Communication Partner Training in Aphasia: An Updated Systematic Review

Archives of Physical Medicine and Rehabilitation
journal homepage: www.archives-pmr.org

Archives of Physical Medicine and Rehabilitation 2016;97:2202-21
REVIEW ARTICLE (META-ANALYSIS)
Communication Partner Training in Aphasia: An

Updated Systematic Review
Nina Simmons-Mackie, PhD,a Anastasia Raymer, PhD,b Leora R. Cherney, PhDc,d,e
From the aDepartment of Health and Human Sciences, Southeastern Louisiana University, Hammond, LA; bDepartment of Communication
Disorders and Special Education, Old Dominion University, Norfolk, VA; cCenter for Aphasia Research and Treatment, Rehabilitation Institute
of Chicago, Chicago, IL; dPhysical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
e
Communication Sciences and Disorders, Northwestern University, Evanston, IL.
Abstract
Objectives: To update a previous systematic review describing the effect of communication partner training on individuals with aphasia and their
communication partners, with clinical questions addressing effects of partner training on language, communication activity/participation,
psychosocial adjustment, and quality of life.
Data Sources: Twelve electronic databases were searched using 23 search terms. References from relevant articles were hand searched.
Study Selection: Three reviewers independently reviewed abstracts, excluding those that failed to meet inclusion criteria. Thirty-two full text
articles were reviewed by 2 independent reviewers. Articles not meeting inclusion criteria were eliminated, resulting in a corpus of 25 articles for
full review.
Data Extraction: For the 25 articles, 1 reviewer extracted descriptive data regarding participants, intervention, outcome measures, and results. A
second reviewer verified the accuracy of the extracted data.
Data Synthesis: The 3-member review team classified studies using the American Academy of Neurology levels of evidence. Two independent
reviewers evaluated each article using design-specific tools to assess research quality.
Conclusions: All 25 of the current review articles reported positive changes from partner training. Therefore, to date, 56 studies across 2
systematic reviews have reported positive outcomes from communication partner training in aphasia. The results of the current review are
consistent with the previous review and necessitate no change to the earlier recommendations, suggesting that communication partner training
should be conducted to improve partner skill in facilitating the communication of people with chronic aphasia. Additional high-quality research is
needed to strengthen the original 2010 recommendations and expand recommendations to individuals with acute aphasia. High-quality clinical
trials are also needed to demonstrate implementation of communication partner training in complex environments (eg, health care).
Archives of Physical Medicine and Rehabilitation 2016;97:2202-21
ª 2016 by the American Congress of Rehabilitation Medicine
Traditionally, aphasia rehabilitation has focused primarily on Sometimes training takes place in a dyad with the communication
direct treatment of the individual with aphasia to decrease the partner and the individual with aphasia both participating. In other
severity of the language impairment and improve functional cases, the communication partners take part in didactic educa-
communication. More recently, environmental approaches that tional opportunities to learn about aphasia and strategies to
involve modifying the communication environment have been facilitate optimum communication. Therefore, this evidence-based
introduced to facilitate communication in aphasia.1 Communica- approach to improving communication involves training people
tion partner training is a form of environmental intervention in other than, or in addition to, the individual with aphasia. The
which people around the person with aphasia learn to use strate- intent is to improve the functional communication, participation,
gies and communication resources to aid the individual with and well-being of the person with aphasia. Communication part-
aphasia.1,2 For example, communication partners might be taught ners include people with whom the person with aphasia might
to use multimodal communication (eg, gestures) or provide access interact (eg, family members, caregivers, friends, health
to pictures or written words to support communication. care providers).
A systematic review of communication partner training in
Disclosures: none. aphasia was published in 2010 to determine the level of research
0003-9993/16/$36 - see front matter ª 2016 by the American Congress of Rehabilitation Medicine
http://dx.doi.org/10.1016/j.apmr.2016.03.023
Communication partner training 2203
evidence supporting this approach.2 In the 2010 article, 31 pub- skills training focused on teaching communication partners to use
lished articles addressing communication partner training in strategies or resources to enhance communication of the person
aphasia were critically reviewed, and clinical recommendations with aphasia. Educational programs focused primarily on
were suggested. In an extension of the 2010 report, Cherney et al3 increasing partner knowledge of aphasia and related issues.
reported on quality indicators for the reviewed articles and high- Counseling programs were defined as those that concentrated on
lighted important design considerations to improve the quality of the psychosocial consequences of aphasia (eg, dealing with
communication partner training research. depression). Studies were excluded if they involved training
Based on the systematic review, the authors of the 2010 article partners to provide traditional language exercises.
concluded that communication partner training focusing on The following electronic databases were searched: Academic
communication skills appeared to be effective in improving partner Search Complete, Communication & Mass Media Complete,
skill in supporting communication for people with chronic aphasia; EBSCOhost, PubMed, CINAHL, PsycINFO, Social Sciences
this approach was recommended for partners of people with aphasia. Citation Index (Web of Science), SocINDEX, Trip database,
However, there was insufficient evidence regarding the effectiveness Embase, REHABDATA, and the Cochrane Database of System-
of partner training during acute aphasia (ie, 4mo postonset) or the atic Reviews. In addition, all articles selected for review were
effect of counseling or educational approaches for partners. hand searched for additional articles. Twenty-three search terms
The purpose of the current project is to update the findings of were used in searches as follows: (partner OR family OR spouse
the 2010 and 2013 articles by evaluating new research, summa- OR support team OR volunteer OR staff OR significant other OR
rizing the effect of communication partner training for adults with dyad) AND (conversation OR communication OR language OR
aphasia and their communication partners, and reconsidering interaction OR social OR pragmatics OR relationship) AND
recommendations based on new evidence. (therapy OR treatment OR intervention OR training OR coaching
OR inservice OR education) AND (aphasia).
The search was limited to articles published in peer-reviewed
Methods journals between 2008 and July 2015. Criteria for inclusion were
as follows: written in English, containing original data, addressing
The 3 major clinical questions addressed in the earlier review 1 of the clinical questions, including adults 18 years of age,
guided this review (box 1). These questions address the effect of and addressing aphasia of any etiology. Study design was not a
communication partner training on individuals with acute aphasia criterion for inclusion/exclusion; group designs, quantitative,
(4mo postonset), individuals with chronic aphasia, and qualitative, single participant experimental research, and case
communication partners. Components of each clinical question studies were included to capture the full range of communication
were derived from domains of the World Health Organization’s partner training treatment research. Group designs were defined as
International Classification of Functioning, Disability and randomized controlled trials, nonrandomized controlled trials,
Health4 and an aphasia-specific framework adapted from the In- case series designs reporting group results, and single-group pre-
ternational Classification of Functioning, Disability and Health.5 post studies. Studies were classified as single participant experi-
Therefore, outcomes were classified into the following categories: mental designs if the design was experimental in nature, involved
language impairment (eg, standard aphasia tests), communication time series measures across baseline, treatment, and follow-up
activity/participation (eg, functional use of language, conversation phases, and included experimental control. Qualitative research
rating scales), personal/psychosocial adjustment (eg, self-esteem, included studies that conformed to accepted qualitative traditions
confidence), and quality of life. Maintenance of changes after (eg, ethnography, phenomenology, grounded theory). Case studies
the intervention was also included in the questions. did not involve experimental control, reported individual results,
In addition, this systematic review followed guidelines for and/or were primarily descriptive in nature.
systematic reviews as defined by the Preferred Reporting Items for A total of 1736 articles were identified in the initial search as
Systematic Reviews and Meta-Analyses.6,7 The Preferred schematized in figure 1 . The research librarian and a member of the
Reporting Items for Systematic Reviews and Meta-Analyses is an review panel eliminated obvious duplicate citations, studies not
evidence-based checklist of minimum items that can improve written in English, and studies in nonepeer-reviewed publications.
quality of reporting in systematic reviews or meta-analyses. This narrowed the search to 101 articles. Abstracts from these were
independently reviewed by the 3 members of the review team to
determine whether articles should be included in the review. Any
Literature search disagreements were discussed to achieve consensus on articles
Studies that investigated communication partner training as an appropriate for inclusion. Based on abstract review, an additional 70
aphasia intervention were identified through a systematic literature articles did not meet criteria for the review (see fig 1).
search. As in the earlier review “intervention was defined broadly The remaining 31 articles were randomly assigned to 2
to include communication skills training as well as educational or members of the review team who independently reviewed and
counseling programs directed at communication partners of in- evaluated the articles. During the full review, consensus was
dividuals with aphasia”2(p1815) with the intent of improving reached that 1 article should be added after hand searching ref-
communication with people with aphasia (PWA). Communication erences, and 7 articles were rejected for failure to fulfill 1 of the
inclusion criteria. A corpus of 25 studies met the final inclusion
criteria for full review.
List of abbreviations:
AAN American Academy of Neurology
PEDro Physiotherapy Evidence Database Descriptive review
PWA persons with aphasia
One reviewer extracted data from each article (using a form used
SCED Single Case Experimental Design
in the 2010 review) to provide a descriptive summary of the study,
www.archives-pmr.org
2204 N. Simmons-Mackie et al
Box 1 Clinical questions that guided the systematic review

