Achieving Rehabilitation Equality for People With Aphasia in a Student-Run Stroke Clinic (SRSC)

PURPOSE: Of the 795,000 new strokes each year, 25-40% result in aphasia, a cognitive impairment of receptive and/or expressive language (Flowers et al., 2016). Persons with aphasia (PWA) experience poorer healthcare outcomes, due in part to inadequate exchange of information between PWA and their health care providers (Flowers et al., 2016). In an occupational therapy (OT) student-run stroke clinic (SRSC) which provides improvement in clinical outcomes for clients (Doherty, Dyer, Wilson & Russell-Thomas, In Press), students participate in an aphasia training protocol. The training includes conversation partner training (CPT) prior to providing client-centered care and facilitates PWAs’ active participation in therapy and valued life activities. CPT is well-established as an effective means of increasing informational and social aspects of communication between persons with and without aphasia (Simmons-Mackie, Rayner, & Cherney, 2016), yet there is a paucity of literature regarding its application to OT. In addition to improving clinical outcomes and quality of life, involvement of PWA in decisions about their care may make it more effective and cost-efficient (Vahdat, Hamzehgardeshi, Hessam, & Hamzehgardeshi, 2014). The purpose of this study was to compare OT outcomes to assess clinical changes and quality of care delivered to individuals with and without aphasia post stroke in a student-run free clinic when OT students are trained to communicate with PWA.

DESIGN: In this comparative pilot study, we analyzed the clinical outcomes of clients in the SRSC. Inclusion criteria: age 18+, stroke diagnosis, served in the SRSC between August 2017 and December 2018, and informed consent to participate in research.

METHOD: The Action Research Arm Test (ARAT), Berg Balance Scale, Patient Health Questionnaire-9 (PHQ-9), Canadian Occupational Performance Measure COPM), and a client satisfaction survey, respectively, were used to assess and compare change in upper extremity function, balance, depressive symptoms, treatment goal attainment, and overall satisfaction with care of clients with aphasia (n=6) and without aphasia (n=13). Change scores were calculated, averaged within groups, and compared between groups using parametric and nonparametric tests and Cohen’s d for effect size.

RESULTS: Both groups demonstrated improvements on all outcome assessments and met published minimal clinically important differences on multiple measures. Change scores were calculated; neither parametric nor non-parametric analyses indicated significant differences (p <0.05) between groups, suggesting equitable care was provided. Cohen’s d effect sizes were small for UE function on the ARAT (0.24), Berg Balance Scale (0.24), PHQ-9 depressive symptoms (0.08), and increase in performance (0.26) and satisfaction (0.06) in COPM goal attainment, indicating only trivial differences between groups. Medium to large effect sizes in client satisfaction with care (0.52-0.97) indicated that, while not statistically significant, there was a meaningful difference between groups, with PWA perceiving moderate rather than high quality of care.

CONCLUSION: Training in evidence-based strategies to communicate with PWA contributes to equitable OT care and outcomes for clients in a student-run stroke clinic and has the potential to reduce disparities for this population. Further study is warranted to assess feasibility of this approach for PWA in additional settings with OT students and experienced clinicians and with a larger sample.

IMPACT STATEMENT: Determining potential clinical, social, and economic benefits of aphasia training for OT students and practitioners is a promising area of further investigation for improving OT practice and therefore improving health care outcomes for PWA.

References

Flowers, H. L., Skoretz, S. A., Silver, F. L., Rochon, E., Fang, J., Flamand-Roze, C., & Martino, R. (2016). Poststroke aphasia frequency, recovery, and outcomes: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 97(12), 2188-2201.e2188. doi:10.1016/j.apmr.2016.03.006

Doherty, M., Dyer, M., Wilson, E., & Russell-Thomas, D. Rehabilitation outcomes from an occupational therapy student-run free clinic for individuals with acquired brain injury (In Press). Journal of Allied Health.

Simmons-Mackie, N., Raymer, A., & Cherney, L. R. (2016). Communication partner training in aphasia: An updated systematic review. Archives of Physical Medicine and Rehabilitation, 97(12), 2202-2221.e2208. doi:10.1016/j.apmr.2016.03.023

Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (2014). Patient involvement in healthcare decision making: A review. Iran Red Crescent Medical Journal, 16(1). doi:10.5812/ircmj.12454