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Dear Ms. Manning,
thank you very much for your response and helpful comments to our study protocol.
You point out that we might have missed to report on two important reviews conducted in the field of stroke survivors' needs. This might be due to our focus on stroke-related aphasia and the accordingly constructed search algorithm. Since the focus of our work will be the comparison of the results of two synthesis methods, we aimed to rule out that QES exist that duplicate our research question. Either way, thank you for pointing us to these important reviews. We will review those studies and use them to refine and inform our research algorithm if neccessary.
We also want to apologize for not having reproduced the results of your study in an appropriate way. We will keep your critique in mind while conducting our QES using two different approaches.
Incorporating two parallel approaches, meta-ethnography and thematic synthesis, this protocol aims to contribute to the methodological discussion around qualitative evidence synthesis (QES) and will examinethe healthcare needs / preferences of older people with post-stroke aphasia. This is an important topic to address due to the general exclusion of this cohort in stroke studies, however the authors should review the existing QES relating to this topic to better discern the unique contribution that this review will bring.
First, I am concerned by the omission of a number of related QES in the Introduction (e.g., (1) WRAY, F. & CLARKE, D. 2017. Longer-term needs of stroke survivors with communication difficulties living in the community: a systematic review and thematic synthesis of qualitative studies. BMJ Open, 7; (2) GALLACHER, K., MORRISON, D., JANI, B., MACDONALD, S., MAY, C. R., MONTORI, V. M., ERWIN, P. J., BATTY, G. D., ETON, D. T., LANGHORNE, P. & MAIR, F. S. 2013. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med, 10, e1001473.) Considering broader concepts around treatment burden and self-management support is essential when examining healthcare needs.
Second, I am concerned by an apparent lack of engagement with the focus and findings of previous QES cited. For example, the authors write that Manning et al. (2019) "did not focus on healthcare needs or healthcare experi...
Second, I am concerned by an apparent lack of engagement with the focus and findings of previous QES cited. For example, the authors write that Manning et al. (2019) "did not focus on healthcare needs or healthcare experiences, but were interested more generally in factors contributing to personal recovery and living successfully with aphasia". This is not a comprehensive or accurate summary of this thematic synthesis (not thematic analysis) of 31 papers reporting qualitative research with >350 people with post-stroke aphasia (PWA).
The purpose of the Manning et al (2019) included advancing conceptual understanding of how best to support PWA to 'live well'. In doing so, the QES comprehensively and systematically searched and synthesised prior qualitative literature around healthcare needs and experiences, and integrated these with issues of quality, access, equity and inclusion - i.e. with wider consideration to structural barriers to being able to access relevant support services.
The findings included analytical themes which explicitly refer to healthcare needs - e.g., the need for long-term, responsive access to a wide range of health / community support services and information, and for healthcare workers to be competent and trained in supporting communication with people with aphasia. The analysis integrates these healthcare needs within a broader conceptual understanding of living well with aphasia, that is aligned with the personal recovery model used in the mental health literature.
In summary, while the protocol is novel in contributing to methodological insights more generally, I would urge the authors to engage with prior QES on this topic to explicate the new knowledge it will generate around healthcare needs of people with aphasia.