1. In persons with acute aphasia,
a. What is the influence of communication partner training on measures of language impairment?
b. What is the influence of communication partner training on measures of communication activity/participation?
c. What is the influence of communication partner training on measures of psychosocial adjustment/identity?
d. What is the influence of communication partner training on measures of quality of life?
e. What intervention outcomes are maintained?
2. In persons with chronic aphasia,
a. What is the influence of communication partner training on measures of language impairment?
b. What is the influence of communication partner training on measures of communication activity/participation?
c. What is the influence of communication partner training on measures of psychosocial adjustment/identity?
d. What is the influence of communication partner training on measures of quality of life?
e. What intervention outcomes are maintained?
3. For communication partners of PWA,
a. What is the influence of communication partner training on partner communication skills/activity/participation?
b. What is the influence of communication partner training on partner psychosocial adjustment/identity?
c. What is the influence of communication partner training on partner quality of life?
d. What intervention outcomes are maintained?
including participant characteristics, intervention characteristics, trials (eg, randomized controlled trials, nonrandomized controlled
outcome measures, and types of results. A second reviewer trials, case series research11,12). Each study is evaluated across 11
confirmed data extraction for accuracy. quality criteria using nominal ratings of yes (1 point) and no
(0 points) (see http://www.pedro.org.au/wp-content/uploads/
PEDro_scale.pdf). A summary of ratings (excluding 1 item) re-
Evaluation of research quality sults in a maximum quality score of 10 for a study.
Modeled after the PEDro Scale, the SCED Scale evaluates
American Academy of Neurology levels of evidence single case research and is reportedly a valid and reliable tool.10
An evaluation of research quality was conducted by 2 reviewers As in the PEDro Scale, judges rate 11 items with 10 of the
using the American Academy of Neurology (AAN) classification items included in a total quality score (see http://www.psycbite.
of evidence system.8 Disagreements were evaluated by the third com/docs/The_SCED_Scale.pdf). For both the PEDro and
reviewer to reach consensus. The AAN clinical guidelines were SCED Scales, items receive points only if adherence to the cri-
used in the 2010 review, consistent with the widespread use of terion is explicitly reported in the article. The SCED Scale has
AAN levels of evidence in medicine and rehabilitation. Based on been substantially revised to create the Risk of Bias in N-of-1
evidence criteria, each article was classified into an AAN class. Trials Scale13; however, the SCED Scale was retained for this
Classes range from class I (highest level of evidence) to class IV review to remain consistent with the earlier quality review.
(lowest level of evidence) (box 2). In addition, in the 2010 review, The PEDro and SCED Scales do not address treatment fidelity
AAN procedures were used to create clinical recommendations for or treatment replicability. Because these are important elements of
partner training in aphasia based on 4 levels of recommendation rigorous behavioral treatment research, these items were added by
(A, B, C, and U), with A representing the highest level of the authors of the 2010 and 2013 reviews to create the PEDroþ
recommendation.2 Recommendation levels depend on the number and SCEDþ Scales,2,3 resulting in a 12-point scale. Therefore, our
of studies that meet specified evidence levels. The current study ratings of communication partner training group and single case
adopted AAN procedures to determine potential changes in clin- experimental research include a PEDro or SCED Scale rating and
ical recommendations for communication partner training. a PEDroþ or SCEDþ Scale rating.
In addition to the PEDro and SCED Scales, a third system was
Additional quality reviews devised for the 2010 reviews to rate qualitative research. The
In addition to the AAN classification, reviewers used design- Rating of Qualitative Research consists of 16 items with 14 items
specific tools to measure the quality of research methods in further included in the overall score (supplemental table S1 for criteria,
detail. Use of well-defined, objective scales to measure design available online only at http://www.archives-pmr.org/).3 Items
provides a clearer evaluation of research quality and helps with examine rigor and bias in the study design, methods of data
comparisons across studies.3 Therefore, the current procedures extraction, and analysis methods. The scale was piloted and
used 3 different quality scales: (1) the Physiotherapy Evidence revised for the earlier review to meet reliability and validity
Database (PEDro) Scale to evaluate group studies9; (2) the Single requirements.3
Case Experimental Design (SCED) Scale10; and (3) the Rating of Table 1 reports the point-to-point agreement for rating the
Qualitative Research.3 current articles using the design-specific scales. A third judge
The PEDro Scale was designed for scoring the research quality rated the article when disagreements occurred, and final ratings
of physical therapy clinical trials (http://www.pedro.org.au) and were agreed on through consensus. Although a rating checklist
has been adapted for other applications (eg, www.otseeker.com). was used in the current study to assess quality of case studies for
The PEDro Scale is a reliable method of evaluating the quality of descriptive purposes, this scale has not been evaluated for
1,736
308 PWA. The higher frequency of partners resulted from studies
records idenƟfied through database that trained large groups (eg, health care workers). For example,
search Welsh and Szabo14 reported training 262 nursing assistant students
to communicate with PWA.
1,634 The total reported participant numbers are not appropriate
Records excluded summary statistics for this review. Several authors published
as duplicates, not English or not multiple articles that each reported on different findings of what
peer reviewed publicaƟon
were apparently overlapping groups of participants. For example,
Rautakoski15-18 reported on different findings for up to 43
101
communication partners across several publications. Two other
Titles and abstracts screened by 3 studies reported different outcomes for the same group of partic-
independent judges ipants.19,20 In addition, 1 study21 reported training of 105 health
care providers, but outcome data are reported for only 31 trained
70 abstracts excluded: partners. To more accurately reflect unique study participants and
o 52 not intervenƟon study those with outcome data, duplicate participants across studies and
o 14 not partner training
participants with no outcome data were eliminated from frequency
o 1 not original data
o 2 not aphasia counts. This resulted in a total of approximately 589 communi-
o 1 duplicate cation partners and 185 PWA across the 25 studies.
Communication partners
1 record added through other Most communication partners (454/589) took part in group
methods (e.g. hand search) designs, with 112 partners in qualitative studies, 22 in case studies,
and 1 partner in a single case experimental study. Most commu-
nication partners (339/454) in the group studies were medical
professionals or health care students. Caregivers, usually the
32
spouse, children, or close friends, served as communication
full text arƟcles reviewed
by 2 independent judges partners in the studies by Rautakoski,15-18 in the single participant
design study,22 and in all of the case studies. The relation of the
7 full text arƟcles excluded: communication partners was not stated in Hagge.23 Relation
o 2 not intervenƟon study length was not typically stated in studies.
o 1 not partner training Twenty-one of the 25 articles reported the sex of communi-
o 2 not one of clinical quesƟons cation partners. In those articles reporting sex, there were 176
o 2 no original data
unique female and 60 unique male communication partners.
Nineteen articles reported ages of partners; ages ranged from 19 to
85 years old. Studies with medical professionals and students
25 generally had younger participants than studies that included
ArƟcles included in final review family, typically spouses, as communication partners. Employ-
ment status of partners was reported in 17 of the 25 articles and
included many medical professionals and students. Education of
Fig 1 Flowchart of the systematic review process, including the the partners was noted for only 11 studies.
number of articles identified and/or excluded.
Persons with aphasia
Most PWA (86/185) took part in group designs, with 77 others in
reliability and validity; therefore, quantitative results of the case qualitative studies, 1 PWA in a single participant design, and 21
study ratings are not reported. PWA in case studies. Across the 19 articles reporting ages of these
participants, most were in the 50 to 70 year range. In those articles
reporting sex of people with aphasia, there were 71 unique female
Results and 114 unique male participants. Nineteen articles reported
aphasia etiology; this was predominately stroke, with only 5
Descriptive review participants categorized as another condition. In the 17 articles
reporting time postonset of aphasia, all participants were in the
Of the 25 articles identified for the current review, 11 were group chronic phase of recovery (>4mo), except for 1 case study24 with
designs, 1 was a single participant experimental design, 2 were 3 participants who were 14 to 63 days postaphasia onset. Aphasia
qualitative studies, and 11 were case studies. A summary of the type was reported in 16 articles, most commonly noting nonfluent
characteristics of those studies follows. forms of aphasia (Broca or global). Of the 19 articles reporting
aphasia severity, most participants had moderate to severe aphasia.
Research participants
Type of intervention
Supplemental tables S2 and S3 (available online only at http://
www.archives-pmr.org/) describe the communication partners A variety of types of partner training were studied in the articles
and the PWA who participated in the 25 studies. Across all studies, (table 2 ). Both partners and PWA were trained in 16 studies, and
reported participants included 720 communication partners and training of partners alone occurred in 9 studies. The format for
Box 2 American Academy of Neurology levels of evidence8

