That’s a wrap! – the APT project

The programme development grant is coming to an end…

It’s the final week of this early-stage research project. This project started on 1st September 2021 and ends on 31st August 2023 and over this brief period, we have learned an incredible amount!

A huge round of applause

Over one hundred people have helped us to reach this milestone.

There are too many to name individually here but we wanted to thank each and every person who has contributed towards the APT project over the past 2 years.

Thank you to our funder, the National Institute for Health and Care Research.

Thank you to our dedicated research management team who have kept the project running to time and budget.

Our sincerest thanks to our wider team:

to our wonderful Patient and Public Involvement Group (3 people with aphasia and 4 family members based across England) who provided such valuable ideas and feedback throughout the project.
to our fabulous Steering Committee spread across 2 continents – who provided expert guidance and advice, and who generously volunteered their time to help us.
to our superb Collaborators – also spread across 2 continents – who provided insightful feedback and lots of practical support.
to our sponsor Sheffield Teaching Hospitals NHS Foundation Trust and our research finance staff across all the research management team institutions for supporting the administration of this grant.

A HUGE thank you to our incredible participants:

to the 25 people with aphasia and 14 family members who met with us in Derbyshire or London and provided thoughtful and candid responses to our questions.
to the 58 speech and language therapists working in the NHS across the UK, and to the 24 CPT researchers based across 4 continents, who took part in our online surveys to share their expertise and experiences.

We are very grateful to several researchers who helped us to gain access to assessments so that we could consider them in our search for outcome measures.

Thank you to the 37 clinicians who generously gave their time to attend our workshop in June 2023 to discuss how to implement and evaluate APT.

A big thank you to the APT co-applicants who are working hard to take the project forwards to the next stage.

And finally, a special thank you to you – our audience – for showing an interest in this endeavour and providing us with support and encouragement along the way!

Recap – what inspired us to do this work?

1 in 3 stroke survivors have a communication disability called aphasia. Aphasia can make it difficult to talk, understand what others are saying, read, and write. Aphasia has a significant impact on everyday communication between the person with aphasia and their family members.

Communication partner training (CPT) is a therapy that aims to improve communication between people with aphasia and their family members. Several small studies have suggested that CPT works. However, not every NHS patient is offered CPT at the moment, and we don’t know enough about what CPT should include or how effective it is.

What did we set out to do?

We had 3 aims:

Agree on what should be included – the essential components – in a new CPT programme for people with aphasia and their family members.
Agree on the likely and desired outcomes of this training.
In a search for relevant and robust outcome measures, assess the extent to which existing assessments capture these hoped for and expected outcomes.

What did we do?

We reviewed existing CPT research literature to identify components that have been used previously, and then asked our expert stakeholders (those with lived experience: people with aphasia and family members; and professionals: NHS speech and language therapists and CPT researchers) to decide on the most important components. These same groups then agreed what outcomes of CPT are most important. We then reviewed existing assessments to determine how to best measure these outcomes.

We have called the new CPT training being developed Aphasia Partnership Training (APT).

What did we find?

We identified 11 mechanisms of action (MoAs) and 13 unique behaviour change techniques (BCTs) to focus on in APT.

We identified the key constructs in which there was agreement between the changes that people with aphasia and family members wanted, and the changes that speech and language therapists and researchers expected. We identified 12 specific examples of changes where there was full agreement across all the groups within the constructs of conversation/communication, thoughts and feelings, and relationships.

We created a box and arrow diagram to represent how these components will work together to achieve the changes our stakeholders hope for and expect to see.

From an initial list of around 220 assessments (!), we have reduced the list of candidate outcome measures to just a handful. Some of these involve speech and language therapists rating conversations whereas others are questionnaires capturing the perception of people with aphasia and their family member. We are carefully considering which outcome measures to trial in future work.

The APT team are currently busy writing up all these findings. We will keep you posted about our publications in the months ahead.

What’s next?

We will use the information gained in this project to apply for further funding to design a large-scale research programme, in which we would investigate how to deliver APT on the NHS with the components we found were most important to our stakeholders, and evaluate how well APT works using the outcome measures we identified. We will keep you posted on our progress with our application.

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So it’s goodbye for now, but not farewell. Watch this space!

Please note

This document presents independent research funded by the National Institute for Health and Care Research (NIHR) under the Programme Development Grants programme [Communication Partner Training for people with aphasia and their family members NIHR202607]. The views expressed in this document are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.