Impact case study database

Impact of Outcomes research

The evidence generated by Hilari and her team has contributed to a paradigm shift in aphasia rehabilitation. Service providers and clinicians are direct beneficiaries of the research with a resulting impact on people with aphasia. Speech and language therapists are now increasingly addressing quality of life in their rehabilitation; in an international survey, the most commonly used measure to guide clinical practice was the SAQOL-39g [3.3]. The underpinning research has had an impact on National Clinical Guidelines; the Australian Aphasia Rehabilitation Best Practice Statement 5 “Providing Intervention” states that rehabilitation should address the impact of aphasia on quality of life and cite our work as the highest level of evidence [5.1] and one of our systematic reviews on diminishing social networks after stroke and links to depression has been cited in a NICE surveillance review as key evidence for the need to update the Stroke Rehabilitation Guideline, CG 162 [5.2].

Two of our tools, the SAQOL-39g and the Scenario Test-UK, are recommended in the international ROMA consensus statement, and these tools now comprise two of the four essential measures included in the Core Outcome Set (COS) for aphasia, which is endorsed by the Collaboration of Aphasia Trialists and the internationally respected COMET Initiative [5.3]. Of all measures evaluated in the aphasia COS, the SAQOL-39g had the highest selection rate (96% compared to 74-83%). A systematic review by Neumann et al. (2019) found that the SAQOL-39g is the most frequently used quality of life measure in aphasia research. The impact the SAQOL-39g has had on clinical practice is evidenced by the fact that it is validated and currently available for use in 19 different languages [5.4].

The team has developed a bespoke online platform, City Access Resources for Aphasia (CARA), to make the SAQOL-39g and other resources developed at City available to clinicians. CARA officially launched in May 2019 and now has more than 2,475 users from across the world, including Europe, Asia, United States, Canada and Australia. The SAQOL-39g, in particular, has been accessed for use 1,343 times. Testimonials from clinicians in the UK and abroad have highlighted how use of the SAQOL-39g has transformed their practice. This has included facilitating collaborative goal setting for patients with aphasia and their families, being used as the core outcome measure across the stroke rehabilitation team and providing evidence for increased therapy that improves rehabilitation of those with aphasia [5.5].

Impact of Intervention research

Our intervention research, led by Marshall, has made a significant contribution to the aphasia therapy evidence base, which in turn guides treatment selection by practising therapists. One study is included in the most recent Cochrane review of speech and language therapy for aphasia [5.6] and there are further citations in international therapy evidence tables, such as Speech Bite (Australia) and Speech Pathology Data Base for Best Interventions and Treatment Efficacy (USA).

Patient benefits have been promoted via extensive training and outreach activities. Over 450 qualified speech and language therapists have been trained in the CommuniCATE treatments, including groups (n = 40) from USA (2015) and Australia (2018). A further 50 speech and language therapy students have been trained through placement opportunities, with a profound impact on their learning and subsequent practice. Manuals for our CommuniCATE and remote treatment approaches are available on our CARA website.

Since the project inception in 2014, at least 200 people with aphasia have directly benefited from the CommuniCATE therapies, delivered by City, the NHS and Australian clinics. Significant improvements have been achieved for those receiving treatment on measures of everyday reading and writing. Participants also report transformative benefits, such as being able to write in full sentences again and post personal stories on the internet [5.7].

EVA Park has been used at City to deliver therapy to 60 people with aphasia, using interventions that target language, communication and social support. Benefits have been demonstrated on formal measures and in the reports of users [5.8]. At least 200 service providers have benefited from practitioner EVA Park training. Forty-six aphasia services, including users from the USA, Australia, Spain and Bermuda, have been given access to EVA Park. All therapists have been trained in its use and provided with EVA Park treatment resources. To date, 427 user avatars have been created in EVA Park and over 5000 hours of therapy and support have been delivered on the platform. Feedback from service providers and recipients report important and novel benefits [5.9].

Online videos about EVA Park, which describe the intervention and its benefits from the perspective of therapists and those with aphasia, have attracted almost 6,000 views [5.10]. EVA Park has been recognised by the 2015 Tech4Good people’s award, which was based on a popular mandate, and by its 2016 nomination as one of the world’s 100 most inspiring uses of technology to drive social change (Nominet Trust). The EVA Park and CommuniCATE team was named as one of the 100 Nation’s Lifesavers, during the UK Universities MadeatUni Campaign. Since the outbreak of the COVID-19 pandemic in the UK, digital technologies have been at the forefront for delivering primary care. The RCSLT Telehealth Guidance issued in response to the pandemic cites our research as part of the evidence base supporting the virtual delivery of speech and language therapy services [5.11].