Class I: Prospective, randomized controlled trial with masked outcome assessment in a representative population. The following are
required: (1) primary outcome(s) clearly defined, (2) exclusion/inclusion criteria clearly defined, (3) adequate accounting
for dropouts and cross-overs with numbers sufficiently low to have minimal potential for bias, and (4) relevant baseline
characteristics are presented and substantially equivalent among treatment groups or there is appropriate statistical
adjustment for differences.
Class II: Prospective matched group cohort study in a representative population with masked outcome assessment that meets criteria
1 through 4 or a randomized controlled trial in a representative population that lacks one criterion from points 1 through 4.
Class III: All other controlled trials (including well-defined natural history controls or patients serving as own controls) in a
representative population, where outcome is independently assessed or independently derived by objective outcome
measurement.
Class IV: Evidence from uncontrolled studies, case series, case reports, or expert opinion.
training included training of groups of people (10/25), training of therapy, as described by Boles.28 Two articles reported on training
dyads (8/25), and mixed formats in which some combination of that appeared to bridge more traditional language-oriented therapy
group, dyad, and individual training was delivered (7/25). Typi- with communication partner training.29,30 For example, Carragher
cally, unfamiliar partners (eg, health care providers, students) were et al30 introduced interactive storytelling in which the PWA
trained in groups in order to introduce generic strategies that are worked to increase skills in telling stories, whereas partners
applicable across people with aphasia, whereas familiar partners learned to support story telling.
(eg, family members) were often trained in dyads (including their
aphasic partner) to learn strategies specific to the individual with
Description of outcome measures
aphasia. Communication partner training of health care providers
or students was reported in 6 articles, training of volunteers was Across the 25 partner training studies, outcome measures were
reported in 1 article, and training of familiar partners (eg, family) highly varied. Outcomes were coded for general categories,
was reported in 18 articles. including communication activity/participation, psychosocial
The amount of training varied, with 1 article reporting only factors, quality of life, and other (eg, knowledge of aphasia)
1.25 hours of training, whereas another reported as many as 100 (table 3 ). In addition, for PWA, language impairment measures
hours of training. Most typically, training took place for 10 to 15 (eg, Western Aphasia Battery,31 Comprehensive Aphasia Test32)
hours. The type of partner training appeared to be related, at least were used to document outcomes in 5 of the 25 studies. Mea-
in part, to regional preferences. For example, 7 of the 26 articles sures of communication activity/participation were included for
described communication partner training as an adaptation of the 17 of the 25 studies for PWA and 20 of the 25 studies for
Supporting Partners of People with Aphasia in Relationships and communication partners. For PWA, these measures were scales
Conversation program, a commercially available conversational of communication use (eg, Communicative Effectiveness
training program published in the United Kingdom.25 The Sup- Index,33 Measure of Participation in Conversation34), question-
porting Partners of People with Aphasia in Relationships and naires about communication strategies, or analysis of conver-
Conversation training programs were reported largely by conversation. For communication partners, communication activities/
sation analysis researchers in the United Kingdom, where this participation outcomes included various measures (eg, coding
approach is widely used. Six articles reported on applications of communication strategy use in conversation, self-reports of
Supported Conversation for Adults with Aphasia.26 The Supported strategy use, ratings of skill in supporting conversation,34
Conversation for Adults with Aphasia approaches were used by analysis of conversational interactions). Psychosocial out-
researchers in Canada, the United States, and Nordic countries. comes were reported in 5 of the 25 articles for both PWA and
Three articles reported on adaptations of the CONNECT communication partners. These included ratings or responses to
communication partner scheme,27 another UK approach that in- interviews about confidence, attitudes, and relations between
volves training volunteers to visit and communicate with people communication partners and PWA. Only 1 study reported
with aphasia in their homes. The remaining articles reported on quality of life outcomes (for PWA only), and 5 studies docu-
various approaches such as total communication15-18 or couples mented changes in knowledge for communication partners. One
study reported attributes of the training program as noted by
communication partners and PWA.
Table 1 Interrater reliability of independent quality ratings
(prior to consensus) Results of intervention for each clinical question
Interrater Table 3 provides a summary of outcome measures and results of
Rating Scale Reliability (%) Range (%) training for communication partners and PWA. These results are
PEDroþ 89 67e100 summarized according to each clinical question in the following
SCEDþ 67 N/A sections (see box 1 for the full text of questions).
RQR 92 75e92
Question 1: acute aphasia
Abbreviations: N/A, not applicable; RQR, Rating of Qualitative
Research.
The only article that provided information pertaining to acute
aphasia was a case study of 3 dyads reported by Blom Johansson
Communication partner training

Table 2 Description of interventions
Total Predominant Participant
CP PWA Training Training Intervention Intervention Focus of
Reference Txed Txed Length Amount Setting Intervention Description Focus Training
Group Designs
Cameron et al, Yes No 1-h lecture 15-min practice 1.25h University Based on the CONNECT partner training program (www. Communication Group CP
201540 with trained PWA (Australia) ukconnect.org). Included didactic content and practical (health care
components (practice with and feedback from trained PWA). students)
Hagge, 201423 Yes No 2-h group communication 12h NS (USA) A learner-centered approach including written and oral Communication Group CP
training for 6wk information about aphasia and communication strategies,
reflection, direct instruction, hands on practice. Homework
activities were based on couples therapy.28
Jensen et al, Yes No 2-d workshop for 25 1 or 2d Hospital (Denmark) Multistage implementation project to introduce supported Communication Group CP
201521 participants; 1-d conversation methods (SCA) to health care staff, develop (health care
workshop for 80 resources, and ultimately train staff in SCA methods. providers)
participants; Outcomes Different participants participated across stages with final
measured for 31 stage introducing the finalized version of a workshop to
individuals staff. Training was based on SCA, including role play,
evaluation of video examples of SCA, and practice with PWA.
McGilton et al, Yes No 1-d workshop and support 1d plus at least Complex Continuing Patient-centered communication intervention, including a Communication Group CP
201119 by SLP for at least 2h per 16h of Care (Canada) workshop on communication strategies, behavior
week for 8wk support management strategies, and the importance of the
environment, abilities-focused care, and personhood.
Continued SLP support for feedback and demonstration.
Additional outcomes reported in Sorin-Peters et al.20
Nykänen et al, Yes Yes 1-h sessions daily for 10d 20h Inpatient Communication Therapy for People with Aphasia and their Communication Individual
201329 during each of 2 rehabilitation Partners was aimed at severe aphasia; couples work with the (PWA)
rehabilitation periods, (Finland) SLP to identify strategies for the PWA to communicate better Dyad
6mo apart and partners learn how to aid the PWA’s communication.
Follow-up evaluation at Focus on the PWA initiating a variety of communication
6mo tasks moving from simple naming to describing news reports.
Rautakoski, Yes Yes Two sessions of 5e6h/d PWA: 60e72h Residential PWA: total communication modeled and strategies practiced in Communication Group PWA
201115 separated by a 3-mo CP: 30e35h rehabilitation group conversations with other PWA Group CP
interval (Finland) CP: lectures on aphasia and communication strategies Dyad
PWA: 8d in first session plus PWAþCP: practiced use of communication strategies
4d in second session
CP: 2þ4d
201116 separated by a 3-mo CP: 30e35h rehabilitation group conversations with other PWAs Group CP
CP: 2þ4d
2207
(continued on next page)
2208
Table 2 (continued )
CP: 2þ4d
CP: 2þ4d
Sorin-Peters Yes No 1-d workshop and support 1d plus Complex Continuing Patient-centered communication intervention: increase staff’s Communication Group CP
et al, 201020 by SLP for 2e6h/wk for 16e48h of Care (LTC) awareness and increase knowledge/use of conversation (heath care
8wk support (Canada) strategies; learn to use personalized communication plans providers)
for each LTC resident. Participated in short version of SCA.
Additional outcomes reported in McGilton et al.19
Welsh and Yes No 75min One 75-min College (USA) Workshop with basic information about aphasia (definition, Education Group CP
Szabo, 201114 session characteristics, causes), first-hand accounts by PWA, and Communication (health care
communication tips and strategies based on SCA. providers)
Single Participant Experimental Design
Boles, 201522 Yes Yes 60-min sessions twice a 40h University (USA) Aphasia couples therapy28: dyad training with clinician to Communication Dyad
week for 20wk increase conversational success, reduce difficulties
encountered in conversation. Improving balance within the
conversation was top a priority (ie, equalizing
participation).
Qualitative Studies
McMenamin Yes No 1e2 semesters; 7h/wk for 70e100h University plus visits 1d of partner training; participation in 10e12 visits with a Education Group CP
et al, 201536 10e14wk with PWA in PWA; weekly reflective blog; fortnightly class tutorials with Communication
different locations student partners.
(home, coffee
shop, clinic)
N. Simmons-Mackie et al
(Ireland)
McVicker et al, Yes Yes Initial training: three 2eh 6-h initial Hospital (Britain) Conversation partner scheme: education on communication, Communication Group CP
200927 sessions or one6-h training disability, health and safety; training with live sessions and Education
session 12h ongoing videos and PWA. Ongoing - completed weekly feedback
Ongoing support: 2-h support sheets; support groups for peer discussion.
sessions every 6wk

