Large variations in intensive speech–language rehabilitation post-stroke
descriptions of practices, and perceptions of barriers and enablers from 26 clinics in Sweden
DOI:
https://doi.org/10.58986/al.2024.17950Nyckelord:
rehabilitation, aphasia, apraxia of speech, stroke, national guidelinesAbstract
Background: Intensive rehabilitation of aphasia is recommended in the national guidelines for stroke care, but is far from implemented in Swedish healthcare.
Aim: To explore current practice and detect barriers and enablers for intensive aphasia rehabilitation among Speech Language Pathologists (SLPs) before they were enrolled in a national intervention study.
Method: Thirty-six SLPs in 26 clinics answered a web-based questionnaire. Responses were processed using descriptive statistics and thematic analysis.
Result: Treatment intensity, duration and delivery format varied widely, and two-thirds offered intensive rehabilitation rarely or never. Thematic analysis generated the following five barriers: understaffing, patient factors, teamwork/scheduling, prioritization, and accessibility, and three enablers: increased staffing, planned intervention programmes, and comprehensive delivery formats.
Conclusions: Compliance with Swedish stroke guidelines for intensive aphasia rehabilitation is low, and the current practice varies widely between different clinics. Increasing SLPs in primary care and restructuring care by using planned and comprehensive intervention approaches are suggested to stimulate implementation.
Abstract på svenska
Intensiv rehabilitering av afasi rekommenderas i de nationella riktlinjerna för strokevård, men är långt ifrån implementerad i svensk sjukvård. Syftet med studien var att utforska nuvarande praxis och upptäcka hinder och möjliggörare för intensiv afasirehabilitering bland logopeder innan de skrivs in i en nationell interventionsstudie. Trettiosex logopeder på 26 kliniker besvarade ett webbaserat frågeformulär. Svaren bearbetades med hjälp av beskrivande statistik och tematisk analys. Resultaten visade att behandlingens intensitet, varaktighet och leveransformat varierade mycket, och två tredjedelar erbjöd sällan eller aldrig intensiv rehabilitering. Tematisk analys genererade följande fem barriärer: underbemanning, patientfaktorer, lagarbete/schemaläggning, prioritering och tillgänglighet, och tre möjliggörare: ökad personalstyrka, planerade interventionsprogram och omfattande förlossningsformat. Efterlevnad av svenska strokeriktlinjer för intensiv afasirehabilitering är låg, och nuvarande praxis varierar stort mellan olika kliniker. Att öka antalet logopeder inom primärvården och omstrukturera vården genom att använda planerade och omfattande interventionsmetoder föreslås för att stimulera implementering.
Den svenska versionen av abstractet lades till i version 2 av denna artikel. Översättningen gjordes av tidskriftens redaktion.
Nedladdningar
Referenser
Babbitt, Edna M, Worrall, Linda & Cherney, Leora R (2015). Structure, processes, and retrospective outcomes from an intensive comprehensive aphasia program. American Journal of Speech-Language Pathology 24(4), S854–S863.
Ballard, Kirrie J, Wambaugh, Julie L, Duffy, Joseph R, Layfield, Claire, Maas, Edwin, Mauszycki, Shannon, & McNeil, Malcolm R (2015). Treatment for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012. American Journal of Speech-Language Pathology 24(2), 316–337.
Berthier, Marcelo L & Pulvermüller, Friedemann (2011). Neuroscience insights improve neurorehabilitation of poststroke aphasia. Nature Reviews. Neurology 7(2), 86–97.
Braun, Virginia & Clarke, Victoria (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77–101.
Breitenstein, Caterina et al. (2017). Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting. The Lancet (British Edition) 389(10078), 1528–1538.
Cacciante, Luisa, Kiper, Pawel, Garzon, Martina, Baldan, Francesca, Federico, Sara, Turolla, Andrea & Agostini, Michela (2021). Telerehabilitation for people with aphasia: A systematic review and meta-analysis. Journal of Communication Disorders 92, 106111–106111.
Crosson, Bruce, Rodriguez, Amy, Copland, David, Fridriksson, Julius, Krishnamurthy, Lisa C, Meinzer, Marcus, Raymer, Anastasia M, Krishnamurthy, Venkatagiri & Leff, Alexander (2019). Neuroplasticity and aphasia treatments: new approaches for an old problem. Journal of Neurology, Neurosurgery and Psychiatry 90(10), 1147–1155.
