intervention, there were significant improvements in confidence in using Facebook (p = 0.002) and enjoyment of using Facebook to connect with others (p = 0.013). There was no significant change in reported quality of life, although participants described the multiple benefits of connection they perceived from involvement in the group. Observational data and feedback interviews were informative about the feasibility and acceptability of the intervention., Conclusions & Implications: This pilot study provided preliminary evidence that an intervention comprising a short, self-guided training course and a private, moderated Facebook group improved outcomes for people with ABI. Key recommendations for future implementation include embedding active peer moderators within groups and taking an individualized approach to delivery of the intervention., What This Paper Adds: What is already known on the subject Research has documented the challenges that people with ABI experience in using social media, and the difficulty for rehabilitation clinicians in providing appropriate support in this field. What this paper adds to existing knowledge This pilot study reports the outcomes of people with ABI completing a short, self-guided social media skills course and participating in a private, moderated Facebook group. After the intervention, participants reported significantly increased confidence and enjoyment in using Facebook, described the benefits of connection found in the groups, and suggested potential improvements for future implementation. What are the potential or actual clinical implications of this work? With the growing use of social media for connection and participation, there is a professional obligation to address social media communication skills in cognitive-communication rehabilitation for people with ABI. The findings of this study will inform interventions and future research to assist people with ABI to build their social media skills for communication, social support and a sense of connection., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: People with aphasia are vulnerable recipients of healthcare. The nature of the communicative environment and the communication disability can adversely impact access to timely and quality healthcare. Student healthcare professionals are often underprepared to interact successfully with people with aphasia and may benefit from communication partner training (CPT)., Aims: To investigate the potential effectiveness and acceptability of a brief, two-part introductory Supported Conversation for Adults with Aphasia (SCA™)-based CPT package, delivered to a sample of students across a diverse range of healthcare disciplines., Methods & Procedures: A pre-post-within group experimental design was used to investigate the potential effectiveness and acceptability of an online CPT package (50 minute module + 1 hour workshop) for healthcare students. The Aphasia Attitudes, Strategies and Knowledge (AASK) survey measured participants' knowledge of aphasia, facilitative communication strategies and attitudes towards people with aphasia. Data were collected pre-training, following the training module and following the workshop, and 6 weeks post-training. Statistical analysis was conducted on the AASK data. In addition, participant feedback (ratings and open text responses) was collected after the workshop. Ratings were analysed descriptively, and thematic content analysis was used for open text responses., Outcomes & Results: 236 participants completed the pre-training AASK and 106 completed the AASK at subsequent time points. Statistically significant gains were demonstrated from pre- to post-module completion. Between the end of the module and the end of the workshop, some gains were maintained and others showed further statistically significantly improvements. While all gains were not maintained at the 6-week follow-up, statistically significantly improvements from pre-training scores remained evident. Student feedback was predominantly positive, with suggested improvements for training content and length., Conclusions & Implications: The results provide preliminary evidence that a brief, online CPT package can support student healthcare professionals' knowledge and attitudes towards aphasia and communicating with people with aphasia. Online training was acceptable to students and feasible as an embedded or optional component of curriculum. Ongoing training (e.g., in the form of refresher sessions) and inclusion of a skills-based component are recommended to maximize communication skill development., What This Paper Adds: What is already known on the subject Student healthcare professionals recognize the need to develop knowledge and skills to successfully support people with communication disability, such as aphasia, to participate effectively in their healthcare. Evidence in favour of online communication partner training for student healthcare professionals is currently limited. What this study adds to the existing knowledge This study demonstrates that a brief introductory online communication partner training program can be efficacious for improving knowledge and attitudes regarding communicating with people who have aphasia. What are the potential or actual clinical implications of this work? Students will likely need further ongoing refresher training with inclusion of practical components to develop and maintain the knowledge and skills required to be proficient communication partners with people with aphasia., (© 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Narrative discourse is central to effective participation in conversations. When discourse is assessed in people with communication disability, structured tasks (e.g., picture descriptions) provide experimental control, while unstructured tasks (e.g., personal narratives) represent more natural communication. Immersive virtual reality (VR) technology may provide a solution by creating standardized experiences for narrative retell, therefore balancing ecological validity and