School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
Queensland Aphasia Research Centre, Herston, Australia.
Disabil Rehabil. 2022 Sep;44(18):5046-5059. doi: 10.1080/09638288.2021.1922514. Epub 2021 May 8.
For people with post-stroke aphasia, "Will I get better?" is a question often asked, but one that is intellectually and emotionally demanding for speech pathologists to answer. Speech pathologists' formulation and delivery of aphasia prognoses is varied and there is limited evidence for optimising practice. We aimed to understand speech pathologists' clinical experiences, reasoning, and support needs in aphasia prognostication.
Twenty-five Australian speech pathologists working with people with aphasia participated in individual, semi-structured interviews. Their age, level of experience, work setting, and location were maximally varied. Interview responses were analysed qualitatively using thematic analysis.
Five themes were drawn from the interviews: (1) prognostic challenges are shared but not voiced; (2) truth is there's no quick fix; (3) recovery is more than words; (4) the power of words; and, (5) prognostic competence is implicit.
Speech pathologists use implicit competencies to formulate and deliver aphasia prognoses. A patient-centred, holistic contextualisation of aphasia recovery may enable realistic, optimistic, and constructive conversations about prognosis. These conversations may have therapeutic potential if prognostic uncertainty, emotional adjustment, and conditional outcomes are carefully addressed. Future research should seek to understand the perceptions and preferences of people with aphasia and their significant others.Implications for RehabilitationAphasia prognostication in clinical practice is complex and nuanced, thus increased clinical and research focus is warranted to ensure key stakeholder needs are met.Conversations about prognosis may be more meaningful to people with aphasia if recovery is conceptualised as encompassing impairment, activity, and participation outcomes.Given the implicit competencies required for prognostication, a structured approach to reflective practice and experience-based training may be beneficial.Conversations about prognosis may have therapeutic value, but further research is needed to explore this potential.
对于中风后失语症患者，“我会好起来吗？”是一个经常被问到的问题，但对于言语病理学家来说，回答这个问题在智力和情感上都有要求。言语病理学家对失语症预后的表述和提供方式各不相同，而且优化实践的证据有限。我们旨在了解言语病理学家在失语症预后预测方面的临床经验、推理和支持需求。
25 名在澳大利亚与失语症患者合作的言语病理学家参与了个人半结构化访谈。他们的年龄、经验水平、工作环境和地点都尽可能多样化。使用主题分析对访谈回答进行定性分析。
从访谈中得出了五个主题：（1）预后挑战是共同的，但没有被表达出来；（2）事实是没有快速解决办法；（3）恢复不仅仅是言语；（4）语言的力量；以及（5）预后能力是隐含的。
言语病理学家使用隐含的能力来制定和提供失语症预后。以患者为中心、全面的语境化失语症康复可能使有关预后的现实、乐观和建设性对话成为可能。如果仔细解决预后不确定性、情绪调整和条件性结果等问题，这些对话可能具有治疗潜力。未来的研究应该努力了解失语症患者及其重要他人的看法和偏好。
临床实践中的失语症预后是复杂和微妙的，因此需要更多的临床和研究关注，以确保满足关键利益相关者的需求。如果将康复理解为包括损伤、活动和参与结果，那么有关预后的对话可能对失语症患者更有意义。鉴于预后所需的隐含能力，结构化的反思实践和基于经验的培训方法可能是有益的。有关预后的对话可能具有治疗价值，但需要进一步研究来探索这种潜力。
