Communication Confidence, Aphasia Severity and Well-Being: A Cross-Sectional and Longitudinal Study in People With...

Communication confidence is increasingly recognised as a clinically crucial yet under-researched topic in aphasiology. It has been reported to be one of the most valuable treatment outcomes by stroke survivors. A scoping review of therapies targeting confidence in stroke survivors revealed a growing interest in this topic and identified outcome measures for confidence. However, there were limited studies, with small sample sizes, that explored communication confidence in stroke survivors with aphasia. Further evidence is needed regarding this topic.

This study aims to examine communication confidence in a comparatively larger and heterogeneous sample of people with post-stroke chronic aphasia. The research questions explore (1) relationships between measures of language, communication confidence, confidence after stroke and well-being and (2) stability of these measures over time and if changes align with self-perceptions.

Participants with chronic aphasia after stroke (i.e., 6 months or more) and interested in exploring their communication confidence were recruited to participate in online assessments. Assessments included a test-battery consisting of the 'Western Aphasia Battery-Revised-WAB-R', 'Confidence after Stroke Measure-CaSM', 'Communication Confidence Rating Scale for Aphasia-CCRSA' and 'ONS-4'. The test battery was administered at two separate time-points approximately 6-months apart.

Twenty-seven participants were recruited for initial assessment and 18 were followed-up after 6 months. Aphasia severities varied from mild to very severe with a mean WAB-R aphasia quotient (AQ) of 74.4 (range from 9.1 to 98.2). Baseline measures indicated mean scores of 43.4/81 for the CaSM, 28.1/40 for the CCRSA and 25.9/40 for the ONS-4. Statistically significant correlations were found between confidence after stroke and well-being (r = 0.76, p < 0.001), communication confidence and confidence after stroke (r = 0.51, p = 0.006), and communication confidence and language skills (r_s = 0.68, p < 0.001). Although language skills and communication confidence remained relatively stable over time, confidence after stroke (r = 0.61, p = 0.01) and well-being (r = 0.55, p = 0.02) significantly improved.

The findings suggested stronger correlations between closer conceptual constructs (e.g., language and communication confidence, confidence and well-being). Improvements in confidence and well-being may have potential implications for rehabilitation approaches and may support the development of more holistic interventions for people with aphasia. This study also demonstrated the feasibility of conducting online, longitudinal research on stroke survivors.

What is already known on the subject Communication confidence is a clinically crucial and valued topic for stroke survivors with aphasia. Previous research has explored relationships between aphasia and communication confidence in small samples of people with mild anomic aphasia or very severe aphasia. However, specific relationships between communication confidence and language skills, confidence after stroke and well-being in a wider range of aphasia types and severities are not yet well understood.What this paper adds to the existing knowledge Conceptually closer constructs had stronger correlations: significant correlations between language and communication confidence, confidence after stroke and communication confidence as well as confidence after stroke and well-being. Confidence and well-being seem to have improved over time while language and communication confidence remained stable. These findings offer refined perspectives on communication confidence and what might serve as potential intervention targets in chronic stages of aphasia. The study also demonstrated the feasibility of conducting online, longitudinal research on stroke survivors.What are the potential or actual clinical implications for this work? Targeting improved confidence and well-being after stroke when language skills have become more stable opens new avenues for therapeutic interventions.