experimental control in discourse assessment. Research is needed to understand how VR immersion affects narrative retell, first for adults with no communication disability, before application with adults with aphasia or related communication disability., Aims: To assess (1) the effects of VR immersion on the linguistic content and structure of narrative retells in a healthy adult population; and (2) whether VR immersion can influence the way a narrative is retold so that the speaker conveys their own experience, rather than the experience of the characters they are watching., Methods & Procedures: In this pilot cohort study, 13 healthy adult participants with no reported communication disability watched an animated short film and a comparable immersive VR short film in a randomized order. Participants were asked to retell the events of the story after each condition in as much detail as possible., Outcomes & Results: Mean length of utterance (in morphemes) was significantly higher in the video condition compared with the VR condition. Significantly more first-person pronouns were used in the VR condition compared with the video condition. No other measures of linguistic content or structure were significantly different between the VR and video conditions., Conclusions & Implications: Increased morpho-syntactic length and complexity in the video condition may suggest effects of elicitation stimulus on the narrative produced. The larger number of first-person pronouns in the VR condition may reflect that participants experienced a sense of presence in the virtual environment, and therefore were able to retell their communication experience rather than narrating the experiences of characters from an external perspective. Given the increasing need for more functional assessment of discourse in people with communication disability, further research is needed to validate these findings., What This Paper Adds: What is already known on this subject As an ecologically valid tool, discourse analysis is often used to assess daily communicative exchanges in adults with acquired communication disability. Clinicians and researchers using narrative discourse assessment must balance the experimental control and diagnostic reference sample capabilities of structured tasks with the ecological validity and real-life transferability of unstructured personal narratives. What this study adds to existing knowledge This study explores the use of immersive VR technologies to create standardized, replicable, immersive experiences as a foundation for narrative discourse assessment. It highlights how the 'sense of presence' in a virtual world can prompt healthy adult speakers to retell a narrative of a personal experience that can be replicated for many different participants. The results suggest that immersive VR narrative assessment for adults with communication disability may balance ecological validity with measurement reliability in discourse assessment. What are the potential or actual clinical observations of this work? Immersion in VR resulted in the production of narratives with morpho-syntactic features that aligned with typical narrative generation, rather than retell. Participants used more first-person pronouns, suggesting retelling of personal experience. Though further study is needed, these preliminary findings suggest clinicians can use immersive VR stimuli to generate structured story generations that balance experimental and diagnostic control with ecological validity in narrative discourse assessment for adults with communication disability., (© 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd behalf of Royal College of Speech and Language Therapists.)

Background: Factors influencing the implementation of communication partner training (CPT) with familiar partners of people with aphasia (PWA) have previously been documented using disparate approaches. To date there has been no synthesis of these factors using a common theoretical framework. Investigating CPT implementation factors using a common theoretical framework may further our understanding of universal barriers and guide future development of tailored, theoretically informed implementation strategies., Aims: (1) To determine the perceived and/or observed barriers and facilitators to implementing CPT with familiar partners of adults with aphasia; (2) to map extracted barriers and facilitators to a common theoretical framework; (3) to synthesize extracted barriers and facilitators; and (4) to identify potential implementation strategies to address the most frequently identified barriers and facilitators., Methods & Procedures: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science) were systematically searched in April 2021. Empirical qualitative and/or quantitative research studies reporting barriers/facilitators to speech-language therapists (SLTs) implementing CPT with familiar partners of adults with aphasia were included. The search was limited to English or French articles with no date limit applied. Methodological quality of included studies was assessed using the Mixed-Methods Appraisal Tool (MMAT). A framework and content analysis was then conducted to extract and synthesize the implementation factors in alignment with the Theoretical Domains Framework (TDF), followed by a theoretically informed mapping exercise to identify potential implementation strategies., Results & Main Contribution: The database searches yielded 2115 studies. Following screening, 17 studies were included in the review. Overall, the included studies had good methodological quality. Extracted implementation factors were classified as barriers, facilitators or mixed (i.e., both) and aligned with 13 of the 14 TDF domains, plus two additional domains: 'carer perspectives on the CPT intervention' and 'patient/carer characteristics'. Synthesized data revealed eight key theoretical domains: Environmental context and resources; Social influences; Beliefs about consequences; Skills; Memory, attention and decision-making; Knowledge; Beliefs about capabilities; and