Case Studies
Beckley et al, Yes Yes 8wk of 1.5-h sessions, once 12h Home (Britain) Better conversations with aphasia: adaptation of SPPARC Communication Dyad
201341 per week conversation training program. Phase 1 focused on learning
concepts of turns, conversational sequences, and repair
using video; phase 2 focused on developing strategy use by
PWA and CP; final stage was role play and reflection by dyad.
Strategies targeted were use of a keyword in turn initial
position, use of writing or drawing, and verbal and nonverbal
behaviors to signal turn continuation.
Beeke et al, Yes Yes 8wk of 1.5h sessions, once 12h Home (Britain) Better conversations with aphasia: adaptation of SPPARC Communication Dyad
201542 per week conversation training program.31 Phase 1 focused on
learning concepts of turns, conversational sequences, and
repair using video; phase 2 focused on developing strategy
use by PWA and CP; final stage was role play and reflection
by dyad. Strategies targeted were writing/drawing,
keywords, and gesture for the PWA and letting the
conversation continue for further clues or if understood,
comment, and paraphrase for CPs. Decreasing test questions
was also targeted for the CP.
Beeke et al, Yes Yes 8wk of 1.5-h sessions, once 12h Home (Britain) Aphasia: adaptation of SPPARC conversation training program. Communication Dyad
201443 per week Phase 1 focused on learning concepts of turns,
conversational sequences, and repair using video; phase 2
focused on developing strategy use by PWA and CP; final
stage was role play and reflection by dyad. Strategies
targeted were writing/drawing, keywords, and gesture for
the PWA and letting the conversation continue for further
clues, passing a turn, and paraphrase for CPs.
Blom Yes Yes 6wk of 45-min sessions, 4.5h Hospital and home Individualized early family-oriented intervention including Counseling CP (3 sessions)
Johansson once per week (Sweden) emotional support and information for the CP and direct Communication Dyad (3
et al, 201324 communication training for the dyad based on SCA. sessions)
Carragher et al, Yes Yes One 1.5-h session per week 9h NS (Britain) Interactive storytelling: goal to improve storytelling; PWA Communication PWA Individual
201530 for 6wk trained individually to retell a story from a video, then CP Dyad
joined session for discussion of story and conversational
coaching; identify goals/strategies, practice story; watch
video for feedback and discussion of strategies.
Fox et al, Yes Yes Two 60-min sessions per 14h University clinic Solution focused couples therapy28: conversational goals set; Communication Dyad
200944 week for 7wk (USA) couple engaged in 3-min conversations on any topic with
15-min daily home practice clinician present, followed by self-reflection and clinician
requested feedback, specifically focused on individual goals.
2209
2210
Saldert et al, Yes No 1.5-h session, once per 9h University clinic SPPARC: Provided with info about communication, observed Communication Group CP
201345 week for 6wk (Sweden) videos to learn strategies to communicate with PWA; role
play; written exercises as home assignments between
sessions. Strategy training individualized to some extent to
the specific dyad.
Saldert et al, Yes No 1.5-h session, once per 9h University clinic SPPARC: provided with info about communication, observed Communication Group CP
201546 week for 6wk (Sweden) videos to learn strategies to communicate with PWA; role
play; written exercises as home assignments between
sessions. Strategy training individualized to some extent to
the specific dyad.
Sorin-Peters Yes Yes 2-h session, once per week 16h Aphasia center Goals for each dyad developed from videotaped conversations Education Group
and for 8wk (Canada) and responses on interview. Group sessions included general Communication Dyad
Patterson, information about communication disorders, learning style
201447 differences and their effect on communication, supportive
communication strategies. Couples practiced their
individualized communication strategies with coaching and
feedback from trainers. Based on adult learning and SCA.
Wilkinson et al, Yes Yes 8 weekly sessions, 1e2h 8e16h Home (Britain) SPPARC/interactive focused intervention: uses, handouts, role Communication Dyad
201048 long play, written exercises, video, and transcripts to increase
awareness of relevant conversational behaviors. Discussion
and practice of strategies for changing relevant
conversational behaviors during direct work with the dyad.
Wilkinson et al, Yes Yes 4 sessions 4e8h Home (Britain) SPPARC/interactive focused intervention: uses, handouts, role Communication Dyad
201149 1e2h long play, written exercises, video, and transcripts to increase
awareness of relevant conversational behaviors. Discussion
and practice of strategies for changing relevant
conversational behaviors during direct work with the dyad.
Specific focus on changing topic initiation behaviors.
Abbreviations: CP, communication partner; LTC, long-term care; NS, not stated; SCA, Supported Conversation for Adults with Aphasia26; SLP, speech-language pathologist; SPPARC, Supporting Partners of
People with Aphasia in Relationships & Conversation25; Txed, trained.
et al.24 The authors noted positive changes in communication for use of communication strategies and satisfaction with communi-
PWA on a Swedish version of a conversation rating scale34 and a cation over time.
postintervention self-report questionnaire of perceived
improvement. Quality review
Question 2: chronic aphasia As described in the methods section, 2 approaches were used to
Of the 25 studies in this review, 17 reported outcomes for people consider the quality of the 25 studies included in this update. First,
with chronic aphasia (the other 5 studies reported outcomes only studies were coded according to AAN classification (see box 2).
for partners or only for acute aphasia). Five of the 17 studies of Although 11 studies used group designs, none of these studies
chronic aphasia reported language impairment outcomes; 2 of included design components to assure control and randomization.
these noted significant improvements, one in a group study with Moreover, many of the studies did not provide independent
the Western Aphasia Battery,31 and one in a descriptive case series assessment of the primary outcome. Therefore, based on AAN
using the Comprehensive Aphasia Test.32 No other significant classification, all 11 group studies received a class IV designation.
changes were reported on language measures. Likewise, all other trials in this update received AAN class IV
In contrast, considerable positive changes were noted in PWA designation because of the lack of experimental control.
on measures of communication activity/participation. After part- To further evaluate the group studies, the PEDro Scale9,11 was
ner training, 9 of the 17 studies of chronic aphasia reported in- used to evaluate design components considered essential to group
creases on rating scales and questionnaires about strategy use and treatment research. As seen in supplemental table S4 (available
the quality of communication in PWA. Conversation samples of online only at http://www.archives-pmr.org/), scores ranged from
PWA, coded in 8 of the 17 studies of chronic aphasia, evidenced 0 to 4 on the 10-point scale, indicating low design quality for
improved use of content words, sentences, communication stra- treatment efficacy studies. Trials consistently met criteria for
tegies, and topic initiation. reporting outcomes for at least 85% of participants, intention to
Five of the 17 studies of people with chronic aphasia incor- treat analysis, and statistical analysis of outcome data. Studies did
porated measures of psychosocial adjustment/identity; all 5 of not incorporate other elements essential in a well-designed treat-
these studies noted psychosocial improvements after communi- ment group trial, however. As noted previously, 2 additional ele-
cation partner training. PWA reported improvements in self- ments, treatment fidelity and treatment replicability, were rated for
confidence, self-perceptions, identity, and relations and reduced group designs. Only 4 studies reported sufficient detail to allow for
depression. Of the 17 studies reporting outcomes of chronic replication of the treatment approach, and no studies reported on
aphasia, 1 single participant study22 reported improvement of the treatment fidelity.
PWA on the Quality of Communication Life Scale35; no other Only 1 study, Boles,22 was assessed with the SCED10 and
studies of chronic aphasia reported results on a standard quality of SCEDþ Scales (supplemental table S5, available online only at
life measure. Five out of 17 studies of chronic aphasia examined http://www.archives-pmr.org/). Although the study obtained a 9 of
maintenance of training effects; 3 of these 5 noted that commu- out 12 score on the SCEDþ Scale, the study was classified as
nication outcomes on rating scales and conversation samples were AAN level IV because of insufficient experimental control in the
maintained up to 23 months after training completion. design (ie, limited to ABA phases).
Two qualitative studies were assessed with the Rating of
Question 3: communication partners Qualitative Research (supplemental table S6, available online only
Of the 25 studies in this updated review, 21 reported outcomes at http://www.archives-pmr.org/). McMenamin et al36 conducted a
pertaining to communication partners who took part in training. well-designed qualitative study with a score of 12 of 14; McVicker
Most outcomes across those studies centered on communication et al27 scored 4 out of 14. Qualitative research is classified as AAN
skills/activity/participation and reported a variety of communica- class IV because it does not fulfill requirements related to
tion improvements. For example, 12 of 21 studies coded aspects of experimental control or randomization, characteristics considered
conversation between communication partners and PWA and essential for formulating generalizable treatment
noted increased use of effective communication strategies or recommendations.
reduced use of negative behaviors by partners. Two of the 21 Many of these reviewed studies were designed to expand un-
studies reported that naı̈ve viewers readily recognized conversa- derstanding of characteristics of partner training, investigate
tion improvements after communication partner training. Among feasibility of a form of intervention, or explore new territory;
the 12 of 21 studies that reported responses to questionnaires or therefore, failure to meet quality criteria for clinical recommen-
interviews, communication partners were consistently positive dations does not negate the value of the research as demonstration
about learning and using communication strategies and accepting studies or preliminary investigations. However, this set of 25
communication changes. An additional 5 of the 21 studies re- studies did not meet accepted quality criteria required to deter-
ported increases in knowledge about aphasia after partner training. mine efficacy or effectiveness of an intervention. Therefore,
Only 5 of 21 studies reported outcomes pertaining to psycho- although studies routinely reported positive outcomes from
social adjustment/identity for communication partners. All 5 noted communication partner training, conclusions should be tempered
positive changes in self-confidence, self-perceptions, or feelings, relative to findings regarding research design quality.
and one study reported reduced depression of communication
partners. No studies noted quality of life outcomes for commu- Clinical recommendations
nication partners.
Four out of 21 studies that assessed communication partner Based on the AAN procedures for translating levels of evidence
outcomes reported maintenance of outcomes at follow-up for into clinical recommendations, the results of the current review
partners; 2 of the 4 reported that improvements were maintained are consistent with the earlier review and necessitate no change to
in knowledge of aphasia, and 2 of the 4 indicated some decline in the earlier recommendations. Communication partner training
2212
Table 3 Summary of outcomes measures and intervention results for communication partners and PWA
Reference Group Outcome Category* Outcome Measure and Results Changey
Group Design
Cameron et al, Communication partner Activity/participation Text responses to listing communication strategies and resources used with Yes
201540 Psychosocial PWA: all identified a greater number of strategies posttraining (0e5
strategies pre and 1e18 strategies post). Total of 39 strategies reported
pre, 69 reported post, with effective strategies increasing from 28 to 66.
Types of strategies changed after training.
Pre-post self-report of confidence (rating); greater confidence in
communicating after the training (zZ4.624, P<.001).
PWA N/A N/A N/A
Hagge, 201423 Communication partner Activity/participation One item on a survey asked if a communication strategy was learned: 80% Yes
agreed or strongly agreed.
PWA N/A N/A N/A
Jensen Communication partner Activity/participation Self-administered questionnaire about knowledge of aphasia and Yes
et al, 201521 Other (knowledge) communication practices: Post tx knowledge increased (PZ.0004; 95% CI
of difference, 5.8e17.6) and less frustration for PWA (PZ.03; 95% CI of
difference, 2.0 to 3.2E-6). No change in other 13 questions.
Text responses showed changes in types of strategies used by partner with
PWA.
Psychosocial Qualitative interviews: staff perceived the training positively (more confident Yes
about communicating and more willing to engage PWA in conversation). (qualitative)
Some challenges reported (particularly by acute care staff) such as time
constraints, picture tools were too complex.
PWA N/A N/A N/A
McGilton Communication partner Other (knowledge) Nurses knowledge of aphasia: increased (PZ.002) Yes
et al, 201119 Psychosocial Nurse attitudes to pts: improved (PZ.007)
No change in nurse relation with pts and ease of caregiving
PWA Activity/participation Perception of own communication skills: improved (PZ.037) Yes
Psychosocial Perception of nurse’s ability to relate effectively: improved (PZ.024)
Perception of relations with nurses: increased closeness (PZ.041)
No change in psychosocial well-being
No change in depression
Nykänen Communication partner Activity/participation Communication skill evaluation: increased (P<.001) Yes
et al, 201329 Older the partner the lower the communication skill scores of PWA
Couple Communication Scale showed better scores for simpler tasks than
more complex tasks
Perceived benefits/satisfaction with program was good post-tx and at follow-

