Adherence to a community based 8-week programme for stroke-related dysarthria, an exploratory study of clients' views of therapy

Background Many dysarthria treatments require adherence to tasks which may have little obvious relevance to people's lives. There is growing interest in patients' experience of dysarthria and its remediation, but little is known about patients' views of therapy, and factors that may impact on their adherence to it. Research Question This study asks: what factors, related to patients' perspectives of a therapeutic programme for dysarthria, impact on adherence to treatment recommendations? Methods & Procedures Fifteen people with post-stroke dysarthria participated, all former patients in an eight-week SLT programme. Data sources comprised: interviews which gathered patients' views; timelogs of patients' self-recorded minutes spent practising; case-notes; Communicative Effectiveness Surveys (Donovan, Velozo, & Rosenbek, 2007) in which participants rated their communication. Analysis Interviews and case notes were transcribed and all potentially interesting data coded. Four coded interviews were quality-checked by an experienced researcher. Cogent groups of themes/subthemes were developed and arranged into two over-arching themes relating to factors impacting on adherence. The timelogs informed as to who had adhered/not adhered to practice recommendations. CES scores were compared to examine any differences between adherers/non-adherers. Outcomes & results Ten patients adhered, and five did not. There were suggestions of relationships: adherers tended to be cohabiting and have support at home, while non-adherers tended to live alone, have more severe dysarthria and rate their communicative effectiveness as lower. Including non-speech oromotor exercises in therapy did not increase adherence. People valued a good therapeutic relationship and tasks tailored to their needs and interests. Several explicitly linked these factors to their adherence. Conclusions & implications The finding that support may have impacted on adherence has implications for practitioners, particularly those working with isolated patients. Therapists should recognise the support of family/partners as a valuable therapeutic tool. Monitoring therapeutic relationships may maintain them, and this, in addition to the provision of person-centred therapy; focussing on the person rather than tasks, and enabling patients to set person-centred goals, may also improve adherence.Background Many dysarthria treatments require adherence to tasks which may have little obvious relevance to people's lives. There is growing interest in patients' experience of dysarthria and its remediation, but little is known about patients' views of therapy, and factors that may impact on their adherence to it. Research Question This study asks: what factors, related to patients' perspectives of a therapeutic programme for dysarthria, impact on adherence to treatment recommendations? Methods & Procedures Fifteen people with post-stroke dysarthria participated, all former patients in an eight-week SLT programme. Data sources comprised: interviews which gathered patients' views; timelogs of patients' self-recorded minutes spent practising; case-notes; Communicative Effectiveness Surveys (Donovan, Velozo, & Rosenbek, 2007) in which participants rated their communication. Analysis Interviews and case notes were transcribed and all potentially interesting data coded. Four coded interviews were quality-checked by an experienced researcher. Cogent groups of themes/subthemes were developed and arranged into two over-arching themes relating to factors impacting on adherence. The timelogs informed as to who had adhered/not adhered to practice recommendations. CES scores were compared to examine any differences between adherers/non-adherers. Outcomes & results Ten patients adhered, and five did not. There were suggestions of relationships: adherers tended to be cohabiting and have support at home, while non-adherers tended to live alone, have more severe dysarthria and rate their communicative effectiveness as lower. Including non-speech oromotor exercises in therapy did not increase adherence. People valued a good therapeutic relationship and tasks tailored to their needs and interests. Several explicitly linked these factors to their adherence. Conclusions & implications The finding that support may have impacted on adherence has implications for practitioners, particularly those working with isolated patients. Therapists should recognise the support of family/partners as a valuable therapeutic tool. Monitoring therapeutic relationships may maintain them, and this, in addition to the provision of person-centred therapy; focussing on the person rather than tasks, and enabling patients to set person-centred goals, may also improve adherence