Reinforcement. Within each domain, the research team identified common categories and developed illustrative examples of theoretically informed implementation strategies., Conclusions & Implications: This systematic review and theory-informed synthesis of previously reported CPT implementation factors enabled the identification of key barriers to SLTs delivering this best practice. This led to proposed implementation strategies that should be validated, refined and evaluated in future research involving stakeholders who have contextual understanding of implementing CPT., What This Paper Adds: What is already known on the subject CPT of familiar partners of PWA is an effective intervention that is inconsistently used in clinical settings. Factors influencing CPT implementation have previously been identified, but using disparate approaches and frameworks. A synthesis of these factors articulated around a common framework is currently not available. What this paper adds to existing knowledge This paper provides a theory-informed synthesis of previously reported barriers and facilitators to SLTs implementing CPT with familiar partners of PWA. It highlights key factors influencing the uptake of this best practice and includes suggestion of implementation strategies to address them. What are the potential or actual clinical implications of this work? The key influencing factors and proposed implementation strategies reported in this paper may support stakeholders in the future design of tailored and theoretically informed implementation strategies aiming to improve the delivery of familiar CPT in their setting., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: While implementation studies in aphasia management have shown promising improvements to clinical practice, it is currently unknown if aphasia implementation outcomes are sustained and what factors may influence clinical sustainability., Aims: To evaluate the sustainment (i.e., sustained improvement of aphasia management practices and domains influencing clinicians' practice) and sustainability (i.e., factors influencing sustainability) outcomes of the Acute Aphasia IMplementation Study (AAIMS)., Methods & Procedures: A convergent interactive mixed-methods sustainability evaluation was conducted on two previously delivered implementation interventions (AAIMS). The AAIMS interventions were targeted at improving either written aphasia-friendly information provision (Intervention A) or collaborative goal-setting (Intervention B). Outcomes were collected 2 and 3 years post-implementation, addressing the research questions of sustainment (e.g., medical record audits and behavioural constructs questionnaires) and sustainability (e.g., post-study focus groups and organizational readiness surveys). Quantitative sustainability data were compared with post-implementation data, allowing for sustainment to be determined. Clinicians' perspectives on sustainability outcomes and challenges were analysed using framework analysis and integrated with the quantitative findings., Outcomes & Results: A total of 35 speech-language therapists (SLTs) from four hospitals participated. The medical records of 79 patients were audited in the sustainability period compared with the 107 medical records audited during AAIMS. Overall, there was variable sustainment of the target behaviours; implementation for Intervention A was not sustained at either sustainability time point (2018 = 47.8% decrease; 2019 = 22.78% decrease), but implementation for Intervention B was sustained at both time points (2018 = 7.78% increase; 2019 = 18.1% increase). There was a pattern of sustained change in the behaviour change domains targeted by the implementation interventions, where scores of the targeted domains increased over time (0.13, 95% confidence interval (CI) = -0.05 to 0.30) and scores of the non-targeted domains declined (-0.03, 95% CI = -0.11 to 0.04). Factors influencing sustainability were mainly related to 'processes', 'the inner context' and 'SLT characteristics', and these interacted dynamically to account for variation between teams., Conclusions & Implications: Implementation outcomes (i.e., practice changes) were not sustained to the same level for three of the four participating SLT teams, with variable or partial sustainment most common. While the factors influencing sustainability differed depending on the context and individuals involved, the most important factor influencing outcomes seemed to be the level to which behaviour-change processes and strategies were embedded within the SLT department. Future implementation studies should incorporate sustainability measures from the onset and include follow-ups and monitoring systems to help support sustained change in the long term., What This Paper Adds: What is already known on the subject In post-stroke aphasia management, there are few examples of long-term sustainability of implementation outcomes. It is therefore unknown what factors are potentially important to sustain implementation of best-practice recommendations in aphasia services. What this paper adds to existing knowledge There is potential for implementation outcomes to be sustained long term, but sustainment is impacted by a range of factors. Ongoing facilitation or follow-up after initial implementation may to useful to promote sustainment, but is not essential if processes are sufficiently embedded. Gradual implementation into practice may lead to better sustainment than rapid change that is quickly forgotten. What are the potential or actual clinical implications of this work? Future implementation efforts should incorporate sustainability measures from the onset. Applying a sustainability framework was useful to guide evaluations and explore factors influencing the sustainment outcomes and is recommended for those interested in sustainability. Results from our evaluation can be used to guide refinement and support future development of sustainable implementation interventions., (© 2021 Royal College of Speech and Language Therapists.)

