Frances M. Tucker, Dorothy F. Edwards, Leslie Kirchner Mathews, Carolyn M. Baum, Lisa Tabor Connor; Modifying Health Outcome Measures for People With Aphasia. Am J Occup Ther 2012;66(1):42–50. https://doi.org/10.5014/ajot.2012.001255
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© 2019 American Occupational Therapy Association
OBJECTIVE. The goal for this study was to determine methods to modify outcome measures for people with aphasia and to provide beginning support for the efficacy of these suggested modifications.
METHOD. Twenty-nine community-dwelling people with aphasia participated. Modified outcome measures included the Stroke Impact Scale, the 36-item short form Medical Outcomes Study, Reintegration to Normal Living Scale, and Activity Card Sort. Participants were supported in their responses by systematically applying a hierarchy of support. An Independence Scale score was determined for each measure for each participant.
RESULTS. Data from an examiner-rated Independence Scale, internal consistency of participants’ responses, correlations among subscale scores across measures, and correlations between aphasia severity and reported outcome provide evidence that people with aphasia are able to understand and respond with these supports.
CONCLUSION. We provide key recommendations for making self-report measures accessible for people with aphasia.
Repeat the question and choices.
Simplify and restate the question (e.g., “How is the strength in your right arm?” [the examiner provides the name of affected limb]), and review choice scale.
Re-explain the entire choice scale (e.g., “This [point to no strength at all] would mean you have no strength in your right arm. This [point to a lot of strength] would mean you have a lot of strength in your right arm). Repeat the restated question.
Combine a yes–no question with scale (e.g., “Do you have a lot of strength in your right arm? Would you say that you have no strength at all in your right arm?”)
Present the next question.
The interview format should be face-to-face. People with aphasia have difficulty comprehending telephone interviews or completing written evaluations independently.
Closed-ended questions should be used with response options to which the participant can point (e.g., yes–no, Likert scale).
Examiners should read aloud each question with the written question available simultaneously. Some people with aphasia will find the auditory modality more supportive, and some will find the reading modality more supportive.
Written questions should be provided in a simplified format (e.g., one question-and-response set per page, simple and large font, increased character spacing, white space in the middle of the page).
Response options should be presented in a manner that is clear to the participants (e.g., written anchors corresponding to number choices).
Examiner support should be hierarchical and based on the participant’s need. Provide the minimal level of support necessary per item to elicit a response; move to the next level of support only if the participant does not respond or the response is ambiguous.
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