The Acute Aphasia IMplementation Study (AAIMS): a pilot cluster randomized controlled trial

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Shrubsole, K, Worrall, L, Powers, E & O'Connor, DA in press, 'The Acute Aphasia IMplementation Study (AAIMS): a pilot cluster randomized controlled trial', International Journal of Language and Communication Disorders (Published online 5 August 2018).

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Background: Effective implementation strategies to improve speech and language therapists’ (SLTs) aphasia manage- ment practices are needed. Australian SLTs working in the acute setting have reported inconsistent implementation of post-stroke aphasia guideline recommendations. Therefore, implementation efforts to address these gaps are necessary. However, little is known about the effectiveness of behaviour-change strategies in SLTs providing acute aphasia management.

Aims: This study designed and tested the feasibility, acceptability and potential effectiveness of a tailored imple- mentation strategy to improve acute SLTs’ uptake of evidence in two areas of practice: aphasia-friendly information provision; and collaborative goal setting.

Methods & Procedures: A pilot cluster randomized controlled trial design was used (retrospective trial registration number ACTRN12618000170224). Four acute SLT teams were randomly assigned to receive either Intervention A (targeted at improving information provision) or Intervention B (targeted at improving collaborative goal setting), and were blinded to their allocation. Interventions were tailored to address known barriers and included a face-to-face workshop incorporating behaviour-change techniques. Outcomes addressed the research questions of feasibility (e.g., treatment fidelity and retention of participants), acceptability (e.g., post-study focus groups) and potential effectiveness (e.g., medical record audits and behaviour construct surveys). The quantitative data were recorded at baseline and 3–6-month follow-up, allowing for change scores to be calculated.

Outcomes & Results: All four clusters completed the study, with 37 SLTs participating. The majority of par ticipants were female (36/37 = 97.3%), entry-level clinicians (15/37 = 40.5%), with a mean age of 30 years. Medical record data from 107 patients were included (post-intervention n = 61; information provision intervention n = 36, goal-setting intervention n = 25). Overall, there was a significant improvement in the target behaviour for Intervention A (mean improvement 52.78%, p = 0.001), but a small non-significant change in the target behaviour for Intervention B (8.46%, p = 0.406). There were potentially significant changes seen in several, but not all, of the domains targeted by the interventions (e.g., Knowledge (p = 0.014), Beliefs about Capabilities (p = 0.032), and Environmental Context and Resources (p = 0.000) for Intervention A).

Conclusions & Implications: This study showed that a tailored implementation intervention targeting acute SLTs’ aphasia management practices was feasible to deliver and acceptable for most participants. In addition, the inter- ventions were potentially effective, particularly for the information provision behaviour targeted by Intervention A. It was possible partially to explain the mechanisms of behaviour change that occurred during the study.

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