up; however, some difficulty reported outside of home

PWA Impairment WAB scores improved from pre- to post-tx (P<.001) Yes
Activity/participation Communication skill evaluation: increased (P<.001) and maintained at 6-
month follow-up
CETI increased (PZ.01)
PWA who previously had more outpatient therapy improved more
Couple Communication Scale showed better scores for simpler tasks than
more complex tasks
Perceived benefits/satisfaction with program was good post-tx but decreased
at follow-up; some difficulty reported outside of home
Rautakoski, Communication partner Activity/participation Communication Strategies of the Communication Partners questionnaire: Yes, at 3mo after training
201115 trained CPs perceived a significant increase in the use of different No, at 6-mo follow-up
strategies (PZ.016) and in the use of strategies to support verbal No, control
comprehension and production (PZ.026) at 3mo after the first part of the
training. A decrease in the use of the strategies was seen at 6-mo
follow-up.
Control partners: improvements were noted but the changes were not
significant.
PWA N/A N/A
Rautakoski, Communication partner N/A N/A
201116 PWA Activity/participation Use of Different Communication Methods questionnaire: PWA perceived Yes
significant changes in use of different means of communication, including
increased use of low-technology devices during (PZ.004) and after
(PZ.014) the intervention (PZ.01); also increased use of spontaneous
nonverbal means of communication after the intervention (PZ.014).
CPs perceived increases in PWA during intervention in spontaneous nonverbal
means (PZ.01), low-technology device use (PZ.004), and high-
technology device use (PZ.032); and at follow-up for overall increase
(PZ.002), spontaneous nonverbal means (PZ.002), low-technology
device use (PZ.008), and high-technology device use (PZ.024)
201217 PWA Activity/participation CETI rated by CP. Significant change from pretreatment to 6mo posttreatment Yes
(P<.002) (mean CETI score increased from 42.616.9 to 51.616.9).
CETI rated by PWA. Change from pretreatment to 6mo posttreatment was not
significant (mean CETI score increased from 49.914.4 to 52.412.5)
201418 PWA Activity/participation Communication style questionnaire completed by CP: significant differences Yes
pre to post on ratings related to talkativeness (PZ.018), rate of speech
(PZ.012), and starting conversations (PZ.046). Other responses showed
slight increases, but they were not significant.
2213
2214
Sorin-Peters Communication partner Activity/participation Informal 4 point rating scale regarding perceptions of workshop Z ratings of Yes
et al, 201020 Other (knowledge) all components of the workshop ranged from 3.4 to 3.9 out of 4. The
median score for all ratings was 4 out of 4.
Five-point questionnaire regarding usefulness of communication plans: plans
rated as very useful in relating to residents (XZ4.3), for residents with
language difficulty (XZ4.3), and in helping understand resident
communication characteristic (XZ4.6); plan presentation was clear
(XZ4.6). Ratings of need to talk to SLP for support was lower (XZ2.1).
Knowledge of Aphasia Questionnaire: paired t test pre-post workshop
(P<.001); pree1-mo follow-up (PZ.002)
PWA N/A N/A
Welsh and Communication partner Activity/participation On program evaluation survey, 94.5% responded they were aware of at least 2 Yes
Szabo, 201114 Other (knowledge) strategies they could use when talking with a PWA, and 94.2% indicated
they would incorporate what they learned into their work.
Questionnaire with true/false items indicated overall improvement in
knowledge about aphasia; pre- to posttraining improvements ranged from
14.4% to 32.8% correct. 64.4% of students improved their performance on
postsession questionnaire.
PWA N/A N/A
Single Participant Experimental Design
Boles, 201522 Communication partner Activity/participation Conversation: % reflective utterances: increased (dZ16.17) Yes
Ratings of conversations by naı̈ve viewers: later sessions viewed as more
positive (ie, more satisfying, more balanced) than earlier sessions. No
perceived difference in the degree of struggle across sessions.
PWA Impairment WAB: no significant change. Yes
Activity/participation Conversation: % utterances contributing to conversation: increased
Quality of life (dZ5.47)
No. of utterances: increased (dZ5.40)
No. of words/utterance: increased (dZ26.76)
Quality of Communication Life: increased from mean of 3.06 pre-tx to 4.06
post-tx.
Qualitative Studies
McMenamin Communication partner N/A N/A
et al, 201536 PWA Activity/participation From flexible brainstorm and card sort techniques, 5 themes captured the Yes
Psychosocial experience for PWA. Overall PWA valued the enhanced social relations,
increased self-confidence, and positive identity changes associated with

the communication partner program.

McVicker et al, Communication partner Psychosocial Nearly all enjoyed visits with PWA Yes
200927 Activity/participation Positive learning curve on communication strategies
PWA Psychosocial Changed confidence: 80% Yes
Felt better about trying new things: 50%
Case Studies
Beckley et al, Communication partner Activity/participation Conversational analysis: wife learned to prompt husband to use strategies Yes
201341 postintervention
PWA Impairment No change on Pyramids & Palm Trees and subtest of the PALPA and VAST. Yes
Activity/participation CAPPA: improvements in ratings of linguistic skill with level of perceived
problem decreased from 71% to 49%.
No change in ratings of repair; decrement in ratings of initiation, turn
taking, and topic.
Conversation analysis: increased insight and acceptance of use of strategies;
increased use of strategies when prompted; failed to generalize to
independent use of strategies.
Beeke et al, Communication partner Activity/participation Counts of behaviors in pre and post conversation samples: Yes
201542 CP 1: no significant effect on strategies chosen to work on, but significant
reduction in test questionsdPoisson trend for frequencies (1-tailed), test
questions (zZe4.74, P<.0001).
CP 2: no significant effect on strategies chosen to work on but CP 2’s use of
test questions reduced significantlydPoisson trend for frequencies
(1-tailed), test questions (zZe6.18, P<.0001).
Conversation analysis: qualitative positive changes for CP 1 and CP 2
PWA Activity/participation Counts of behaviors in pre- and postconversation samples: Yes
PWA 1: significant increased use of strategies in posttherapy samples:
Poisson trend for frequencies (1-tailed), writing (zZ2.83, P<.01); mime
(zZ1.89, P<.05); keyword (zZ2.87, P<.01).
PWA 2: no significant effect on strategies chosen to work on.
Conversation analysis: qualitative positive changes for PWA 1.
Beeke et al, Communication partner Activity/participation Counts of behaviors in pre-and postconversation samples. No increase in Yes
201443 selected behavioral strategies but eradicated an unhelpful conversation
behavior (nonacceptance of writing as a form of communication)
PWA Activity/participation Strategy of writing/drawing increased significantly in posttherapy samples: Yes
Poisson trend for frequencies (1-tailed), writing (zZ2.50, PZ.0063).
Gesture remained at preintervention levels, and keywords showed a
numerical, but not statistically significant, increase.
2215
2216
Blom Johansson Communication partner Activity/participation Swedish adaptation of MSC.46 Graphs show improvements for CP 2 and 3, but Yes
et al, 201324 Other/knowledge not for CP 1. Not all changes were maintained by CP 2.
Estimation of conversational skills. Perceptions varied with CP 1 and 2 noting
improvements, but not for CP 3.
Program evaluation questionnaire (5-point scale): CPs rated the extent to
which the intervention provided support from 3 to 5 and the extent to
which it improved conversation, increased knowledge, and increased
understanding of aphasia from 3 to 4.
Understanding of aphasia and communication questionnaire: perceived
understanding increased; increases ranged from 3 points (CP 1) to about
15 points (CP 3)
PWA Activity/participation Swedish adaptation of MPC.46 Graphs show improvements for PWA 2 and PWA Yes
3, but not for PWA 1. Not all changes were maintained by PWA 2.
CP’s estimation of PWA’s conversational skills: perceived improvements noted
by all CPs, but these were not maintained in dyad 3.
Program evaluation questionnaire/interview (5-point scale): PWAs rated
extent to which the intervention helped from 4 to 5 and extent to which it
improved conversations from 3 to 5.
Carragher Communication partner Activity/participation No. of salient ideas understood by CP from PWA story: Yes
et al, 201530 3/4 increased for simple stories
2/4 increased for complex stories
PWA Activity/participation No. of salient content words in storytelling: Yes
3/4 increased for simple stories
2/4 increased for complex stories
Fox et al, 200944 Communication partner Activity/participation MSC33 increased from a range of 1.5 to 2.5 (on 0e4 scale) to a range of 3 to Yes
3.5 after training.
Researcher rating of selected goal behaviors in conversational samples (eg,
probe questions, repair strategies, interruptions)dessentially no change
Satisfaction Rating Scale of Conversation: average mean increase of 1.8;
however, slightly reduced at the 1-mo follow-up.
Person with Aphasia Activity/participation MPC34: increased from a range of 1.5 to 2.0 (on 0e4 scale) to range of 2.5 to Yes
3.0 after training.
Researcher rating of selected goal behaviors in conversational
samplesdincreased topic initiation, no change in speech rate or use of
questioning
Satisfaction Rating Scale of Conversation: average increase of 2.7 post-tx

(with maximum increase of 6 points)/some increases maintained at 4wk
post-tx.

