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    Measurement properties of frenchay aphasia screening test across different languages: A COSMIN systematic review.
    (University of Kelaniya, Sri Lanka, 2023) Jayasingha, J.A.P.P.; Ariyasena, A.D.K.; Siriwardhana, D.D.
    BACKGROUND: Aphasia is a language disorder that occurs due to damage to the brain; the left side of the brain contributes more towards language. Aphasia may cause problems in understanding, speaking, reading, or writing (American Speech-Language-Hearing Association, 2022a). The main goals of speech therapy treatments are to enhance communication, restore speech and language ability as much as possible, and teach different communication strategies (Schulman, 2020). Frenchay Aphasia Screening test (FAST) is used to identify aphasia (Enderby et al., 1987). The best-evaluated and most widely used aphasia assessment is the Frenchy aphasia screening test (Salter et al., 2006). No matter how valid this original tool is, a systematic review is yet to be conducted collating the psychometric properties of the FAST test across different languages. It is therefore important to summarize the measurement properties in those studies to analyzed the methodological quality of those validation studies. It will aid in identifying research gaps and inform future research. The study describes the measurement properties of Frenchay Aphasia Screening Test across different languages. OBJECTIVE/S: This systematic review aimed to appraise and summarize the psychometric properties of the Frenchay Aphasia Screening Test across different languages. METHODS: This study was conducted as a systematic review and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 guideline. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD - 383989). Research studies were searched using the following electronic databases: MEDLINE, EMBASE, PsychInfo, AMED, CINAHL Plus, and Web of Science. Reference lists of selected articles were also searched, and a forward citation search was done through Google Scholar. Studies were included if they presented at least one psychometric measurement property described in the consensus-based standards for the selection of health states measurement instrument (COSMIN) risk of bias checklist. Study selection involved two stages: 1) title and abstract screening and 2) full-text review. Disagreements between the two reviewers were discussed in both stages until a consensus was researched. The inter-rater reliability between the two raters was good (kappa=0.76) during the full-text review. The methodological quality of studies on measurement properties was assessed using the COSMIN risk of bias checklist. Data were synthesized according to the COSMIN guidelines. RESULTS: One hundred fifty-two articles were screened; 143 articles were excluded, and nine articles were selected for full-text review; four articles were included from full-text review. Overall, seven articles were included. This review included the original English version and six translations/adaptations of FAST. Two independent reviewers were involved in the article selection to avoid bias. According to the results, the PROM development studies on FAST were low. When considering the methodological quality of 16 measurement properties, hypothesis testing was rated as high as it was analyzed in four studies, and in each of those studies, it was rated as sufficient. The results were inconsistent and insufficient for other measurement properties to make conclusions. CONCLUSION/S: Based on the overall findings, only hypothesis testing demonstrated high-quality evidence for Frenchay Aphasia Screening Test. Furthermore, due to insufficient results, it was not possible to come to a conclusion about the measurement properties of content validity, internal consistency, cross-cultural validity, reliability, and criterion validity of the Frenchay aphasia screening test.
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    Measurement properties of instruments assessing Aphasia impact on social participation: A COSMIN systematic review
    (University of Kelaniya, Sri Lanka, 2023) de Za, T.A.P.; Munasinghe, T.U.; Siriwardhana, D.D.
    BACKGROUND: Aphasia is a language disorder that significantly limits a person's social participation. Patient-reported outcome measures (PROMs) of social participation play an important role in clinical practice to identify activity limitations and participation restrictions. Even though PROMs of the impact of aphasia on social participation are used to measure this aspect, their suitability is unclear. It is crucial that these PROMs demonstrate adequate measurement properties, such as validity, reliability and responsiveness for the intended population. Additionally, people with aphasia are excluded from research due to communication deficits. However, their involvement during assessment tool development is crucial to construct high-quality assessments. OBJECTIVE/S: The objective of this study is to critically appraise and summarize the measurement properties of instruments assessing the impact of aphasia on social participation using COSMIN criteria, to map the domains of instruments that assess the impact of aphasia on social participation against the social participation domains framework introduced by the ICF and to compare the measurement properties of the included instruments that are created with and without direct patient involvement. METHODS: The study protocol was developed with adherence to the statement of PRISMA-P, and the study was registered in PROSPERO (CRD-384044). A comprehensive electronic search was conducted in MEDLINE, EMBASE, CINAHL Plus, PsycINFO, AMED, and Web of Science Core Collection databases, and a secondary search was performed in Web of Science and Google Scholar. Studies on the development and testing measurement properties of instruments assessing the impact of aphasia on social participation were included in this review. The quality of evidence regarding measurement properties of the selected tools, including risk of bias, was evaluated against COSMIN criteria. RESULTS: Four articles featuring three instruments (Community Integration Questionnaire (CIQ), Social Activities Checklist (SOCACT), and Stroke Social Network Scale (SSNS)) assessing the impact of aphasia on social participation were identified. The quality of evidence for ‘CIQ’ development, reliability, and construct validity were ‘satisfactory’. The quality of evidence for ‘SSNS’ PROM development was ‘low- very serious risk of bias’. However, ‘satisfactory’ evidence was reported for construct validity. CIQ and SOCACT instruments showed good face validity. Compared to other instruments, SSNS reported satisfactory involvement of persons with aphasia during instrument development. The quality of evidence for internal consistency was only evaluated for two instruments due to a lack of evidence. There was no evidence for content validity, measurement error, measurement invariance, criterion validity and responsiveness. CONCLUSION/S: Instruments that exclusively measure the impact of aphasia on social participation have limited evidence of measurement properties. Further work is required to update and investigate the missing 13 measurement properties of these instruments. Based on the available evidence, the Community Integration Questionnaire can be recommended to measure the impact of aphasia on social participation.
