To identify important treatment outcomes from the perspective of people with aphasia and their families using the ICF as a frame of reference. The nominal group technique was used with people with aphasia and their family members in seven countries to identify and rank important treatment outcomes from aphasia rehabilitation. People with aphasia identified outcomes for themselves; and family members identified outcomes for themselves and for the person with aphasia. Outcomes were analysed using qualitative content analysis and ICF linking. A total of 39 people with aphasia and 29 family members participated in one of 16 nominal groups. Inductive qualitative content analysis revealed the following six themes: (1) Improved communication; (2) Increased life participation; (3) Changed attitudes through increased awareness and education about aphasia; (4) Recovered normality; (5) Improved physical and emotional well-being; and (6) Improved health (and support) services. Prioritized outcomes for both participant groups linked to all ICF components; primary activity/participation (39%) and body functions (36%) for people with aphasia, and activity/participation (49%) and environmental factors (28%) for family members. Outcomes prioritized by family members relating to the person with aphasia, primarily linked to body functions (60%). People with aphasia and their families identified treatment outcomes which span all components of the ICF. This has implications for research outcome measurement and clinical service provision which currently focuses on the measurement of body function outcomes. The wide range of desired outcomes generated by both people with aphasia and their family members, highlights the importance of collaborative goal setting within a family-centred approach to rehabilitation. These results will be combined with other stakeholder perspectives to establish a core outcome set for aphasia treatment research. Implications for Rehabilitation Important outcomes for people with aphasia and their families span all components of the ICF. The relevancy and translation of research findings may be increased by measuring and reporting research outcomes which are important to people living with aphasia. The results of this study indicate that important treatment outcomes for people living with aphasia most frequently link to the activity/participation and body function components of the ICF. The outcomes identified in this study suggest a broad role for clinicians working in aphasia rehabilitation. The categories of identified outcomes may be used clinically as a starting point in goal-setting discussions with clients and their families.

To evaluate the effectiveness of the Active Communication Education (ACE) program for older people with hearing impairment and to investigate factors that influence response to the program. The ACE is a group program that runs for 2 hr per week for 5 wk. In this double-blinded, randomized, controlled trial, 178 older people with, on average, mild to moderate hearing impairment were randomly allocated to one of two groups. Approximately half had been fitted with hearing aid/s in the past. One group (N = 78) undertook a placebo social program for the first 5 wk, followed by the ACE program. They were assessed before the social program, immediately after it, and then again immediately post-ACE. The other group (N = 100) undertook the ACE program only and were assessed before and after ACE. In addition, 167 participants were reassessed 6 mo after completing ACE. Assessments were all self-report and included two sets of measures: 1) those administered both before and after the program-the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, the Ryff Psychological Well-Being Scale, the Short-Form 36 health-related quality of life measure; and 2) those administered postprogram only-the Client Oriented Scale of Improvement, the International Outcome Inventory-Alternative Interventions, and a qualitative questionnaire. All assessments were conducted by a researcher blinded to participants' group membership. The relationships between participant response to the ACE program and a number of client-related factors were also investigated. These factors were the participants' age, gender, hearing loss, hearing aid use, attitudes to hearing impairment (as measured using the Hearing Attitudes to Rehabilitation Questionnaire) and the involvement of significant others. For those participants who completed the social program initially, significant improvements were found on the Quantified Denver Scale of Communicative Function and on the Mental Component Score of the Short-Form 36 only, when pre- and postprogram scores were compared. For those who completed the ACE program, there were significant pre-to-post improvements on the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, and the Ryff Psychological Well-Being Scale. These improvements after ACE were maintained at 6 mo. Higher scores on the Hearing Attitudes to Rehabilitation Questionnaire before the ACE program were associated with greater positive change on a number of the pre-post program measures. Using the Client Oriented Scale of Improvement, 75% of participants reported some improvement on the primary goal they wished to achieve with the ACE. Positive outcomes were also recorded with the International Outcome Inventory-Alternative Interventions. This research study provides evidence for the effectiveness of the ACE program and indicates that such communication programs have an important place in the audiological rehabilitation of older adults. They should be considered as an alternative or a supplement to traditional interventions such as hearing aid fitting.

The prevalence of hearing impairment (HI) in older people and its detrimental effects on their quality of life and well-being is well known. To date however, there have been few studies investigating the impact on the person's spouse. To investigate this topic, a qualitative study consisting of in-depth interviews was conducted with five female and five male spouses of older people with HI. The aims of the study were: (1) to describe the spouses' experiences of living with someone with a HI; (2) to describe the effect of HI on the couples' communication and relationship; and (3) to identify coping strategies adopted by spouses. An interpretive analysis revealed four themes that described the experience of spouses of older people with HI: (1) the broad ranging effects of the HI on the spouses' everyday lives; (2) the spouses' need to constantly adapt to their partners' HI; (3) the effect of acceptance of the HI on the spouse; and (4) the impact of ageing and retirement. Spouses in this study experienced a wide range of effects as a result of their partners' HI. Implications for audiological rehabilitation are discussed.

The prevalence and severity of dysphagia in people treated non-surgically for primary head and neck cancer (HNC) is well documented. However, few studies have looked beyond the physiological impairment to explore the lived experience of dysphagia in the post-treatment period of HNC. The current study adopted a person-centred, qualitative approach to describe the experiences of people living with dysphagia in the months and years following non-surgical treatment for HNC. Using maximum variation sampling, 24 participants who had undergone radiotherapy treatment for HNC were recruited. Individual interviews were conducted to explore the impact of dysphagia on participants' everyday lives. The themes identified included: (1) physical changes related to swallowing; (2) emotions evoked by living with dysphagia; (3) altered perceptions and changes in appreciation of food; and (4) personal and lifestyle impacts. The data revealed the breadth and significance of the impact of dysphagia on the lives of people treated curatively for HNC. Assessment and management in the post-treatment period must be sufficiently holistic to address both the changing physical states and the psychosocial needs of people with dysphagia following HNC. Rehabilitation services which focus only on impairment-based management will fail to fully meet the support needs of this clinical population.

The aim of this article is to describe the disability experienced by older people with hearing impairment using the framework provided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF). The nature and prevalence of hearing impairment in the older population are outlined, along with the Activity Limitations and Participation Restrictions associated with such impairments, and the contextual factors that influence the disability. Appropriate assessments of hearing Impairments, Activity Limitations, and Participation Restrictions applicable in a rehabilitation context are also described. Hearing impairment leads to breakdowns in communication, a fact that suggests that the impairment is likely to influence frequent communication partners. It is argued here that the impact of the impairment on others is a so-called Third-Party Disability. Finally, an example of how the ICF can be applied in the rehabilitation of an older person with hearing disability is presented.