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Self- and surrogate-reported communication functioning in aphasia

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Abstract

Purpose

To evaluate the dimensionality and measurement invariance of the aphasia communication outcome measure (ACOM), a self- and surrogate-reported measure of communicative functioning in aphasia.

Methods

Responses to a large pool of items describing communication activities were collected from 133 community-dwelling persons with aphasia of ≥ 1 month post-onset and their associated surrogate respondents. These responses were evaluated using confirmatory and exploratory factor analysis. Chi-square difference tests of nested factor models were used to evaluate patient–surrogate measurement invariance and the equality of factor score means and variances. Association and agreement between self- and surrogate reports were examined using correlation and scatterplots of pairwise patient–surrogate differences.

Results

Three single-factor scales (Talking, Comprehension, and Writing) approximating patient–surrogate measurement invariance were identified. The variance of patient-reported scores on the Talking and Writing scales was higher than surrogate-reported variances on these scales. Correlations between self- and surrogate reports were moderate-to-strong, but there were significant disagreements in a substantial number of individual cases.

Conclusions

Despite minimal bias and relatively strong association, surrogate reports of communicative functioning in aphasia are not reliable substitutes for self-reports by persons with aphasia. Furthermore, although measurement invariance is necessary for direct comparison of self- and surrogate reports, the costs of obtaining invariance in terms of scale reliability and content validity may be substantial. Development of non-invariant self- and surrogate report scales may be preferable for some applications.

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Notes

  1. The term “proxy” has been used with two distinct meanings in the literature. Some authors have used the term to refer to a person close the patient who responds as he or she believes that the patient would respond [9, 16]. Others have used the term to refer to a person close to the patient who provides his or her own assessment, without considering how the patient might respond [12, 14]. In still other cases, the meaning is not clearly specified [13].

  2. We use the term “surrogate” here to specify the second meaning of the word “proxy” discussed above in Footnote 1, i.e., a person close to the patient who provides his or her own assessment, without trying to respond as he or she thinks that the patient would respond.

  3. The CFI and TLI are measures of incremental or relative fit that compare the tested model to a null model, which assumes that there are no relationships between any of the observed variables. They both adjust for model complexity, the CFI with an expression that subtracts the model degrees of freedom from the model Chi-square value, while the TLI is based on the ratio of the Chi-square to its degrees of freedom. CFI and TLI values of zero indicate worst possible fit, while values close to 1 indicate relatively good fit. The RMSEA is a badness-of-fit measure where a value of zero indicates best possible fit. It is based on the model Chi-square, its degrees of freedom, and the sample size. The WRMR is a newer statistic that measures the weighted average difference between the observed and model-estimated population variances and covariances.

Abbreviations

ACOM:

Aphasia communication outcome measure

CFI:

Comparative fit index

PWA:

Person with aphasia

RMSEA:

Root mean square error of approximation

SUR:

Surrogate

TLI:

Tucker–Lewis index

WRMR:

Weighted root mean square residual

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Acknowledgments

The authors gratefully acknowledge the assistance of Beth Friedman, Jessica Rapier, Mary Sullivan, Brooke Swoyer, Neil Szuminsky, and Sandra Wright.

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Authors and Affiliations

  1. Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Patrick J. Doyle & William D. Hula

  2. Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA

    Patrick J. Doyle & William D. Hula

  3. Research Service, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Shannon N. Austermann Hula

  4. Department of Psychology in Education, University of Pittsburgh, Pittsburgh, PA, USA

    Clement A. Stone

  5. Research Service, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA

    Julie L. Wambaugh

  6. Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA

    Julie L. Wambaugh

  7. Audiology and Speech Pathology, Phoenix VA Healthcare System, Phoenix, AZ, USA

    Katherine B. Ross

  8. Audiology and Speech Pathology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    James G. Schumacher

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  1. Patrick J. Doyle
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  2. William D. Hula
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Correspondence to William D. Hula.

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Doyle, P.J., Hula, W.D., Austermann Hula, S.N. et al. Self- and surrogate-reported communication functioning in aphasia. Qual Life Res 22, 957–967 (2013). https://doi.org/10.1007/s11136-012-0224-5

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