“That doesn’t translate”: Speech pathologists’ perceptions of evidence-based practice for acute aphasia management Abby Foster1, Linda Worrall1,3, Miranda Rose2,3, and Robyn O’Halloran2,3 1. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia 2. Department of Human Communication Sciences, La Trobe University, Melbourne, Australia 3. NHMRC CCRE Aphasia Rehabilitation, Australia
ABSTRACT This qualitative research project explores speech pathologists’ perceptions of evidence-based practice for acute aphasia management and its application to clinical practice, within an Australian context. Findings highlight the complexity of speech pathologists’ relationship with EBP, and the influence this complexity has on the clinical reasoning process.
BACKGROUND Acute hospital speech pathology practice is primarily focused on patients with dysphagia, with less time and resources available to dedicate to people with aphasia and their families in the acute hospital setting. This has prompted growing international interest and an increasing amount of research evidence exploring aphasia management in the acute phase. Concurrent with this change in role, the momentum towards evidence-based practice (EBP) in healthcare grew strength, driven by the requirement from organisational management, policy makers, the profession, and the public to demonstrate efficacy and effectiveness of interventions. To implement EBP, healthcare workers must consider and integrate four elements: research-based clinical evidence, clinical expertise, patient preferences and values, and context. However, little is known about speech pathologists’ understanding of EBP, or of the barriers and facilitators to achieving EBP in specific contexts. Further to this, little is known about how this understanding may influence speech pathologists’ clinical reasoning, and how this relates to clinical practice when working with patients with acute aphasia.
AIMS This study forms the primary study in a suite of post-graduate qualitative research exploring the acute management of aphasia. Interviews were with speech pathologists regarding their acute aphasia management practice and experience. This poster is a particular analysis of the data in relation to speech pathologists and evidence-based practice in relation to aphasia management. The aim of this poster is to provide an understanding of speech pathologists’ conceptualisation of evidence-based practice for acute post-stroke aphasia and its implementation. By extension, participants’ perceptions regarding their role in aphasia management in the acute stroke unit will be explored, as well as their perception of agents for change to promote the implementation of EBP.
METHOD A purposive sampling approach was utilised to recruit speech pathologists who were working in or had recently worked in a clinical role which involves the management of acute post-stroke aphasia within Australia. Sampling allowed for diversity across years of clinical experience, public/private sector employment, presence/absence of an acute stroke unit in place of employment, and location of clinical practice. Recruitment was undertaken through professional development events, professional networks, and direct requests to speech pathology departments known to have acute stroke units. Using an interpretive phenomenological approach, data was collected through single semi-structured interviews with fourteen speech pathologists. A topic guide was used during the recorded interview, with broad questions asked about the speech pathologists’ experience of working in acute post-stroke aphasia management, the perceived influences on decision-making, and the perceived barriers and facilitators to achieving evidence-based approaches to care in this setting. Using a thematic analysis approach, the coded interview data was analysed. Member checking and peer review processes were implemented to enhance methodological rigour.
RESULTS Preliminary analysis of the data relating to speech pathologists’ perceptions of EBP for acute aphasia management has resulted in the creation of key themes, which will be presented in the poster. The results highlight the complexity of speech pathologists’ relationship with EBP, and the influence this complexity has on the clinical reasoning process. Themes will be discussed, with reference to the literature, to describe the collective findings on speech pathologists’ perceptions of EBP for acute aphasia management.
DISUCSSION This study provides preliminary in-depth information regarding acute speech pathologists’ conceptualisation evidencebased practice, and its application in acute post-stroke aphasia management. This emerging evidence helps to create a greater understanding of speech pathologists’ perceptions of the different streams of evidence in EBP, and the influence of these streams on clinical practice. Preliminary findings suggest that the implementation of EBP in acute aphasia management may be influenced by the speech pathologist’s personal definition and understanding of EBP. Speech pathologists’ clinical reasoning and decision making in relation to acute aphasia management are influenced by a complex range of factors. By exploring acute speech pathologists’ experiences and motivations regarding the implementation of evidence-based aphasia management, and the barriers and facilitators to achieving this in the acute hospital to effect change in this setting. Specifically, this may influence how speech pathologists can take up the new research evidence in acute management of aphasia as part of evidence-based practices, decreasing the sense of an evidence-practice gap for clinicians in this setting, and promoting person-centred approaches to care.
LEARNER OUTCOMES After viewing this poster, participants will be able to: Describe major elements of the study design Discuss the authors' conclusions Identify possible implications for practice ABOUT THE AUTHORS Abby is an Australian speech pathologist who has worked predominantly in acute stroke units since graduating from university. She is currently a full-time remote PhD student through The University of Queensland. Abby’s research and clinical interest lies in the acute management of post-stroke aphasia. She currently lives in Vancouver, Canada. Abby Foster Professor Worrall is the Director of the Centre for Clinical Research Excellence in Aphasia Rehabilitation, and Co-Director of the Communication Disability Centre at The University of Queensland. She has applied the WHO ICF to research in a range of disabilities, but has a particular interest in aphasia rehabilitation. Linda Worrall Dr Rose is an Australian Research Council Future Fellow & Senior Researcher with the Centre for Clinical Research Excellence in Aphasia Rehabilitation. She is working on projects examining the effectiveness of treatments for aphasic word retrieval impairments and strategies for living successfully with aphasia. She is based at La Trobe University, Melbourne. Miranda Rose
Robyn O’Halloran
Dr O'Halloran is a lecturer at La Trobe University, Melbourne, and a Post-Doctoral Fellow in the Centre for Clinical Research Excellence in Aphasia Rehabilitation. She is working on the development of the Australian Aphasia Rehabilitation Pathway. Her interests are patients' ability to communicate their healthcare needs, and communicatively accessible healthcare environments.
These are preliminary results from the first phase of Abby Foster’s PhD research. Any comments or discussion are welcome. Copies of the complete poster will be available at the conference. For an extended discussion of EBP in acute aphasia management, please see: Foster, A. M., Worrall, L. E., Rose, M. L., & O'Halloran, R. (2013). Turning the tide: Putting acute aphasia management back on the agenda through evidence-based practice. Aphasiology, 27(4), 420-443.
We look forward to meeting you in Chicago! Correspondence:
[email protected] 