Background: Training conversation partners of people with aphasia who use facilitative communication strategies is one method that can improve access to healthcare for people with aphasia. However, the efficacy of communication partner training (CPT) has been investigated almost exclusively in the context of face-to-face (F2F) delivery. Online training may offer more cost-effective and accessible options to a wider range of conversation partners, including student healthcare professionals., Aims: To conduct a pilot randomized controlled trial with student healthcare professionals comparing (1) an online aphasia CPT program, (2) a F2F CPT program and (3) no program (control group) on outcomes relating to attitudes and knowledge of aphasia., Methods & Procedures: A 45-min introductory aphasia CPT program was developed using the theories and techniques of Supported Conversations for Adults with Aphasia (SCA)™. A total of 30 first-year undergraduates studying occupational therapy at The University of Sydney were randomly allocated to one of three conditions: online CPT delivery, F2F delivery or delayed training control (no program). Outcomes measures included pre-post-testing with the Aphasia Attitudes, Strategies and Knowledge (AASK) survey., Outcomes & Results: A significant difference existed for the AASK survey pre-post-change scores between the online, F2F and control groups (χ 2 (2) = 20.038, p = 0.000). Post-hoc analysis revealed that, compared with the control (Ctrl) group, participants in both the online and F2F groups had significantly higher knowledge of aphasia (Online versus Ctrl: p = 0.000; F2F versus control: p = 0.002), knowledge of facilitative strategies (Online versus Ctrl: p = 0.000; F2F versus Ctrl: p = 0.002), and positive attitudes towards aphasia (Online versus Ctrl: p = 0.031; F2F versus Ctrl: p = 0.032). No significant difference was observed between the online and F2F groups for the Total or any subtotals (p = 1.000)., Conclusions and Implications: The results from this pilot randomized controlled trial indicate that online delivery of the 45-min introductory CPT is equally as efficacious as F2F delivery, and thus may be a viable mode of delivery for future aphasia CPT programs. These pilot results pave the way for a larger study that will comprehensively evaluate the efficacy of an online aphasia CPT program for improving attitudes, knowledge and skills in a broad range of student healthcare professionals. What this paper adds What is already known on this subject The efficacy of F2F CPT for aphasia is well established. Online delivery of CPT programs may offer more cost-effective and accessible services when compared with F2F approaches; however, there is a need to explore the efficacy of online programs. What this paper adds to existing knowledge The 45-min online aphasia CPT program was found to be efficacious for improving student healthcare professionals' knowledge and attitudes towards aphasia and communication, and produced equally successful outcomes when compared with F2F delivery. This is the first study to report the efficacy of an online CPT program that is aligned with SCA for use with student healthcare professionals that also uses a self-report outcome measure with validated psychometric properties. What are the potential or actual clinical implications of this work? Online CPT programs may be useful in both clinical and education contexts to support improved efficiency of services and to enhance communication environments for people with aphasia in healthcare contexts., (© 2020 Royal College of Speech and Language Therapists.)

