ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings.

PURPOSE: Exploration of the clinical uptake of a novel conversation partner training (CPT) programme in aphasia in 10 Dutch rehabilitation facilities and identification of its perceived facilitators and barriers in service providers, and the evaluation of the implementation methods used.

METHOD: Ten rehabilitation centres took part in a multifaceted implementation of CPT over 13 months. Each centre selected two speech and language therapists to act as knowledge brokers whose role was to raise awareness of CPT in the team and to facilitate getting partners of people with aphasia into the programme. The implementation was evaluated using analysis of recruitment data and questionnaires, supplemented by consensus data and scrutiny of implementation plans.

RESULTS: Successful implementation was described as (1) four dyads included during the intervention period, (2) two more dyads included after the intervention period, before the end of the study, and (3) inclusion of the Partners of Aphasic clients Conversation Training (PACT) programme in a description of the logistics of local stroke care (stroke care pathway). Seven centres were successful in reaching the target inclusion of six dyads in total. Only one centre had care pathways in place. From a recruitment pool of 504 dyads, 41 dyads were recruited and 34 partners completed the implementation study of the PACT. Observed facilitators included the motivation to engage partners in the rehabilitation process and the perceived added value of PACT. The perceived barriers focused on time limitations within current systems to discuss the consequences of PACT with relevant professionals and to establish allocated time for this training within existing care routines.

CONCLUSIONS: The motivation of professionals to involve partners in the rehabilitation process assisted with the introduction of PACT in practice. The main barrier was time, linked to the requirement to think through integration of this innovation within existing care. Longer term evaluation would ascertain how centres sustain uptake without support. Implications for Rehabilitation The integration of a new treatment method that reaches beyond the boundaries of one group of professionals needs to be facilitated by providing time to all team members involved to discuss and think through the consequences of that approach for clinical decision making within the care trajectory of a client and his/her significant other. Partners of people with aphasia need to be properly informed about the collaborative nature of communication with a view to the longer term adjustment to living with someone with aphasia.