Self- and surrogate-reported communication functioning in aphasia

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.

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.

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.

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.