Better Conversations Communication Partner Training for Progressive and Non-Progressive Aphasia: What Can We Learn From Intensive Conversation Groups?
Anna Volkmer, Nina Unger, Rosemary Townsend and 7 others
Nine dyads completed a 2-week intensive group communication-partner programme.
Self-rated goal achievement was high, but objective measures did not show a clear group-level change, and PPA confidence gains were lost by 3 months. Too small to change practice, but group CPT is feasible and well-received.
Key findings
1Of 31 conversation goals set by participants, 26 were self-rated as achieved (rated 'a lot more' or 'a bit more') and 5 as no change. In the PPA group, 13 of 18 goals were achieved; in the non-progressive aphasia group, all 13 goals were achieved.
2No objective outcome measure (Kagan Scales, CCRSA, CPIB, QoCPR) showed a statistically significant group-level change. The one borderline result — CCRSA confidence in the non-progressive aphasia group (p = 0.050) — did not survive post-hoc pairwise testing (all p = 0.75).
3PPA group confidence (CCRSA) rose from a mean of 604 to 622 immediately after the group but fell to 542 at 3-month review, below the pre-intervention level. In contrast, the non-progressive aphasia group's confidence rose from 488 to 501 immediately post and to 543.3 at 3 months.
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What it does not show
Nine dyads total, no control group, no randomisation — this is a service improvement project, not an efficacy trial, and the findings cannot be generalised. The non-progressive aphasia group had only four participants, below the minimum recommended sample size of five for the Friedman test the authors used, so the statistical analysis for that group is underpowered. Goal achievement was self-rated by the participants who received the intervention, with no independent verification or control comparison. The PPA group's 3-month confidence decline may reflect disease progression rather than intervention failure; without a control group it is impossible to tell. No participants had severe aphasia or the semantic variant of PPA; the PPA group were all monolingual English speakers from higher socioeconomic backgrounds, limiting generalisability. The Kagan Scales had an initial inter-rater agreement of only 53.3% between two raters, and no MDC90 values exist for the Kagan Scales or the QoCPR, so individual-level change on those measures cannot be interpreted with confidence. Missing data at various time points (one dyad lost to 3-month follow-up, one communication partner missed post-intervention assessment, individual missing scores at post-intervention and 3-month time points). The QoCPR relationship measure was not collected at 3-month review because participants found it inappropriate, so relationship outcomes could only be assessed at two time points. The intervention was delivered by student SLTs supervised by qualified SLTs in a university clinic; it is unclear whether results would hold in a routine NHS or community setting. The intervention was multi-component (video feedback, goal setting, pair practice, art, community outings, partner counselling, home practice), so the effect of any single element cannot be isolated.
Declared interests
The authors declare no conflicts of interest. One author (A.V.) is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship (NIHR302240). The study was approved by the UCL Language and Cognition Ethics Committee (project ID: LCD-2024-05).
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