Duffy, Joseph R (2020) Motor speech disorders: substrates, differential diagnosis, and management. 4. ed. St. Louis, Mo: Elsevier Mosby, 312.
Dignam, Jade, Rodriguez, Amy & Copland, David (2016). Evidence for intensive aphasia therapy: Consideration of theories from neuroscience and cognitive psychology. PM & R 8(3), 254–267.
Edwards, Phil (2010). Questionnaires in clinical trials: guidelines for optimal design and administration. Current Controlled Trials in Cardiovascular Medicine 11(1), 2–2.
Emerson, Robert Wall (2015). Convenience sampling, random Sampling, and snowball sampling: How does sampling affect the validity of research? Journal of Visual Impairment & Blindness 109(2), 164–168.
Grönberg, Angelina, Henriksson, Ingrid & Lindgren, Arne (2021). Accuracy of NIH Stroke Scale for diagnosing aphasia. Acta Neurologica Scandinavica 143(4), 375–382.
Gunning, Dana, Wenke, Rachel, Ward, Elisabeth C, Chalk, Shannon, Lawrie, Melissa, Romano, Michelle, Edwards, Ann, Hobson, Tania, & Cardell, Elizabeth (2017). Clinicians’ perceptions of delivering new models of high intensity aphasia treatment. Aphasiology 31(4), 406–426.
Hubbard, Isobel J, Harris, Dawn, Kilkenny, Monique F, Faux, Steven G., Pollack, Michael R & Cadilhac, Dominique A (2012). Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice. Archives of Physical Medicine and Rehabilitation 93(6), 965–971.
Kleim, Jeffrey A & Jones, Theresa A (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research 51(1), S225–S239.
Lam, Jonathan M C & Wodchis, Walter P (2010). The relationship of 60 disease diagnoses and 15 conditions to preference-based health-related quality of life in Ontario hospital-based long-term care residents. Medical Care 48(4), 380–387.
Mitchell, Claire, Bowen, Audrey, Gittins, Matthew, Vail, Andy, Conroy, Paul, Paley, Lizz, Bray, Ben & Tyson, Sarah (2018). Prevalence of aphasia and co-occurrence of dysarthria: the UK Sentinel Stroke National Audit Programme. Aphasiology 32(sup1), 145–146.
Neuro (2021). Neurorapporten 2021 - Ojämlik tillgång till rehabilitering [Unequal access to rehabilitation], Neuro, Linköping (SE). https://neuro.se/forening/foereningar-a-oe/neuro-linkoeping/webbarkiv/neurorapporten-2021/[10 Feb 2023].
Palmquist Emma (2018) Svenska logopeders omhändertagande av personer med afasi och deras närstående [Swedish speech language pathologist’s care of people with aphasia and their relatives], [degree project]. Uppsala: Uppsala University. Swedish.
Persson, Klara, Bråndal, Rut, Karlsson, Fredrik, & Blom Johansson, Monica (2022). Do best practice recommendations align with current aphasia practices in the Swedish care context: a national survey. Aphasiology 36(8), 903–920.
Pierce, John E, Menahemi-Falkov, Maya, O’Halloran, Robyn, Togher, Leanne & Rose, Miranda (2019). Constraint and multimodal approaches to therapy for chronic aphasia: A systematic review and meta-analysis. Neuropsychological Rehabilitation 29(7), 1005–1041.
Pulvermüller, Friedemann, Neininger, Bettina, Elbert, Thomas, Mohr, Bettina, Rockstroh, Brigitte, Koebbel, Peter & Taub, Edward (2001). Constraint-induced therapy of chronic aphasia after stroke. Stroke 32(7), 1621–1626.
Putman, Koen & De Wit, Liesbet (2009). European comparison of stroke rehabilitation. Topics in Stroke Rehabilitation 16(1), 20–26.
REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE) Collaborators (2022). Dosage, intensity, and frequency of language therapy for aphasia: A systematic review-based, individual participant data network meta-analysis. Stroke 53(3), 956–967.
