{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:58:55Z","timestamp":1769043535371,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:00:00Z","timestamp":1639008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>While implementation studies in aphasia management have shown promising improvements to clinical practice, it is currently unknown if aphasia implementation outcomes are sustained and what factors may influence clinical sustainability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To evaluate the sustainment (i.e., sustained improvement of aphasia management practices and domains influencing clinicians\u2019 practice) and sustainability (i.e., factors influencing sustainability) outcomes of the Acute Aphasia IMplementation Study (AAIMS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods &amp; Procedures<\/jats:title><jats:p>A convergent interactive mixed\u2010methods sustainability evaluation was conducted on two previously delivered implementation interventions (AAIMS). The AAIMS interventions were targeted at improving either written aphasia\u2010friendly information provision (Intervention A) or collaborative goal\u2010setting (Intervention B). Outcomes were collected 2 and 3 years post\u2010implementation, addressing the research questions of sustainment (e.g., medical record audits and behavioural constructs questionnaires) and sustainability (e.g., post\u2010study focus groups and organizational readiness surveys). Quantitative sustainability data were compared with post\u2010implementation data, allowing for sustainment to be determined. Clinicians\u2019 perspectives on sustainability outcomes and challenges were analysed using framework analysis and integrated with the quantitative findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes &amp; Results<\/jats:title><jats:p>A total of 35 speech\u2013language therapists (SLTs) from four hospitals participated. The medical records of 79 patients were audited in the sustainability period compared with the 107 medical records audited during AAIMS. Overall, there was variable sustainment of the target behaviours; implementation for Intervention A was not sustained at either sustainability time point (2018 = 47.8% decrease; 2019 = 22.78% decrease), but implementation for Intervention B was sustained at both time points (2018 = 7.78% increase; 2019 = 18.1% increase). There was a pattern of sustained change in the behaviour change domains targeted by the implementation interventions, where scores of the targeted domains increased over time (0.13, 95% confidence interval (CI) = \u22120.05 to 0.30) and scores of the non\u2010targeted domains declined (\u22120.03, 95% CI = \u22120.11 to 0.04). Factors influencing sustainability were mainly related to \u2018processes\u2019, \u2018the inner context\u2019 and \u2018SLT characteristics\u2019, and these interacted dynamically to account for variation between teams.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Implications<\/jats:title><jats:p>Implementation outcomes (i.e., practice changes) were not sustained to the same level for three of the four participating SLT teams, with variable or partial sustainment most common. While the factors influencing sustainability differed depending on the context and individuals involved, the most important factor influencing outcomes seemed to be the level to which behaviour\u2010change processes and strategies were embedded within the SLT department. Future implementation studies should incorporate sustainability measures from the onset and include follow\u2010ups and monitoring systems to help support sustained change in the long term.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>In post\u2010stroke aphasia management, there are few examples of long\u2010term sustainability of implementation outcomes. It is therefore unknown what factors are potentially important to sustain implementation of best\u2010practice recommendations in aphasia services.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds to existing knowledge<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>There is potential for implementation outcomes to be sustained long term, but sustainment is impacted by a range of factors. Ongoing facilitation or follow\u2010up after initial implementation may to useful to promote sustainment, but is not essential if processes are sufficiently embedded. Gradual implementation into practice may lead to better sustainment than rapid change that is quickly forgotten.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the potential or actual clinical implications of this work?<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Future implementation efforts should incorporate sustainability measures from the onset. Applying a sustainability framework was useful to guide evaluations and explore factors influencing the sustainment outcomes and is recommended for those interested in sustainability. Results from our evaluation can be used to guide refinement and support future development of sustainable implementation interventions.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.12684","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T09:34:58Z","timestamp":1639042498000},"page":"152-171","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Sustaining acute speech\u2013language therapists\u2019 implementation of recommended aphasia practices: A mixed methods follow\u2010up evaluation of a cluster RCT"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7805-2447","authenticated-orcid":false,"given":"Kirstine","family":"Shrubsole","sequence":"first","affiliation":[{"name":"Faculty of Health Southern Cross University  Gold Coast QLD Australia"},{"name":"The Queensland Aphasia Research Centre 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