The Aphasia Communication Outcome Measure: Motivation, Development, Validity Evidence, and Interpretation of Change Scores

The Aphasia Communication Outcome Measure (ACOM) is a patient-reported measure of communicative functioning developed for persons with stroke-induced aphasia. It was motivated by the desire to include the perspective of persons with aphasia in the measurement of treatment outcomes and to apply newly accessible psychometric tools to improve the quality and usefulness of available outcome measures for aphasia. The ACOM was developed within an item response theory framework, and the validity of the score estimates it provides is supported by evidence based on its content, internal structure, relationships with other variables, stability over time, and responsiveness to treatment. This article summarizes the background and motivation for the ACOM, the steps in its initial development, evidence supporting its validity as a measure of patient-reported communication functioning, and current recommendations for interpreting change scores.

Two to Tango or the More the Merrier? A Randomized Controlled Trial of the Effects of Group Size in Aphasia Conversation Treatment on Standardized Tests

Purpose Group conversation treatment has the potential to improve communication and reduce social isolation for people with aphasia. This project examined how 2 conflicting hypotheses—treatment dosage and group dynamics—affect treatment outcomes. Method Forty-eight participants with chronic aphasia were randomly assigned to either a dyad, a large group, or a delayed control group. Conversation group treatment was provided for an hour, twice per week, for 10 weeks. Individual goals were developed by each participant and addressed in the context of thematically oriented conversation treatment. Standardized testing across language domains was completed pretreatment (Time 1), posttreatment (Time 2), at a 6-week maintenance point (Time 3), and at 11-month follow-up for the experimental groups. Results Treatment groups showed greater changes on standardized measures than the control group posttreatment. Dyads showed the most changes on measures of language impairment, whereas changes on the self-reported functional communication measure (Aphasia Communication Outcome Measure) and connected speech task only showed significant changes in the large group. Conclusions This randomized controlled trial on conversation treatment indicated that both treatment groups—but not the delayed control group—showed significant changes on standardized tests. Hence, conversation treatment is associated with changes in measures of language impairment and quality of life. Dyads showed the most changes on measures of language impairment, whereas changes on the functional communication measure (Aphasia Communication Outcome Measure) and discourse production only showed significant changes in the large group. Thus, group size may be associated with effects on different types of outcome measures.

The Aphasia Communication Outcome Measure (ACOM): Dimensionality, Item Bank Calibration, and Initial Validation

Purpose The purpose of this study is to investigate the structure and measurement properties of the Aphasia Communication Outcome Measure (ACOM), a patient-reported outcome measure of communicative functioning for persons with aphasia. Method Three hundred twenty-nine participants with aphasia responded to 177 items asking about communicative functioning. The data were analyzed using a categorical item factor analysis approach. Validity of ACOM scores on the basis of their convergence with performance-based, clinician-reported, and surrogate-reported assessments of communication was also assessed. Results Fifty-nine items that obtained adequate fit to a modified bifactor measurement model and functioned similarly across several demographic and clinical subgroupings were identified. The factor model estimates were transformed to item response theory graded response model parameters, and the resulting score estimates showed good precision and moderately strong convergence with other measures of communicative ability and functioning. A free software application for administration and scoring of the ACOM item bank is available from the first author. Conclusions The ACOM provides reliable measurement of patient-reported communicative functioning in aphasia. The results supported the validity of ACOM scores insofar as (a) factor analyses provided support for a coherent measurement model, (b) items functioned similarly across demographic and clinical subgroups, and (c) scores showed good convergence with measures of related constructs.

Communicating temporal information about autobiographical events

The communication of temporal information about autobiographical events was investigated by asking 39 pairs of adults to describe to each other a remote autobiographical event. Each member of the participant pairs was then asked to date the event which they had described and also to date the event which was described to them. The date when the event narrator stated their event happened was compared with the date when the listener stated the event happened. Four different temporal communication strategies were identified. It was rare for individuals to communicate temporal information by giving a calendar date. Rather, the narrator gave either a life theme or chronological age, as a cue to when the event happened. The listener appears to use these cues in combination with their autobiographical knowledge, and an estimate of the narrator's age to produce a temporal information communication outcome.