Towards a core outcome set for dysarthria after stroke: What should we measure?

Abstract

Objective: To identify and agree on what outcome domains should be measured in research and clinical practice when working with stroke survivors who have dysarthria.

Design: Delphi process, two rounds of an online survey followed by two online consensus meetings.

Setting: UK and Australia.

Participants: Stroke survivors with experience of dysarthria, speech and language therapists/pathologists working in stroke and communication researchers.

Methods: Initial list of outcome domains generated from existing literature and with our patient and public involvement group to develop the survey. Participants completed two rounds of this survey to rate importance. Outcomes were identified as 'in', 'unclear' or 'out' from the second survey. All participants were invited to two consensus meetings to discuss these results followed by voting to identify critically important outcome domains for a future Core Outcome Set. All outcomes were voted on in the consensus meetings and included if 70% of meeting participants voted 'yes' for critically important.

Results: In total, 148 surveys were fully completed, and 28 participants attended the consensus meetings. A core outcome set for dysarthria after stroke should include four outcome domains: (a) intelligibility of speech, (b) ability to participate in conversations, (c) living well with dysarthria, (d) skills and knowledge of communication partners (where relevant).

Conclusions: We describe the consensus of 'what' speech outcomes after stroke are valued by all stakeholders including those with lived experience. We share these findings to encourage the measurement of these domains in clinical practice and research and for future research to identify 'how' best to measure these outcomes.