Factors Influencing Communication Quality of Life in Persons with Aphasia: Results and Implications

PROBLEM: Deficits in verbal and nonverbal communication can lead to persons with aphasia (PWAs) feeling socially isolated, resulting in lower quality of life (Cruice, Worrall, Hickson, et al., 2003). Various assessments have been developed to measure communication quality of life (CQoL) as well as overall quality of life (QoL); however, it is unclear which aspects of PWAs’ lives are specifically influencing the outcomes. Past studies have considered how aphasia influences QoL (Ross & Wertz, 2003), and more recently, the impacts aphasia has on CQoL have been analyzed (Bose et al., 2009). With the development of new measures, it is important to determine which assessment will yield effective outcomes in persons with different profiles of aphasia. The ASHA-FACS and ASHA-QCL are two measures that are commonly used in the assessment of CQoL with different response recording systems. Each have been separately studied with regards to other QoL measures to determine which measure will provide a more unique representation of CQoL in persons with aphasia. The purpose of the current study is to determine how the ASHA-FACS and ASHA-QCL correlate with each other, and if the participants’ factors of post-onset period, aphasia severity level, cognitive functioning, and therapy received will impact these outcomes. PROCEDURE: Twenty-one people with aphasia with ages ranging from 47 to 91 years old (mean= 67 years, SD= 11.4) and post-onset periods ranging from two months to fourteen years (mean= four years, four months; SD= 2.9) participated in the study. Each individual completed six assessments, including both standardized and criterion referenced measures (WAB-R, CLQT, SAQOL-39, ASHA-FACS, ASHA-QCL, and CCRSA). In addition, participants completed a demographics questionnaire which included questions about when their stroke occurred (post-onset period) and the type and duration of therapies they had received. Assessments were conducted over two sessions to prevent fatigue and the order of presentation in the two sessions was randomized across the participants to control for order effects of test administration. The assessments were analyzed using a correlation matrix to determine the strength of relationships between each of the measures. ANOVAs were used to compare QoL and CQoL outcome scores for participant groupings based on time post-onset, aphasia severity, cognitive functioning, and therapy received. FINDINGS: The ASHA-QCL and ASHA-FACS were found to have large positive correlations with each other, however, the ASHA-QCL had more positive correlations with other QoL measures than the ASHA-FACS. Some of the factors examined including aphasia severity, cognitive limitations and therapy received each had a significant influence on either QoL or CQoL. These factors should be considered when planning treatment for PWAs. Selection of QoL and CQoL measures should be based upon the PWA’s profile and personal factors to ensure the measure will be sensitive to identifying areas of the individual’s life that have been compromised due to having aphasia