Finding a focus for quality of life with aphasia: Social and emotional health, and psychological well-being

Background: Speech pathologists infrequently address the quality of aphasic people's lives in a direct manner in rehabilitation, most likely due to the difficulty in grasping the role of communication in quality of life (QOL). Despite considerable research into aphasic language impairments and communication disabilities, there is no clear evidence how aphasia impacts on clients' QOL. This paper reports on a comprehensive evaluation of 30 people with mild to moderate aphasia to determine which aspects of communication predict their QOL. A conceptual model of the relationship between communication and QOL was devised, using the disablement framework of the International Classification of Impairment, Activity and Participation Beta-2 Draft (ICIDH-2) (World Health Organisation, 1998). Communication was conceptualised as language impairment, functional communication ability and activity, and social participation. QOL included both health-related QOL (HRQOL) and psychological well-being concepts. Aims: The aim of this study was to investigate how measures of impairment, activity and participation, and measures of QOL related to each other for people with aphasia, for the purpose of. (1) determining which specific communication assessments were most predictive of their QOL; and (2) determining whether HRQOL or psychological well-being was represented more in relationships, thus indicating a focus for QOL in aphasia. Methods & Procedures: Thirty people aged 57-88 years (mean = 70.7 yrs) with predominantly mild to moderate chronic aphasia (mean WAB AQ = 74.4, range 21.9-95.8; mean TPO = 41 mths, range 10-108 mths) participated in this study. In total, 13 standardised and specifically designed measures evaluated the different concepts of the model. Maximal multiple regression analysis illustrated which communication measures were most predictive of participants' HRQOL and psychological well-being. Outcomes & Results: Overall, aphasic people's communication predicted their psychological well-being and social health (a subscale of HRQOL). Specifically, the findings demonstrated that functional communication ability, and language functioning to a lesser degree, were implicated in QOL, providing evidence for particular speech pathology interventions in addressing clients' QOL. Finally, emotional health powerfully influenced the relationships among variables, and physiological/physical health was a determinant of social participation. Conclusions: The findings suggest that aphasic people's QOL may be understood best in terms of their social participation, emotional health, and psychological well-being. Clinicians may directly target these three areas, and indirectly target them through language and functional communication, as well as targeting the contextual factors of people's lives. A new model of communication-related QOL has been devised.