Content validity of the aphasia customised electronic patient reported outcome (ACe-PRO) - revealing hidden difficulties post stroke

Purpose: This study aimed to evaluate the content validity of the Aphasia Customised electronic Patient Reported Outcome (ACe-PRO) questionnaire, designed for people with aphasia following stroke. ACe-PRO serves as a dialogue tool to address hidden difficulties in post-stroke consultations.
Method: The study followed the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) guidelines for content validity, focusing on relevance, comprehensiveness, and comprehensibility. Data were collected through cognitive interviews with nine people with aphasia and structured as well as semi-structured interviews with seventeen healthcare professionals.
Result: Both people with aphasia and healthcare professionals found ACe-PRO relevant. However, healthcare professionals identified challenges with unclear underlying concepts in certain items. People with aphasia reported issues with wording and pictorial support. The comprehensiveness of the tool was generally rated as good, though suggestions for additional items were made.
Conclusion: ACe-PRO was assessed somewhat relevant. Adjustments are required to enhance its comprehensibility, particularly regarding wording, pictorial support, and the response scale. Further testing is needed to assess respondent burden in clinical practice and to validate its use in a digital format.