Optimizing our evidence map for cognitive-communication interventions: How it can guide us to better outcomes for adults living with acquired brain injury

Abstract

Background: Speech and language therapists (SLTs) share a collective goal of ensuring that adults with cognitive-communication disorders (CCD) due to acquired brain injuries (ABI) attain their highest possible level of participation and satisfaction in family, community, social, work and academic communications through evidence-based interventions. While there is a considerable evidence base to support SLT cognitive-communication interventions, there are also numerous barriers to its implementation.

Aims: The first aim is to describe the development of a comprehensive knowledge translation tool that synthesizes evidence-based practice recommendations for SLT cognitive-communication interventions across the care continuum. The second aim is to critically analyse the barriers to implementation of these interventions and to explore how this knowledge translation tool might assist in overcoming these challenges.

Methods & procedures: We developed a map of 148 clinical practice recommendations extracted from 129 reviews and guidelines called the Cognitive-Communication Evidence Application for SLTs (CCEAS-Map). The process of developing the CCEAS-Map included: (1) examination of implementation science frameworks to inform knowledge tool creation; (2) search and synthesis of the evidence provided in reviews and guidelines that met specific criteria; (3) development of a framework to critically analyse and categorize the barriers and facilitators affecting the implementation of these clinical recommendations; (4) consultation with potential end users of the CCEAS-Map, including 16 expert SLTs and eight persons with lived experience (PWLE), regarding the tool's construction, barriers and facilitators to implementation, and the potential of the CCEAS-Map to address evidence-practice gaps; and (5) refining the CCEAS-Map based on expert input.

Main contribution: To our knowledge this is the first synthesis of all available clinical recommendations for SLT cognitive-communication interventions for ABI, across all severities of injury, stages along the continuum of care, and areas of CCD practice. The paper presents a novel approach to analysing knowledge-practice gaps: drawing on implementation science tools, analysing barriers and facilitators, and collaborating with end users in designing a knowledge translation tool.

Conclusions & implications: The CCEAS-Map provides a comprehensive synthesis of the available evidence in a format that can facilitate clinical application of the evidence, provide education for all stakeholders, serve as a basis for CCD pathway development, support researcher-clinician collaboration and encourage advocacy at the system level. As a knowledge translation tool, the CCEAS-Map can promote the availability of SLT services and has the potential to ultimately improve the lives of those with CCD.

What this paper adds: What is already known on this subject A great deal is known about cognitive-communication deficits incurred after ABI, including their impact on daily functioning, optimal methods for sensitive and ecologically valid assessment, and the efficacy of various speech-language therapy interventions along the care continuum. However, considerable constraints remain that interfere with the application of this evidence to daily SLT practice. A need was identified to develop a knowledge translation tool to help close these evidence-practice gaps. What this paper adds to existing knowledge This study describes the development of the CCEAS-Map, a critical synthesis of 129 reviews and guidelines, leading to 148 evidence-based clinical recommendations, which can be used to guide SLT cognitive-communication practice and education, as well as clinical pathway development, and advocacy for systemic changes and other healthcare policy improvements. What are the potential or actual clinical implications of this work? The CCEAS-Map is a clinical knowledge translation tool designed to guide cognitive-communication interventions by linking practice recommendations directly to the current evidence. This paper also offers insights into barriers to SLT intervention across the care continuum and strategies for improving implementation of cognitive-communication best practices, to improve the lives of those living with ABI related disabilities.

Keywords: acquired brain injury; cognitive–communication; evidence‐based practice (EBP); speech and language therapy; speech–language pathology.