What do people with aphasia want from the Queen Square Intensive Comprehensive Aphasia Programme and do they achieve it? A quantitative and qualitative analysis of their short, medium, long-term and economic goals

Abstract

ABSTRACT Background The most effective model for achieving therapist-delivered, high-dose SLT for People with Aphasia (PWA) is through Intensive Comprehensive Aphasia Programmes (ICAPs). ICAPs are often assessed using standardised outcome measures; however, as SLT is personalised, it is of interest to examine individualised goal-based outcome measures as well. In the Queen Square ICAP, we use a goal-setting approach (Goal Attainment Setting [GAS]) where the PWA and their therapist negotiate which goals to work on and over what timescales. This process involves recording and scoring the agreed goals, which makes them amenable to formal quantitative and qualitative analysis. Aims The aim of this study was twofold. Firstly, to test the hypothesis that a pre- versus post- ICAP analysis of individual’s goal scores would show statistically significant and clinically meaningful improvements. Secondly, to better understand what PWA wanted to achieve from the ICAP service, we performed a qualitative analysis across all agreed goals. Methods & Procedures Forty-four PWA who varied in aphasia severity from mild to severe took part. PWA jointly set goals with their therapists using the SMART framework (Specific, Measurable, Achievable, Relevant, and Time-Bound). The goals were split into four categories: short (3 weeks), medium (3-6 months), long-term (12 months) and economic, (defined as any outcome that will improve, either directly or indirectly, the economic system that the PWA lives within). Quantitative scores were obtained for each PWA both pre- and post- ICAP and were analysed using paired t-tests, with subsequent ANOVAs to investigate possible confounding factors. The qualitative analysis was carried out by two researchers not involved in delivering the ICAP. Data was collapsed across all goal categories and analysed using thematic analysis. Outcomes & Results Quantitatively, statistically significant gains were made across all four goal categories (ps < 0.001). Unstandardized effect-sizes were clinically significant (ΔGAS ~16). Qualitatively, we identified five main themes: staying connected with the world, understanding aphasia better, raising awareness, the importance of having a work identity and managing personal relationships. Conclusions Quantitative goal-setting for PWA in the context of an ICAP provides robust evidence that PWA can achieve a variety of aspirational goals given high enough doses of specialist input from SLTs and a clinical psychologist. Although the ICAP only spanned 3 weeks, PWA continued to reach medium, long-term and even economic goals up to a year post-recruitment. This is the first time that economic goals have been captured in PWA using GAS. The qualitative analysis describes what the PWA wanted to achieve from participating in our ICAP, while the quantitative analyses demonstrate how much they succeeded in doing so.