Influence of the Big Five personality traits on intensive therapy adherence within people with aphasia

Guideline-based aphasia rehabilitation recommends intensive speech and language therapy, yet people with aphasia in German-speaking countries often receive substantially lower doses. Personality traits predict adherence in chronic disease, but their relevance for aphasia care is unclear. We examined associations between Big Five traits and therapy frequency and explored trait links to reported reasons for non-guideline-based care.

From January to April 2024 we conducted a cross-sectional survey on patient-reported reasons for insufficient therapy. Overall, 260 individuals with aphasia participated; 243 completed the BFI-10. Median age was 62 years (range 20-88) and median aphasia duration 5.5 years. Therapy frequency was recorded categorically (none, monthly, weekly, twice weekly, 3 times weekly). Associations were tested using Spearman correlations and Mann-Whitney U tests.

Conscientiousness correlated positively with therapy frequency (r = 0.212, p < 0.001), whereas neuroticism (r = -0.115, p = 0.038) and openness (r = -0.138, p = 0.017) correlated negatively. Participants currently in therapy reported higher conscientiousness than those without therapy (U = 4472.5, Z = -2.961, p = 0.003). Agreeableness was higher among those endorsing "my therapist said I do not need therapy anymore" (U = 1839.5, Z = -2.175, p = 0.030). Neuroticism was higher among those endorsing "therapy was/is too exhausting" (U = 1327.5, Z = -2.238, p = 0.025). Conscientiousness correlated with perceived financial situation (r = 0.143, p = 0.027). No significant associations emerged for aphasia severity, age, or duration.

Personality shows small but significant associations with therapy frequency and selected perceived barriers in aphasia rehabilitation. Given the cross-sectional, exploratory design, inferences are tentative. These effects were small and should be interpreted with caution. Results support incorporating personality into biopsychosocial models and motivate hypothesis-driven longitudinal studies.