Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Does an Implementation Toolkit Improve Aphasia Care? Preliminary Results of a Pilot Study. (106875)

Kirstine Shrubsole 1 2 , Charmaine Briffa 3 , Joanna Nestor 3 , Rachel Levine 1 2 , Elizabeth Lynch 4 , John Pierce 5 , Bridget Burton 1 2 , Megan Trebilcock 6 , Sarah J Wallace 1 2 , Emma Power 7
  1. Queensland Aphasia Research Centre, The University of Queensland, Brisbane
  2. STARS Education and Research Alliance, Metro North Hospital and Health Service, Brisbane
  3. Speech Pathology Department, Eastern Health, Melbourne
  4. College of Nursing and Health Sciences, Flinders University, Adelaide
  5. Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne
  6. School of Allied Health, Australian Catholic University, Sydney
  7. Graduate School of Health , University of Technology Sydney, Sydney

Introduction: Targeted implementation efforts can reduce evidence-practice gaps in aphasia care1. Guidelines recommend speech pathologists provide information to people with aphasia in ‘aphasia-friendly’ formats2, but there are challenges in doing so3. A toolkit led by trained Change Champions that contains evidence-based implementation tools is a potential solution. This study sought to determine preliminary feasibility and acceptability of a prototype toolkit to improve provision of aphasia-friendly information.

Methods: Design: Mixed methods, pre-post, feasibility study. Participants: Speech pathologists in one health service (acute, inpatient rehabilitation, and community). Intervention: Change Champion training was provided to two clinicians who identified local barriers and selected a suite of relevant implementation tools. Tools included documentation templates, aphasia-friendly materials, and action planning tools. Change Champions supported clinicians for a 3-month implementation period. Outcome measures: (i) pre-post practice audits, (ii) pre-post clinician barriers surveys, (iii) post-study clinician focus groups. Analysis: Descriptive statistics and non-parametric tests for quantitative data, content analysis for qualitative data. Data were integrated using a convergent interactive mixed methods approach.

Results: Thirteen speech pathologists, including two Change Champions, participated. Provision of written aphasia-friendly information increased by 60% (p = 0.005). Twelve of 14 barriers targeted by the implementation tools improved, including local processes, access to resources, and clinician knowledge and skills. Clinicians perceived the toolkit elements to be feasible and acceptable, and highlighted the benefit of Change Champions in facilitating implementation.

Conclusion: The Change Champion-led toolkit prototype was feasible and acceptable, and resulted in improved practice. This pilot project is the first step in developing an expanded Aphasia Implementation Toolkit to improve priority evidence-based gaps in aphasia services.

Relevance to clinical practice or patient experience: Trained Change Champions with access to implementation tools have the potential to drive meaningful improvements in aphasia services. Embedding Change Champion roles within aphasia services may lead to sustained implementation.

  1. Shrubsole, K., Worrall, L., Power, E., & O'Connor, D. A. (2018). The Acute Aphasia IMplementation Study (AAIMS): a pilot cluster randomized controlled trial. International journal of language & communication disorders, 53(5), 1021–1056. https://doi.org/10.1111/1460-6984.12419
  2. Power, E., Thomas, E., Worrall, L., Rose, M., Togher, L., Nickels, L., Hersh, D., Godecke, E., O'Halloran, R., Lamont, S., O'Connor, C., & Clarke, K. (2015). Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method. BMJ open, 5(7), e007641. https://doi.org/10.1136/bmjopen-2015-007641
  3. Briffa, C., Sullivan, R., Murray, J., & van den Berg, M. (2023). Providing aphasia-friendly information in the healthcare setting: Applying the Theoretical Domains Framework to identify factors that influence speech pathologists’ self-reported practice. Aphasiology, 37(9), 1335–1362. https://doi.org/10.1080/02687038.2022.2093324