'A Meaningful Difference, but Not Ultimately the Difference I Would Want': A Mixed-Methods Approach to Explore and...

Area of Science:

• Neurology
• Speech-Language Pathology
• Rehabilitation Medicine

Background:

• Establishing benchmarks for meaningful change in post-stroke aphasia rehabilitation is crucial for interpreting patient outcomes.
• Minimal important change (MIC) values represent the smallest change patients perceive as significant.
• This research program aims to define MIC for core outcome measurement instruments (OMIs) in aphasia.

Purpose of the Study:

• To explore the perspectives of individuals with aphasia and speech pathologists on clinically meaningful change.
• To reach a consensus on the threshold for MIC in aphasia rehabilitation.
• To inform the development of relevant OMIs for aphasia.

Main Methods:

• A sequential mixed-methods design involving focus groups and consensus workshops with surveys.
• Participants included individuals with post-stroke aphasia and speech pathologists.
• Qualitative data were analyzed using reflexive thematic analysis, and quantitative data from consensus workshops were reported using descriptive statistics.

Main Results:

• Four themes emerged regarding meaningful change: individuality, continuous small improvements, goal-oriented progress, and influence of personal factors.
• 'Slightly improved' was identified as the MIC threshold within 6 months post-stroke (75%-92% agreement).
• After 6 months, there was a trend towards 'much improved' as the MIC threshold (36%-66% agreement).

Conclusions:

• This mixed-methods study provides novel evidence for defining MIC in aphasia rehabilitation.
• The findings highlight the importance of patient and clinician perspectives in establishing meaningful change.
• Future research will focus on establishing MIC values for core OMIs in aphasia.