Do best practice recommendations align with current aphasia practices in the Swedish care context: a national survey

Figures & data

Table 1. Description of the participants.

	Number of participants (n)
Total	109
Years of experience^c
0–2	23
3–5	24
6–10	25
11–20	29
>20	8
Region
Northen Sweden	19
Central Sweden	21
Stockholm (capital)	23
South-eastern Sweden	12
South-western Sweden	18
Southern Sweden^d	15
Rehabilitation phase^e
Acute phase	24
Subacute rehabilitation phase	26
Chronic rehabilitation phase	18
Acute to chronic phase	40
Work context
Regional care	91
Private care	9
Municipal care	1
State care	1
State and private care	1
Regional and municipal care	1
Number of PWA^a that the SLP^b meet per week
1–3	45
4–6	47
7–10	11
11–15	4
>15	1

^aPeople with aphasia.

^bSpeech and language pathologist.

^c Years of experience, number of years the participant has worked with people with aphasia.

^dThe region of Southern Sweden includes in this compilation the entire Region Halland.

^eRehabilitation phase, accordning to the classification used by Johansson et al. (2011).

Figure 1. The degree to which the participants applied the best practice recommendations in their work with people with aphasia.

Table 2. Comments on the perceived applicability of the best practice recommendations for aphasia in a Swedish healthcare context.

Theme	Category	Subcategory	Example of quotations
Aspects related to the health care organization	Not enough SLP resources	Strict prioritizations	We have excluded for instance, aphasia connected with dementia due to lack of resources. (BPRA 5 c) Presently, the time available is too limited to give it focus. It [the treatment] will be offered where there is a clear need. (BPRA 7a) The lack of time available and the need to prioritize prohibits us from offering intensive treatments, despite the evidence of it being effective. (BPRA 5)
		Restricted possibility or extent of assessments and interventions	We only have time to do screenings and as good assessments of type of communicative impairment as we can. (BPRA 2) We involve the patient’s relatives as often as possible, but the involvement requires that the relative visits coincides with the SLP being available. In practice, this occurs too seldom. (BPRA 7) Not within our clinic, but there are more time available for doing that later in the health care chain (BPRA 5)
		Interventions according to workload	Unfortunately, the lack of resources makes intensive treatment not available, but [I] aim to provide it when possible. (BPRA 5) It is offered when time allows or when there is a need for it. (BPRA 6)
		Restricted possibility to follow guidelines	Treatment of language impairment does not however meet the requirements of the National Board of Health and Welfare in terms of intensity. (BPRA 5a) The resources that are required to meet the recommendations are lacking. (BPRA all)
		Reduced implementation of new knowledge	One of my colleagues has received the required training but has not been able to apply it in clinical practice due to lack of resources. (BPRA 6) The knowledge exists but the resources are too scarce to meet the requirements. (BPRA 5d)
		Causes worse rehabilitation outcome	With more resources and more opportunities to meet more persons in the patients’ immediate surroundings, the rehabilitation would become so much better. (BPRA all)
	No SLP at all	Access to SLP, but only as a consultant	We don’t know to what extent we receive referrals from departments where there is no SLP continuously on site. (BPRA all)
		No SLP at important health care units	The patient’s contact with an SLP is ended if the patient is transferred to a municipal care facility. Even patients with a brain tumor, who are attached to the oncology clinic, lack access to an SLP. (BPRA 4) A psychologist makes [the language] assessment when assessing cognition. (BPRA 2)
		No SLP in primary health care or community	There is no time. You wish that there would be an SLP within primary or municipal care who would be able to take over treatment there. (BPRA 7b)
	The priorities and routines of the health care organization	Services only to a specific patient group	The clinic only takes patients with acquired brain injury. (BPRA 5 c)
		Type of SLP services is decided by the organization	I work only with intensive treatment in private practice. (BPRA 5)
		The health care program decides duration of services and thereby the SLP services that can be delivered	With the reduced time in inpatient care it is difficult to find the time to do more than a screening. (BPRA 2)
		Organizational decisions restrict certain kinds of services	The way we do treatment is guided by organisational restrictions. (BPRA 5)
Aspects related to the workplace	Access to information- and assessment materials	Necessary information- and assessment materials are lacking	Difficult sometimes with relevant material due to the fact that there is not so much material available. (BPRA 8) There is no national evidence-based screening test. (BPRA 1)
		Existing materials need to be improved or updated	The printed information that should be easy to read is not very easy to read. (BPRA 10)
	Coordination with other professions		The patients may become too tired and are required elsewhere for assessments and other treatments while they are inpatients. (BPRA 5).
Aspects related to the SLPs	Attitudes and opinions of the SLP		Unnecessarily resource-intensive. (BPRA 1)
	Lack of knowledge		I do not have training in communication partner training. (BPRA all) [It is] somewhat difficult to imagine what cultural adaptation means in concrete terms. (BPRA 8)
Aspects related to the patients or their significant others	Aspects related to the person with aphasia that hampers their engagement in rehabilitation	Limitation of the patient (lack of stamina, motivation, or other disabilities)	Yes, but [I] also take into account the person’s level of insight, cognitive ability and motivation. It can sometimes be about giving indirect treatment in the form of information and advice to relatives or staff. (BPRA 5 c)
		Living a far distance from rehabilitation clinic	But we have problems not only with limited resources but also that patients do not have the strength for intensive therapy or that patients do not have the opportunity to go to the SLP clinic several times a week. (BPRA 5d)
		Foreign mother tongue	There are great difficulties in meeting the needs of multilingual patients for rehabilitation in their mother tongue. (BPRA 8)
		Competing activities	We offer it [treatment], but some say no due to other activities or reduced energy. (BPRA 5)
	Aspects related to significant others that hampers involvement in rehabilitation	Difficult to motivate significant others	We offer both CPT and training for relatives – but have difficulty finding enough interested people. (BPRA 7a)
		Limited possibilities to engage in rehabilitation	To the degree that they themselves want and can attend. (BPRA 7)
		Non-existing, small, or varying informal network	Necessary [to include significant others], but difficult when the patient has a small network or may be completely handed over to personal assistants who tend to be replaced frequently. (BPRA 7)
		Cultural beliefs may hamper “active” rehabilitation	In some cultures “active” rehabilitation is a foreign concept and when they attempt to help the patient as much as possible, s/he instead becomes passive. Sometimes it can also be believed to be “God’s will” or you expect a medicine that cures. (BPRA 8)
Aspects related to other professionals	Lack of knowledge about aphasia and communication	Other professions are not educated about aphasia and communication	[I] work in a neuro-care team where the new people in the team have not yet had time to receive education. (BPRA all)
		High staff turnover reduces the knowledge level among health care staff	We have too large a turnover of staff, which lowers the level of knowledge. (BPR 9)
		Dependent on other professions to identify the presence of aphasia	I do not perform screenings. I find out from [other] healthcare professionals if a person has come in with aphasia symptoms. (BPR 1)
	Other professions’ views of SLP services		Whether the patient can communicate or not is often not something that the doctors care about, they discharge patients from the wards, although we often point out that the patient needs more SLP support. (BPR 4)

Johansson, M. B., Carlsson, M., & Sonnander, K. (2011). Working with families of persons with aphasia: A survey of Swedish speech and language pathologists. Disability and Rehabilitation, 33(1), 51–62. https://doi.org/https://doi.org/10.3109/09638288.2010.486465

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