Saldert et al Communication partner Activity/participation Measure of Interaction in Communication: some improvement in 2 out of 3 Yes
201345 Psychosocial CPs with following effect sizes: CP 2 after tx Z 2.01 at follow-up Z 1.26;
CP 3 effect size after tx Z 3.03 and at follow-up Z 2.02.
Carer COAST: perceived functional communication; variable results of pre/
post/follow-up: 1/3 CP’s ratings higher postintervention and 2/3 CPs
ratings higher at 12-wk follow-up
Geriatric Depression Scale: 2/3 CPs improved after intervention and 3/3
improved at follow-up
PWA Impairment Token Test (comprehension) and word fluency: no obvious patterns on either Yes
Activity/participation test across pre/post/follow-up
Psychosocial Parts of COAST: Perceived functional communication: 2/3 PWA rated higher
after intervention and 3/3 rated higher after follow-up
Geriatric Depression Scale: 3/3 PWA improved after intervention and
follow-up
Saldert et al, Communication partner Activity/participation Conversation analysis showed reduced negative behaviors (teaching, Yes
201546 inattentiveness, dismissive language) at posttreatment. Positive behaviors
remained unchanged (ie, use of response tokens, such as mm hm)
PWA N/A N/A
Sorin-Peters and Communication partner Activity/participation Family Intervention for Chronic Aphasia couples interview and questionnaire: Yes
Patterson, 201447 reported using specific strategies to facilitate conversation and appeared
more accepting of communicating in different ways with PWA. Mixed
pattern of change across subjects and items on Family Intervention for
Chronic Aphasia questionnaire.
MSC34: improved ratings for 3 of 4 partners on acknowledging competence;
improved ratings on revealing competence on at least 1 measure for all
partners.
PWA Activity/participation Family Intervention for Chronic Aphasia Couples interview and questionnaire: Yes
all reported increased satisfaction with their communication abilities. All
reported that spouses were using more specific communication strategies
and appeared more understanding of their role in conversation. Mixed
pattern of change across subjects and items on Family Intervention for
Chronic Aphasia questionnaire.
MPC: improved interaction ratings for 3 of 4 PWA.
Wilkinson Communication partner Activity/participation Qualitative changes in sequential patterns in pre- and postconversations Yes
et al, 201048 Quantitative comparisons of samples from pre- and postconversations: no. of
turns with questions (negative behavior) decreased from 78% to 22%
Ratings of pre- and postconversations by naı̈ve SLPs: 14 of 15 SLPs correctly
identified post- from pretreatment segments
Interview indicated improved interaction (eg, CP does not interrupt, but
allows PWA to continue)
2217
2218
PWA Impairment CAT: no change postintervention Yes
Activity/participation CAPPA: perceived improvements included speaking with more people in a
wider range of places about a wider range of topics.
Qualitative changes in sequential patterns in pre- and postintervention
conversations
Quantitative comparisons of samples from Ratings of pre- and
postconversation: turns with at least 1 sentence increased from 41% to
59%, and with 2 sentences from 0% to 12%
Ratings of pre- and postconversations by naı̈ve SLPs: 14 of 15 SLPs correctly
identified post- from pretreatment segments
Conversation partner interview postintervention indicated PWA beginning to
use complete sentences
Wilkinson Communication partner Activity/participation Postintervention: more actively involved in PWA’s turns through the use of Yes
et al, 201149 continuers (eg, mm hm, head nods)
PWA Impairment CAT: significant change (P<.05) on 2 language subtests (naming and reading Yes
Activity/participation aloud)
Psychosocial Conversation analysis: qualitative changes in management of topic initiation
Qualitative changes maintained at 23mo postintervention
Disability questionnaire: perceived impact of the disability decreased
postintervention with improvements across categories of confidence, self-
esteem, and other emotional consequences
Abbreviations: CAPPA, Conversation Analysis Profile of People with Aphasia; CAT, Comprehensive Aphasia Test32; CETI, Communicative Effectiveness Index33 (rating of functional communication typically by
report of caregiver); CI, confidence interval; COAST, Communication Outcome After Stroke Scale50 (measure of functional communication and effectiveness using self-report ratings); CP, communication
partner; MPC, Measure of Participation in Conversation; MSC, Measure of Skill in Supported Conversation; N/A, not applicable; PALPA, Psycholinguistic Assessments of Language Processing in Aphasia; pts,
patients; SLP, speech language pathologist; tx, training; VAST, Verb and Sentence Test; WAB, Western Aphasia Battery.31
* Outcome Category: Activities/Participation refers to measures of participation in conversation or communication unless otherwise noted; Psychosocial refers to measures of affective issues (eg, confidence,
self-esteem, identity, depression). Isolated ratings of communicative comfort or connectedness are included under measures of participation in conversation. Environment is used here to refer to measures of
environmental support and/or behaviors of the communication partner designed specifically to change the communicative environment for the person with aphasia.
y
For change, yes refers to improvement demonstrated on at least 1 measure of outcome for the targeted domain, and no refers to no improvement demonstrated on any measure of outcome for the targeted
domain.
focusing on communication skills remains a recommended Also, there were a number of studies that the reviewers found
approach for enhancing functional communication of individuals difficult to categorize methodologically. For example, Blom
with chronic aphasia. However, no new data have been offered to Johansson24 reported multiple baseline and follow-up measures,
strengthen the earlier findings. Furthermore, there remains insuf- but they did not adhere to traditional time series measurement (eg,
ficient research evidence to make recommendations regarding the ABA, ABAB design), precluding inclusion as a single case
effect of communication partner training in acute aphasia or on experimental design. These challenging designs were typically
language impairment, psychosocial adjustment, or quality of life included as case studies despite adherence to multiple quality
in chronic aphasia. No new evidence supports communication criteria. Interestingly, the inclusion of additional quality criteria
partner training described as counseling approaches or educational resulted in a corpus of case studies that were superior to those
partner training. reviewed in the 2010 review.
Reviewers also noted comparisons relative to the descriptive
data. Although studies of communication skill training predomi-
Discussion nated in the 2010 review, 11 of the original 31 studies were cate-
gorized as educational or counseling approaches. In the current
Between the 2010 review and the current project, 56 different review, all 25 research studies focused on training communication
studies of communication partner training in aphasia were skills of partners. Either counseling and educational approaches
reviewed. AAN classes of evidence for both review periods are have fallen out of favor or possibly they are no longer labeled as
presented in table 4. Of these, 2 met criteria for a high-quality communication partner training in the aphasia literature.
clinical treatment trial (class I), and 3 single participant designs As in the earlier review, the current articles primarily reported
were sufficient to meet class III criteria; all 5 of these were outcomes for people with chronic aphasia and/or partners in the
included in the 2010 review and according to AAN criteria allowed domain of communication activities and participation. Re-
for positive clinical recommendations. However, none of the 25 searchers used a wide array of outcome measurement tools.
studies in this updated review met AAN criteria required for pos- Despite an ongoing call in the aphasia literature for use of
itive clinical recommendations. Therefore, the strength and scope consistent outcome measures across similar treatments,37,38 there
of evidence supporting communication partner training in aphasia was little consistency in outcome measures for both the current
remain unchanged despite several years of additional research. and past review, making cross-study comparisons difficult. In fact,
Additionally, there appears to have been little adherence to a number of studies used their own measures (eg, novel ques-
suggestions offered in the Cherney3 article regarding research tionnaires, self-report scales). Although these measures provided
design criteria. In that article, the authors recommended that au- interesting data, validity and reliability data were unavailable.
thors use quality scales (eg, PEDro Scale, SCED Scale, AAN Additionally, despite the movement toward self-report measures,
criteria) to guide research design and reporting to improve the the need for concurrent objective measures by independent as-
quality of research reporting in communication partner training. In sessors would help avoid biased results or placebo effects in
fact, the quality of communication partner training research for treatment trials. Therefore, it is recommended that both self-report
both the current and 2010 reviews has been highly varied. For and objective clinical assessment (eg, trained judges, formal tools
example, PEDro scores across the 2 review periods ranged widely administered by independent assessors) be incorporated in
from ratings of 0 to 9 (out of 10). Reports on treatment fidelity communication partner training research.
were limited for both review periods, with no fidelity data in the Another trend observed in the current review was an effort to
most recent review and only 13% of studies reporting fidelity in move out of the research laboratory and into real-life settings. For
the earlier review. Details about treatment procedures were also example, Jensen et al21 reported on an ambitious implementation
lacking in many studies. For example, some studies reported using project involving a staged approach to training health care pro-
adaptations of a published approach, but they failed to clearly viders (105 staff trained) to communicate with PWA in a hospital
specify the actual changes made to original protocols. Future setting. Rautakoski15,16 reported on communication partner
research in communication partner training should include man- training involving PWA and their family members in an inpatient
ualized training procedures that are available to researchers and rehabilitation setting. Sorin-Peters et al20 trained nursing staff to
clinicians who wish to replicate methods. implement individualized communication plans in a nursing fa-
Although the current review does not change the 2010 rec- cility. Although all of these projects were categorized as class IV
ommendations, a number of observations were gleaned from the studies, they demonstrated the feasibility of implementing
current analysis and from comparison with the earlier review. For communication partner training in complex natural environments
example, the reviewers found that the current review presented and provided demonstration studies that serve as a basis for
challenges not apparent in the 2010 review. There appeared to be a controlled clinical trials.
trend for researchers to publish multiple articles reporting results Types of partners trained shifted somewhat from the earlier
on different aspects of one study. This inflated the number of ar- review. In the 2010 review, 84% of articles focused on training of
ticles on communication partner training in the current review. familiar partners (eg, family members, caregivers), with only 6%
addressing health care providers and 10% volunteers. In the cur-
rent study, 72% of articles focused on training familiar partners,
Table 4 Number of research studies classified by AAN level of whereas 24% focused on training health care providers or health
evidence for 2 systematic review periods care students. The increased training of health care providers
likely reflects a growing interest in improving communication
Review Class I Class II Class III Class IV access and patient-provider communication in health care.39
2
2010 review 2 0 3 26 Related to the shift in types of partners, 2 studies expanded the
Current review 0 0 0 25 types of communication disorders included in communication
partner training research.19,20 Both demonstrated positive results
associated with training health care providers to communicate research is needed to identify the most effective methods of
with people with cognitive communication disorders and/or introducing communication partner training into complex systems
aphasia. Although this evidence was insufficient for clinical rec- (eg, patient-provider communication in health care) to improve
ommendations, it is important that researchers are beginning to communication access for people with aphasia.
address clinical realities (ie, staff in health care facilities are faced
with a variety of communication challenges). Training across
disorders would seem to be a reasonable practice.
Keywords
Aphasia; Communication; Interpersonal relations; Rehabilitation;
Study limitations Treatment outcome
One potential limitation of this study is the fact that the reviewers
were not blind to article authorship. It is almost impossible for
reviewers who are highly familiar with an area of research to
Corresponding author
remain blind to authorship; however, reviewer blinding is the Nina Simmons-Mackie, PhD, 580 Northwoods Dr, Abita Springs,
preferred method. The heterogeneity of the communication part- LA 70420. E-mail address: nmackie@selu.edu.
ner training approaches that were reported across the reviewed
studies could also constitute a limitation. As the corpus of
communication partner training studies grows, reviewers might
consider dividing reviews into categories (eg, generic training of References
health care providers vs individualized training of familiar part-
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to communication partner training, and these tools should be trials. Phys Ther 2003;83:713-21.
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the Jadad scale in stroke rehabilitation literature. J Clin Epidemiol
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2005;58:668-73.
There is insufficient research evidence to generate recommenda- 13. Tate R, Perdices M, Rosenkoetter U, et al. Revision of a method
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2221.e1 N. Simmons-Mackie et al
Supplemental Table S1 Abbreviated description of the Rating of Qualitative Research quality criteria
Item No. Criterion
1a Qualitative design is appropriate to the question and aims of the research
1b Not rated Qualitative research tradition is reported
2 Data collection methods suit the research questions and subject matter
2b Not rated Data collection methods are reported
3 Participants are described sufficiently to meet the study goals
4 Settings are described sufficiently to meet the study goals
5 Role of investigator(s) and relation to participants/procedures are stated
6 Data collection procedures are described
7 Data analysis procedures are described and suit the goals
8 Findings emerge logically from the data
9 Detailed description of the subject matter is presented
10 Clear effort is made to interpret meanings or explanations of phenomena under study (eg, not a simple listing of categories)
11 Preponderance of triangulated evidence supports findings
12 Procedures for auditing or verifying findings are reported
13 Adherence to the treatment protocol is assessed and reported
14 Treatment process is described or made available in enough detail for replication