Background: Communication partner training (CPT) programmes for health and care staff working with people with the neurologically based communication disorders associated with stroke, traumatic brain injury (TBI) and dementia are efficacious in improving communication. However, current programmes are lengthy and disorder specific, and therefore may not be suitable as staff training tools in environments with people with multiple communication disorders, and services with a variety of neurological populations., Aims: To identify common and distinct components of CPT programmes for stroke, TBI and dementia in order to determine whether there are common delivery methods and content that can be consolidated to improve implementation of CPT in health and care services., Methods & Procedures: A qualitative enquiry was used. Four CPT programmes targeting three disorders were identified from systematic reviews and literature searches. Programme data were recorded onto data sheets from manuals, study articles and supplementary materials, and were categorized using the Intervention Taxonomy (ITAX). Content analysis and elements of constant comparative analysis were employed to analyse the CPT programmes., Outcomes & Results: Delivery characteristics were similar across all four programmes. All were delivered face to face in either group or individual contexts. However, duration varied from 1 to 35 h. Six of the 12 categories of information provided were common across all programmes, including 'strategy' 'background to disorder', 'information about communication', 'information about program', 'negative behaviours to avoid' and 'purpose of program'. Programmes differed in the types of skill-building techniques used, with the most common being videos (3/4 programmes), discussions (2/4 programmes) and trainer demonstrations (2/4 programmes). While strategies provided to trained partners targeted similar domains of communication, only 3/96 individual strategies were common to all programmes., Conclusions & Implications: There are both common and distinct components in content and delivery methods across CPT programmes. Further research is needed to evaluate the distinct components of the programmes, to determine which individual strategies are efficacious, and which approach to skill-building techniques is most effective. The present study has contributed a comprehensive list of programme components, which can form a basis for describing and refining CPT programmes in future., (© 2018 Royal College of Speech and Language Therapists.)

Background: Communication partners (CPs) find it challenging to communicate with people with communication disorders post-stroke. Stroke communication partner training (CPT) can enhance CPs' ability to support the communication and participation of people post-stroke. While evidence for the efficacy of aphasia-based CPT is strong, implementation in healthcare settings is unclear., Aims: To investigate Australian speech pathologists' current stroke CPT practices, factors influencing the implementation of CPT and how reported practice compares with the research evidence., Methods & Procedures: Speech pathologists in Australia who had worked with people post-stroke were invited to complete a 99-item online survey. The survey was informed by a comprehensive review of the literature review, the Template for Intervention Description and Replication (TIDieR) intervention taxonomy, and the theoretical domains framework. data were analyzed using descriptive statistics and content analysis., Outcomes & Results: A total of 122 clinicians were surveyed. Most participants reported providing CPT to treat a range of post-stroke communication disorders. While 98.3% reported training familiar CPs, only 66.1% reported training unfamiliar CPs. Current stroke CPT practice is characterized by one to two < 1 h sessions of informal face-to-face education and skills training. Only 13.3% and 10.0% of participants used evidence-based published programmes with unfamiliar and familiar CPs respectively. The main barriers included the perceived lack of behavioural regulation, skills, reinforcement, beliefs about consequences, positive social influences and resources. The main facilitators included clinicians' intentions to provide CPT, perception of CPT as part of their role and perceived compatibility of CPT with clinical practice., Conclusion & Implications: A significant evidence-practice gap exists. Research exploring the implementation of stroke CPT in healthcare settings, expanding evidence to support CPT for the range of post-stroke communication disorders, developing freely accessible step-by-step CPT programmes that consider restrictions in current practice and providing explicit instructions of CPT best practice are warranted. A supportive workplace culture and freely accessible formal training opportunities are also needed., (© 2018 Royal College of Speech and Language Therapists.)

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., (© 2018 Royal College of Speech and Language Therapists.)

Background: speechBITE (http://www.speechbite.com) is an online database established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making. In addition to containing more than 3000 journal references, the database also provides methodological ratings on the PEDro-P (an adapted version of the PEDro) scale to assist clinicians in identifying the scientific quality of randomized (RCTs) and non-randomized control trials (NRCTs). While reliability of the PEDro scale has been established by similar allied health databases, the reliability of the PEDro-P scale has yet to be reported., Aims: To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE database and benchmark these results to the published reliability for the original PEDro scale. Both the total score (out of ten) as well as each of the 11 scale items were included in this analysis., Methods & Procedures: speechBITE's volunteer rater network of 17 members rated the first 100 RCTs and NRCTs on the website. The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale. Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability., Outcomes & Results: The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items. Furthermore, reliability was equal to that of other databases., Conclusions & Implications: speechBITE users can be confident of the reliability of ratings published on the website. Further analysis of differences between this study and previous PEDro scale reliability studies are discussed., (© 2013 Royal College of Speech and Language Therapists.)