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    Use of spontaneous gesture patterns of people with aphasia at conversational level
    (Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Withana, H.
    Introduction: Gestures are spontaneous hand and arm movements that are part of everyday communication. The roles of gestures are facilitating speech; particularly when word finding difficulties (WFDs) occur. Objectives: This study aimed to examines the type of gestures used during WFDs by Person with Aphasia (PwA), and determine the relationship between WFDs and production of gesture patterns and, use of gesture among PwA as a successful repair mechanism in conversational breakdowns. Methods: Ten minutes the spontaneous conversation was conducted with Ten PwA and Ten HCs (Healthy Controls). Data were analyzed in two phases. Gesture patterns and word finding difficulties were thematically analyzed. The checklist was used analyzed for descriptive cross-sectional design to identify the objectives. Results: Twelve gesture patterns were produced by PwA. The referential, Iconic character viewpoint, Iconic observer viewpoint, and metaphoric gesture pattern were most used PwA during the WFDs. Independent Mann Whitney U test showed that use of gesture patterns was significantly higher in PwA than in HCs (p < 0.01). A positive correlation was seen between the gesture patterns and WFDs of PwAs (r = 0.99, p < 0.01). Those with aphasia used a higher percentage of gestures as a repair mechanism of communication breakdown than HCs. Conclusions: The findings suggest that most of the gestures produced by PwA convey information for understanding their communication. The gestures are used by PwA during the WFDs to prevent a communication breakdown.
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    The Adaptation and Validation of Stroke and Aphasia Quality of Life (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan Context.
    (19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Karunathilake, K.M.M.G.S.L.; Rathnayake, S.; Ranawaka, U.K.
    Stroke and aphasia rehabilitation aims to improve the quality of life of the individuals affected. Aphasia is a disturbance of the language. Most of scales for measuring health-related quality of life in stroke exclude people with aphasia due to inability to communicate during the questionnaires. However, it is vital to identify the effect on quality of life among individuals with aphasia to provide proper rehabilitation. No reliable measure was developed in Sri Lankan context to analyze this, which became the research question of the present study. The Stroke and Aphasia Quality of Life Scale-39 which is the commonest, valid and reliable measures was used in assessing quality of life among aphasia and it was analyzed applying to the Sri Lankan context. The following were the aims of the study, translate and adapt the (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan context, identify its reliability and validity, identify the relationship between the severity level of communication and the quality of life level and analyze the most affected domain among aphasia population. The original (English) version of the SAQOL-39 has been adapted and translated using Delphi method. The sociocultural and linguistically adapted Sinhala version was administered on a group of 35 patients with aphasia to examine the test-retest reliability, inter rater reliability internal consistency reliability as well as the concurrent validity of the instrument. The inclusion criteria of the study population were as following, Aphasia resulting from a stroke at least after 6 months from the onset and not with the evidence of psychiatric illnesses and cognitive difficulty. 10 patients were used for the test retest assessment. And for the inter rater reliability assessment 2 raters were used. The Sinhala version of SAQOL-39 exhibited high test-retest reliability (ICC =0.83) as well as the inter rater reliability (ICC=0.99). This instrument exhibited high internal consistency (Chronbach's∝ =0.845) and also the concurrent validity was examined with the WHOQOL BREF and found a significant correlation between SAQOL-39 and WHOQOL-BREF (r=0.75, p=0.000). The most affected domain of the aphasia patients as the communication domain was identified through this study and it was also identified that there is a significant positive correlation (r=0.685, p=0.000) between the severity level of aphasia and quality of life. Despite the small sample size, the Sinhala version of the SAQOL-39 showed good internal consistency, inter rater reliability, test-retest reliability and concurrent validity. The importance of communication ability in perceiving the quality of life in patients with aphasia has also been highlighted.
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