Supplemental Table S2 Participant characteristics: communication partners
Reference No. of CP Age (y) Sex Education Employment Relation Relation Length
Group Designs: Communication Partner Characteristics
Cameron et al, Total: 28 (no controls) Mean SD, 23.23.4 7 M, 21 F 18 third year UG, 10 7 OT students, 21 PT None (health care N/A
201540 (range, 19e36) second year Master’s students students)
students
Hagge, 201423 Total: 38 NS NS NS NS NS NS
Trained: 20
Controls: 18
Jensen et al, 201521 Trained: 105 NS NS NS 15 nurses, 16 nurse None (health care N/A
Assessed: 31 assistants providers)
Interviewed: 7 NS NS NS 5 nurses, 2 nursing None (health care N/A
assistants providers)
McGilton et al, Total: 18 (no controls) Mean SD, 49.69.9 1 M, 16 F, 1 NS NS Nurses None (health care N/A
201119 providers)
Nykänen et al, Total: 34 (no controls) Mean SD, 61.27.5 4 M, 30 F 23 vocational school NS Spouse NS
201329 or lower
Rautakoski, 201115 Trained: 33 Trained: Mean SD, Trained: 11 M, 22 F Treatment: Mean NS Trained: 23 spouse, 2 NS
Controls: 10 54.79.9 (range, Control: 1 M, 9 F SD, 11.74.5y children, 2 siblings,
33e70) (range, 1 friend, 4 parents,
Control: Mean SD, 6e20y) 1 interpreter
46.015.8 (range, Control: Mean SD, Control: 1 spouse, 5
29e70) 12.13.6y (range, children, 2 siblings,
8e19y) 2 friends
Rautakoski, 201116 Total: 38 (no controls) Mean SD, 10 M, 28 F Mean SD, NS 20 spouse, 7 children, NS
52.412.4 (range, 12.14.1y (range, 3 siblings, 3 friends,
29e71) 6e20y) 4 parents, 1
interpreter
52.711.8 (range 11.94.3y (range, 4 sibling, 3 friends,
29e71) 6e20y) 4 parents, 1
interpreter
52.111.9 (range, 12.14.5y (range, 5 sibling, 2 friends,
26e71) 6e20y) 4 parents
Sorin-Peters et al, Total: 17 (no controls) Mean SD, 49.69.9 1 M, 16 F NS 10 nurses, 7 practical None (health care N/A
201020 (range, 35e63) nurses providers)
Welsh and Szabo, Total: 262 (no NS NS NS Certified nursing None (health care N/A
201114 controls) assistant students students)
2221.e2
2221.e3
Supplemental Table S2 (continued )
Reference No. of CP Age (y) Sex Education Employment Relation Relation Length
Single Participant Experimental Design: Communication Partner Characteristics
Boles, 201522 1 75 M Law degree Semiretired law Spouse NS
professor
Qualitative Design: Communication Partner Characteristics
McMenamin et al, Approximately 40 (ie, NS NS Undergrad students, SLP students None N/A
201536 5 pairs per cycle; third year
approximately 3e4
cycles)
McVickers et al, 72 20e40 10% M, 90% F NS NS Volunteers N/A
200927
Case Study Design: Communication Partner Characteristics
Beckley et al, 1 NS 1F NS Full-time manager for Wife NS
201341 large company
Beeke et al, 201542 2 Early 60s, mid 50s 1 M, 1 F NS Retired nurse; school Partner; wife NS
dinner lady
Beeke et al, 201443 1 Early 60s 1F NS Housewife Wife NS
Blom Johansson 3 85, 70, 75 2 M, 1 F NS 2 retired (manual Spouses 60y
et al, 201324 labor), 1 retired 45y
(health care 50y
services)
Carragher et al 4 NS 2 M, 2 F NS NS Spouses NS
201530
Fox et al, 200944 1 71 1M 16y Retired manager of Husband NS
branch of
international
company
Saldert et al, 201345 3 58, 61, 47 1 F, 2 M 15y, 13y, 11y Teacher, nursing 2 spouses, 1 partner 35y, 37y, 4.5y
assistant, product
manager
Saldert et al, 201546 1 40s 1M 11y Product manager Partner 4.5y
Sorin-Peters and 4 Mean, 67.3 (range, 4F NS 1Zwork full time, Spouses Mean years of
Patterson, 201447 60e76) 1Zwork part time, marriage, 43.5
2ZNS
Wilkinson et al, 1 63 1F NS Retired teacher Wife NS
201048
Wilkinson et al, 1 40 1M NS Manager Husband NS

201149
Abbreviations: CP, communication partner; F, female; M, male; N/A, not applicable; NS, not stated; OT, occupational therapy; PT, physical therapy; SLP, speech language pathology; UG, undergraduate.

