Current practice and barriers and facilitators to outcome measurement in aphasia rehabilitation: a cross-sectional study using the theoretical domains framework

Background: Speech-language pathologists (SLPs) measure outcomes to gauge the impact of their interventions and to inform best care for clients. Previous research has explored outcome measurement practices in aphasia rehabilitation, however the factors driving clinician behaviour have not been examined.Aim: To explore current clinical practice and perceived barriers and facilitators to aphasia outcome measurement.Methods and Procedures: Australian SLPs who worked clinically with people with aphasia completed a cross-sectional online survey. Current practice was explored using a combination of multiple-choice questions (with open-text response options) and Likert rating scales. Barriers and facilitators to outcome measurement were explored through ratings of statements aligned with the Theoretical Domains Framework. Data were analysed using descriptive statistics and cross-tabulations.Outcome and Results: Data from 74 Australian SLPs were included. All SLPs reported measuring outcomes and these most frequently related to communication and language. SLPs reported using a diverse range of outcome measures across construct areas and stage-post stroke of service provision, with more than 80 unique instruments/approaches identified. The most frequently used outcome measurement instruments/approaches were: The Western Aphasia Battery – Revised (WAB-R) for language; the Therapy Outcome Measures/Australia Therapy Outcome Measures (TOMs/AusTOMS) for communication, participation, and quality of life; and Goal Attainment Scaling for psychological and carer/significant other outcomes. Overall, SLPs identified more facilitators than barriers to outcome measurement. The main barriers related to the theoretical domains “behavioural regulation” (managing or changing actions) and “memory, attention and decision-making processes” (ability to retain information, focus selectively and choose between alternatives). The main facilitators related to the theoretical domains “beliefs about consequences” (acceptance of the truth, reality, or validity about outcomes of a behaviour) and “social/professional role and identity” (a coherent set of behaviours and displayed personal qualities in a social or work setting).Conclusions: All SLPs reported measuring outcomes with clients with aphasia and these primarily related to language and communication. The outcome measurement instruments/approaches used were heterogeneous within construct areas. SLPs see outcome measurement as part of their role and believe it to be an important activity, however report a need for training and workplace systems and strategies to support optimal practices. The results of this study may inform the development of theoretically informed implementation interventions which seek to improve SLP outcome measurement practice in aphasia rehabilitation.