RIKSSTROKE [The Swedish Stroke Register] (2021). Quality of Swedish stroke care 2020 - A brief summary of data for the full year 2021. Umeå (SE). https://www.riksstroke.org/wp-content/uploads/2021/10/Arsrapport-2020-engelsk-sammanfattning.pdf.pdf [27 Aug 2023].
RIKSSTROKE [The Swedish Stroke Register] (2022). Quality of the Swedish stroke care 2021 - A brief summary of data for the full year 2021. Umeå (SE). https://www.riksstroke.org/wp-content/uploads/2022/11/Arsrapport-2021-engelsk-sammanfattning_final.pdf. [25 Aug 2023].
Rose, Miranda, Cherney, Leora & Worrall, Linda (2013). Intensive comprehensive aphasia programs: An international survey of practice. Topics in Stroke Rehabilitation 20(5), 379–387.
Shrubsole, Kristine, Worrall, Linda & Power, Emma (2018). Priorities for closing the evidence-practice gaps in poststroke aphasia rehabilitation: A scoping review. Archives of Physical Medicine and Rehabilitation 99(7), 1413–1423.e24.
Simmons-Mackie, Nina, Worrall, Linda, Murray, Laura L, Enderby, Pam, Rose, Miranda L, Paek, Eun Jin & Klippi, Anu (2017). “The top ten: Best practice recommendations for aphasia.” Aphasiology 31(2), 131–151.
Socialstyrelsen (2020). Nationella riktlinjer för vård vid stroke, stöd för styrning och ledning [National guidelines for stroke care, updated 2020, support for management]. Stockholm: Report for the National Board of Health and Welfare (SE). Report no. 2020-1-6545. Swedish.
Socialstyrelsen (2023). Hälso- och sjukvård i hemmet, kunskapsstöd för personcentrerad vård och rehabilitering [Healthcare in the home, knowledge support for person-centred care and rehabilitation], 2023-3-8458. https//www.socialstyrelsen.se/globalassets/ sharepoint-dokument/artikelkatalog/kunskapsstod/2023-3-8458.pdf [19 Sept 2023].
Socialstyrelsen (2023). Personalstatistik inom primärvården, Delrapport 1 - en förstudie [Personnel statistics in primary care, Interim report 1 - a preliminary study], 2023-3-8459. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/statistik/
2023-3-8459.pdf [29 Jan 2024].
Socialdepartementet och SKR – Sveriges Kommuner och Regioner (2023). God och nära vård 2023. En omställning av hälso-¬ och sjukvården med primärvården som nav. [Good and close care in 2023. A restructuring of health care with primary care as the hub. https://www.regeringen.se/contentassets/f814b739c29447efb04753bfa37baa11/overenskommelse-mellan-staten-och-sveriges-kommuner-och-regioner-om-god-och-nara-vard-2023.pdf [19 Sept 2023].
Teasell, Robert, Meyer, Matthew J, McClure, Andrew, Pan, Cheng, Murie-Fernandez, Manuel, Foley, Norine, & Salter, Katherine (2009). Stroke rehabilitation: An international perspective. Topics in Stroke Rehabilitation 16(1), 44–56.
Trebilcock, Megan, Worrall, Linda, Ryan, Brooke, Shrubsole, Kirstine, Jagoe, Caroline, Simmons-Mackie, Nina, Bright, Felicity, Cruice, Madeline, Pritchard, Madeleine & Le Dorze, Guylaine (2019). Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries. Aphasiology 33(7), 865–887.
Wambaugh, Julie L., Wright, Sandra, Boss, Emily, Mauszycki, Shannon C, DeLong, Catherine, Hula, William & Doyle, Patrick J (2018). Effects of treatment intensity on outcomes in acquired apraxia of speech. American Journal of Speech-Language Pathology 27(1S), 306–322.
World Stroke Organisation (2023). Why stroke matters. Learn about stroke. http://www.world-stroke.org/world-stroke-day-campaign/why-stroke-matters/learn-about-stroke/ [27 Aug 2023].
Publicerad
Versioner
- 2024-10-15 (2)
- 2024-04-25 (1)
Referera så här
Nummer
Sektion
Licens
Copyright (c) 2024 Marika Schütz, Ingrid Henriksson, Trandur Ulfarsson, Ellika Schalling
Det här verket är licensierat under en Creative Commons Erkännande 4.0 Internationell-licens.
