Conceptually closer constructs showed stronger correlations, with confidence after stroke and well-being significantly improving over 6 months while language skills and communication confidence remained relatively stable in people with chronic post-stroke aphasia.
Key Findings
Results
Communication confidence was significantly correlated with language skills in people with post-stroke aphasia.
Spearman correlation between CCRSA (Communication Confidence Rating Scale for Aphasia) and WAB-R aphasia quotient was rs = 0.68, p < 0.001.
The WAB-R aphasia quotient (AQ) measures language ability, with a mean of 74.4 in this sample (range 9.1 to 98.2).
Mean CCRSA score was 28.1/40 at baseline.
Sample included 27 participants with aphasia severities ranging from mild to very severe.
Results
Confidence after stroke and well-being showed the strongest correlation of all measured construct pairs.
Pearson correlation between CaSM (Confidence after Stroke Measure) and ONS-4 (well-being) was r = 0.76, p < 0.001.
Mean CaSM score was 43.4/81 at baseline.
Mean ONS-4 score was 25.9/40 at baseline.
This was identified as the strongest relationship among all measured construct pairs, consistent with their conceptual proximity.
Results
Communication confidence and confidence after stroke were significantly correlated.
Pearson correlation between CCRSA and CaSM was r = 0.51, p = 0.006.
This correlation was weaker than the confidence-well-being correlation (r = 0.76), consistent with the authors' hypothesis that conceptually closer constructs show stronger correlations.
Both measures were administered at baseline to 27 participants.
Results
Confidence after stroke and well-being significantly improved over approximately 6 months, while language skills and communication confidence remained relatively stable.
Confidence after stroke improved significantly at follow-up: r = 0.61, p = 0.01.
Well-being improved significantly at follow-up: r = 0.55, p = 0.02.
Language skills (WAB-R AQ) and communication confidence (CCRSA) did not show significant change over the same period.
18 of the original 27 participants completed the 6-month follow-up assessment.
Participants were in the chronic phase of aphasia (6 months or more post-stroke) at enrollment.
Results
The study demonstrated the feasibility of conducting online longitudinal research with stroke survivors with aphasia.
27 participants were recruited and completed initial online assessments; 18 (67%) completed the 6-month follow-up.
Assessments were conducted online and included the WAB-R, CaSM, CCRSA, and ONS-4.
Participants had aphasia severities ranging from mild to very severe (AQ range 9.1–98.2), demonstrating feasibility across a heterogeneous sample.
The study represents a comparatively larger and more heterogeneous sample than prior studies on communication confidence in aphasia.
Methods
The sample included people with a wide range of aphasia severities, with a mean aphasia quotient in the mild range.
Mean WAB-R AQ was 74.4, with a range from 9.1 to 98.2.
Aphasia severities ranged from mild to very severe.
All participants were in the chronic stage of aphasia, defined as 6 months or more post-stroke.
27 participants were recruited for initial assessment.
Results
Stronger correlations were found between conceptually closer constructs across all measured relationships.
The strongest correlation was between confidence after stroke and well-being (r = 0.76, p < 0.001).
A moderate correlation was found between communication confidence and language skills (rs = 0.68, p < 0.001).
A moderate correlation was found between communication confidence and confidence after stroke (r = 0.51, p = 0.006).
The authors interpret the gradient of correlations as reflecting the conceptual distances between constructs.
What This Means
This research suggests that in people living with aphasia (language difficulties caused by stroke), communication confidence, general confidence after stroke, and well-being are meaningfully related to each other, but in ways that reflect how closely connected these concepts are. Specifically, constructs that are more similar in nature — like general confidence after stroke and overall well-being — were more strongly linked to each other than constructs that are more distinct, such as language ability and well-being. The study also found that language ability and communication confidence tended to stay stable over six months, while general confidence after stroke and well-being showed significant improvements over the same period.
The study involved 27 adults with chronic aphasia (meaning they had aphasia for at least 6 months after their stroke), representing a wide range of severity from mild to very severe. Participants completed online assessments at two time points roughly 6 months apart. This research suggests that even when language skills have plateaued in the chronic stage of recovery, there may still be meaningful gains to be made in how confident and well people feel overall — suggesting that targeting confidence and well-being could be valuable goals for rehabilitation beyond just focusing on language improvement.
The study also showed that online research with stroke survivors with aphasia across a range of severities is feasible, which has implications for future research access and inclusivity. This research suggests that holistic interventions addressing emotional well-being and confidence — not just language therapy — may offer important benefits for people with aphasia long after their stroke.
AlFraih S, Patchwood E, Kenny C, Conroy P. (2026). Communication Confidence, Aphasia Severity and Well-Being: A Cross-Sectional and Longitudinal Study in People With Post-Stroke Aphasia.. International journal of language & communication disorders. https://doi.org/10.1111/1460-6984.70316