Looking beyond what works: exploring the potential of realist review to enhance implementation of complex aphasia interventions in real world settings

Background Realist review, a theoretical, explanatory form of evidence synthesis, enhances understanding of how complex interventions work in open fluid social systems such as healthcare and education. In aphasiology, this approach enables researchers to shift the focus beyond what works to examine how, under what conditions and for whom interventions work.Aim To introduce the key concepts of realist review and elucidate how this approach to evidence synthesis enhances understanding of implementing complex aphasia interventions in healthcare and educational systems.Methods & Procedures We compare realist review and systematic review and describe the key concepts of realist review. We explain how realist review enables research-practice partnerships with concrete examples from a review of communication partner training conducted incorporating advisors with methodological expertise(n = 3); communication partner training expertise (n = 4); lived experience expertise (n = 3); pedagogical expertise (n = 1), participant expertise. We describe integrating an implementation science framework – the Consolidated Framework for Implementation Research into the review process.Outcomes and Results Programme theories developed explain how contexts enact mechanisms that affect intervention and implementation outcomes. The programme theory we developed has been mapped to the domains of the Consolidated Framework for Implementation Research to direct delivery of communication partner training across healthcare curricula.Conclusion Realist review can enhance the field of IS in aphasiology by looking beyond what works to ask how and why interventions work, under what conditions and for whom. Programme theories developed have the potential to increase understanding of pertinent implementation considerations in aphasia research and provide practical, pragmatic guidance to advance implementation strategies.