Supplemental Table S3 Participant characteristics: PWA
Reference N Age (y) Sex Education Employment Handedness TPO Etiology Aphasia Type Aphasia Severity Coexisting Deficits
Group Designs: PWA Characteristics
Cameron et al, NA NA NA NA NA NA NA NA NA NA NA
201540
Hagge, 201423 NA NA NA NA NA NA NA NA NA NA NA
Jensen et al, NA NA NA NA NA NA NA NA NA NA NA
201521
McGilton et al, 9 Mean SD, 9M NS NS NS NS Stroke (left NS Mild to Severe Neglect, dysarthria,
201119 85.42.2 and right) cognitive deficits
Nykänen et al, 34 Mean SD, 30 M, 4 F 23 vocational NS 31 R Mean: 53.937.7mo Stroke 30 Broca, 1 Severe Hemiparesis,
201329 63.38.2 school or lower Wernicke, 2 WAB AQ Mean neuropsychology
conduction, 1 SD, 23.19.0 symptoms
global
Rautakoski, 43 Mean SD, 26 M, 17 F Mean SD, 10.2 NS 41 R, 2 L 36.235.9mo 38 stroke, 3 9 global, 15 BDAE severity 23 hemiparesis, 14
201115 54.38.8 3.3y (range, (range, 8e185) head nonfluent, 19 rating apraxia, 3 neglect,
(range, 6e18y) injury, 2 fluent 0Z2 2 poor vision, 9
26e65) other 1Z15 hemianopia, 6
2Z15 wheelchair, 8 used
3Z8 cane
4Z3
Rautakoski, 38 Mean, 54.49.1 24 M, 14 F Mean SD, NS 36 R, 2 L Mean SD, 34 stroke, 2 7 global, 13 BDAE severity 20 hemiparesis, 5
201116 (range, 10.13.3y 36.937.6mo head nonfluent, 18 rating wheelchair, 6 used
26e65) (range, (range, 8e185mo) injury, 2 fluent 0Z2 cane, 1 poor
6e18y) other 1Z12 vision 8
2Z15 hemianopia, 3
3Z7 hearing problem
4Z2
Rautakoski, 38 Mean SD, 22 M, 16 F Mean SD, NS 36 R, 2 L Mean SD, 34 stroke, 2 6 global, 14 BDAE severity 21 hemiparesis, 5
201217 53.89.0 10.23.5y 32.828.4mo head nonfluent, 18 rating hemianopia, 1
(range, (range, 6e18) (range, 8e120) injury, 2 fluent 0Z2 poor vision, 5
26e65) other 1Z10 wheelchair, 6 used
2Z15 cane, 3 hearing
3Z8 problem
4Z3
Rautakoski, 38 Mean SD, 24 M, 14 F Mean SD, NS 36 R, 2 L Mean SD, 33 stroke, 3 5 global, 14 BDAE severity 23 hemiparesis, 7
201418 53.49.4 9.83.3 40.438.1mo head inury, nonfluent, 19 scale hemianopia, 3
(range, (range, 6e18) (range, 8e185) 2 other fluent 0Z1 poor vision, 5
26e65) 1Z9 wheelchair, 6 used
2Z17 cane, 2 hearing
3Z8 problem
4Z3
2221.e4
2221.e5
Sorin-Peters 9 Mean SD, 9M NS NS NS NS CVA Only 1 person 1 PWA was severe Comorbidities
et al, 201020 85.42.2 with aphasia; mean SD,
(range, most exhibited 7.73.7
82e89.6) cognitive (range, 2e12)
deficits
Welsh and NA NA NA NA NA NA NA NA NA NA NA
Szabo, 201114
Single Participant Experimental Design: PWA Characteristics
Boles, 201522 1 75 1F College Office R 3y Stroke Wernicke Moderate R hemiparesis
manager WAB AQ 58.6
Qualitative Studies: PWA Characteristics
McMenamin 5 83, 85, 60, 69, 4 M, 1 F NS Retired NS 3, 4, 4, 6, 10y Stroke 4 expressive 1 severe, 2 1 apraxia of speech
et al, 201536 69 aphasia, 1 moderate
cognitive to severe,
comm. with 1 mild to
word finding moderate,
deficit 1 cognitive
comm. deficit
McVickers 72 Mean, 71 (range, 45% M, NS NS NS NS NS NS 47.9% severe 68% wheelchair
et al, 200927 35e94) 55% F (BDAE rating users or mobility
0e1), 41.1% restrictions
moderate (BDAE
rating 2e3),
6.9% mild (BDAE
rating 4e5)
Case Studies: PWA Characteristics
Beckley et al, 1 55 M NS Sales NS 5y L MCA infarct Agrammatic Severe
201341 manager aphasia impairment in
verb retrieval
and sentence
production
Beeke et al, 2 63, 57 2M NS Nurse, van R, R 5y, 10mo L MCA infarct, Agrammatic Severe Moderate to severe
201542 driver CVA aphasia verbal dyspraxia
Beeke et al, 1 Approximately M NS Gardener, R 17mo Stroke Agrammatic Moderate-severe Mild apraxia
201443
60 book aphasia word finding
illustrator difficulties;
severe sentence
construction
deficits 15% on
the Verb and
Sentence Test

Blom 3 75, 65, 80 1 M, 2 F 2 NS, 1 university All retired NS 41, 14, 63d Stroke Wernicke, Severe, Moderate 1 with hemiparesis
Johansson nonfluent to severe, and in wheelchair
et al, 201324 Broca severe
Carragher 4 Mean SD, 2 M, 2 F 16e23y Pub R Mean SD, Stroke Nonfluent BNT scores, NS
et al, 201530 59.514.5 manager, 51.527.5mo mean SD,
(range, teacher, (range, 26e80 26.3/6010
36e64) secretary, mo) (range,
business 16e36); OANB
scores, mean
SD, 44.3/
10011.7
(range,
30.5e59)
Fox et al, 1 78y F 12y Office NS 1y Stroke NS Mild Premorbid stutter
200944 manager WAB AQ 93.8 treated 25y before
in legal
firm
Saldert et al 3 73, 63, 45 1 M, 2 F 13, 12, 18 Carpenter, NS 5, 1, 1.5y R parietal Dynamic, Mild, severe, mild NS
201345 nurse, bleed; L efferent, to moderate
nurse MCA mixed
infarct; L
MCA infarct
Saldert et al, 1 40s F 18 Nurse NS 18mo L MCA infarct Mixed aphasia Mild to moderate Childhood diagnosis
201546 of dyslexia,
dysgraphia
Sorin-Peters 4 Mean, 68.3 4M NS NS NS 0.6. 1.0 1.6, 5.8y Stroke 1 receptive/ 1Zsevere 1Zapraxia of
and (range, expressive 1Zmoderate to speech;
Patterson, 61e74) aphasia severe 1Zmemory,
201447 3Z NS 2ZNS planning, and
organization
deficits
Wilkinson 1 66 M NS Retired R 18mo Left stroke Broca NS R hemiplegia
et al, 201048 teacher
Wilkinson 1 36 F NS Catering NS 14mo Left Broca Mild dysarthria and
et al, 201149 manager stroke AOS
and R hemiplegia
automobile
accident
Abbreviations: AOS, apraxia of speech; BDAE, Boston Diagnostic Aphasia Exam51; BNT, Boston Naming Test51; comm., communication; CVA, cerebrovascular accident; F, female; L, left; M, male; MCA, middle
cerebral artery; NA, not applicable; NS, not stated; OANB, Object and Action Naming Battery; R, right; TPO, time postonset; WAB AQ, Western Aphasia Battery31 Aphasia Quotient.
2221.e6
2221.e7
Supplemental Table S4 Quality review scores for group studies using the PEDro scale
Random Similar Outcome Between- PEDro PEDroþ
Allocation Groups Measured Intent Group Outcome Score Score
Eligibility to Conceal at Subject Therapist Assessor 85% of to Statistic Measure (out Treatment Treatment (out
Reference Criteria* Groups Allocation Baseline Blind Blind Blind Subjects Treat Comparison Statistics of 10) Fidelity Replicability of 12)
Cameron Yes No No No No No No Yes Yes No Yes 3 No Yes 4
et al,
201540
Hagge, No Yes No No No No No No No No No 1 No No 1
201423
Jensen No No No No No No No No No No No 0 No No 0
et al,
201521
McGilton Yes No No No No No No Yes Yes No Yes 3 No Yes 4
et al,
201119
Nykänen Yes No No No No No No Yes Yes No Yes 3 No Yes 4
et al,
201329
Rautakoski, No No No No No No No Yes Yes Yes Yes 4 No No 4
201115
Rautakoski, No No No No No No No Yes Yes No Yes 3 No No 3
201116
201217
201418
Sorin-Peters Yes No No No No No No Yes Yes No Yes 3 No Yes 4
et al,
201020
Welsh and Yes No No No No No No Yes Yes No No 2 No No 2
Szabo
201114
No. meeting 5 1 0 0 0 0 0 9 9 1 8 0 4
criteria
(out of
11)
* Eligibility criteria: this item is not counted in the PEDro score.


Supplemental Table S5 Quality scores for studies using single participant experimental designs (SCED)
Behavior SCED SCEDþ
Target Control Sampled Raw Replication Generalizability Score Score
Clinical Behavior in Sufficient in Data Interrater Independent Statistical Across Tasks (out Treatment Treatment (out of
Reference History* Defined Design Baseline Treatment Record Reliability Assessor Analysis Participants Reported of 10) Fidelity Replicability 12)
Boles, Yes Yes No Yes Yes Yes Yes Yes Yes No Yes 8 No Yes 9
201522
* Clinical history is not included in the overall SCED scores.
Supplemental Table S6 Quality scores for studies using the Rating of Qualitative Research
Research Data Data Data Score
Appropriate Tradition Collection Collection Participant Setting Investigator Collection Data Findings Thick Interpret Treatment Treatment (out of
Reference Design Reported* Appropriate Labeled* Description Description Role Detailed Analysis Emerge Description Themes Triangulation Verification Fidelity Replicability 14)
McMenamin Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No 11
et al,
201536
McVicker Yes No Yes Yes Yes No No No No Yes No No No No No No 4
et al,
200927
No. meeting 2 1 1 2 2 1 1 1 1 2 1 1 1 1 0 0
criteria
(out
of 2)
* Items are not counted in total score.
2221.e8

Communication Partner Training in Aphasia: An Updated Systematic Review

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Archives of Physical Medicine and Rehabilitation

journal homepage: www.archives-pmr.org

REVIEW ARTICLE (META-ANALYSIS)

Communication Partner Training in Aphasia: An

Box 1 Clinical questions that guided the systematic review

Box 2 American Academy of Neurology levels of evidence8

Communication partner training

Communication partner training

Perceived benefits/satisfaction with program was good post-tx and at follow-

Communication partner training

increased self-confidence, and positive identity changes associated with

Communication partner training

Satisfaction Rating Scale of Conversation: average increase of 2.7 post-tx

Communication partner training

Communication partner training

Wilkinson et al, 1 40 1M NS Manager Husband NS

Communication partner training

Communication partner training

* Eligibility criteria: this item is not counted in the PEDro score.

Communication partner training

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