Core Outcome Set Use in Poststroke Aphasia Treatment Research: Examining Barriers and Facilitators to Implementation Using the Theoretical Domains Framework

Purpose
A core outcome set (COS; an agreed minimum set of outcomes) was developed to address the heterogeneous measurement of outcomes in poststroke aphasia treatment research. Successful implementation of a COS requires change in individual and collective research behavior. We used the Theoretical Domains Framework (TDF) to understand the factors influencing researchers' use and nonuse of the Research Outcome Measurement in Aphasia (ROMA) COS.

Method
Aphasia trialists and highly published treatment researchers were identified from the Cochrane review of speech and language therapy for aphasia following stroke and through database searches. Participants completed a theory-informed online survey that explored factors influencing COS use. Data were analyzed using descriptive statistics and qualitative content analysis.

Results
Sixty-four aphasia researchers from 13 countries participated. Most participants (81%) were aware of the ROMA COS, and participants identified more facilitators than barriers to its use. The TDF domain with the highest agreement (i.e., facilitator) was “knowledge” (84% agree/strongly agree). Participants had knowledge of the measures included in the ROMA COS, their associated benefits, and the existing recommendations. The TDF domains with the least agreement (i.e., barriers) were “reinforcement” (34% agree/strongly agree); “social influences” (41% agree/strongly agree); “memory, attention, and decision processes” (45% agree/strongly agree); and “behavioral regulation” (49% agree/strongly agree). Hence, participants identified a lack of external incentives, collegial encouragement, and monitoring systems as barriers to using the ROMA COS. The suitability and availability of individual measurement instruments, as well as burden associated with collecting the COS, were also identified as reasons for nonuse.

Conclusions
Overall, participants were aware of the benefits of using the ROMA COS and believed that its implementation would improve research quality; however, incentives for routine implementation were reported to be lacking. Findings will guide future revisions of the ROMA COS and the development of theoretically informed implementation strategies.

Contributors

Sarah J. Wallace, Bridget Sullivan, Tanya A. Rose, Linda Worrall, Guylaine Le Dorze and Kirstine Shrubsole

Publication

Journal: Journal of Speech, Language, and Hearing Research
Volume:
Issue:
Pages: -
Year: 2021
DOI: 10.1044/2021_JSLHR-20-00683

Further Study Information

Current Stage: Completed
Date:
Funding source(s):


Health Area

Disease Category: Neurology

Disease Name: Aphasia , Stroke

Target Population

Age Range: 18 - 100

Sex: Either

Nature of Intervention: Rehabilitation

Stakeholders Involved

- Researchers

Study Type

- COS methods research

Method(s)

- Survey