Department of Language and Communication Science, City University of London, London, UK.
Int J Lang Commun Disord. 2023 Nov-Dec;58(6):2077-2102. doi: 10.1111/1460-6984.12918. Epub 2023 Jul 2.
Research evidence suggests aphasia therapy must be delivered at high intensity to effect change. Comprehensive therapy, addressing all domains of the International Classification of Functioning, Disability and Health, is also called for by people with aphasia and their families. However, aphasia therapy is rarely intense or comprehensive. Intensive Comprehensive Aphasia Programmes (ICAPs) were designed to address this challenge, but such programmes are not widely implemented.
This study surveyed the views of UK-based speech and language therapists (SLTs) regarding intensive and comprehensive aphasia therapy. It explored definitions of intensive and comprehensive therapy, patterns of provision, views about candidacy and barriers/facilitators. It also investigated awareness of ICAPs and perceived potential of this service model. Differences across UK regions and workplace settings were explored.
METHODS & PROCEDURES: An e-survey ran for 5 months. Quantitative data were analysed using descriptive and inferential statistics. Qualitative free text comments were analysed using content analysis.
OUTCOMES & RESULTS: Two hundred twenty-seven respondents engaged in the e-survey. Definitions of intensive aphasia therapy did not reach UK clinical guideline/research-level thresholds for most of the sample. Those providing more therapy provided definitions with higher standards of intensity. Mean therapy delivered was 128 min/week. Geographical location and workplace setting influenced the amount of therapy delivered. The most frequently delivered therapy approaches were functional language therapy and impairment-based therapy. Cognitive disability and fatigue were concerns for therapy candidacy. Barriers included lack of resources and low levels of optimism that issues could be solved. 50% of respondents were aware of ICAPs and 15 had been involved in ICAP provision. Only 16.5% felt their service could be reconfigured to deliver an ICAP.
CONCLUSIONS & IMPLICATIONS: This e-survey evidences a mismatch between an SLT's concept of intensity and that espoused by clinical guidelines/research. Geographical variations in intensity are concerning. Although a wide range of therapy approaches are offered, certain aphasia therapies are delivered more frequently. Awareness of ICAPs was relatively high, but few respondents had experience of this model or felt it could be executed in their context. Further initiatives are needed if services are to move from a low-dose or non-comprehensive model of delivery. Such initiatives might include but not be confined to wider uptake of ICAPs. Pragmatic research might also explore which treatments are efficacious with a low-dose model of delivery, given that this model is dominant in the United Kingdom. These clinical and research implications are raised in the discussion.
What is already known on this subject There is a gap between the high intensity of aphasia treatment provided in research versus mainstream clinical settings. A lower standard of 45 min/day set by UK clinical guidelines is also not achieved. Although speech and language therapists (SLTs) provide a wide range of therapies, they typically focus on impairment-based approaches. What this study adds This is the first survey of UK SLTs asking about their concept of intensity in aphasia therapy and what types of aphasia therapy they provide. It explores geographical and workplace variations and barriers and facilitators to aphasia therapy provision. It investigates Intensive Comprehensive Aphasia Programmes (ICAPs) in a UK context. What are the clinical implications of this work? There are barriers to the provision of intensive and comprehensive therapy in the United Kingdom and reservations about the feasibility of ICAPs in a mainstream UK context. However, there are also facilitators to aphasia therapy provision and evidence that a small proportion of UK SLTs are providing intensive/comprehensive aphasia therapy). Dissemination of good practice is necessary and suggestions for increasing intensity of service provision are listed in the discussion.
研究证据表明，失语症治疗必须高强度进行才能产生效果。国际功能、残疾和健康分类所要求的全面治疗，即解决所有领域的问题，也是失语症患者及其家属所呼吁的。然而，失语症治疗很少是高强度或全面的。强化综合失语症计划（ICAP）旨在应对这一挑战，但这种计划并未得到广泛实施。
本研究调查了英国言语治疗师（SLT）对强化和全面失语症治疗的看法。它探讨了强化和全面治疗的定义、提供方式、对候选资格的看法以及障碍/促进因素。它还调查了对 ICAP 的认识和对这种服务模式的潜在认识。还探讨了英国不同地区和工作场所之间的差异。
进行了为期 5 个月的电子调查。使用描述性和推断性统计对定量数据进行了分析。对定性自由文本评论使用内容分析进行了分析。
227 名受访者参与了电子调查。对于大多数样本来说，强化失语症治疗的定义没有达到英国临床指南/研究水平的标准。那些提供更多治疗的人提供的定义标准更高。每周平均提供的治疗时间为 128 分钟。地理位置和工作场所设置影响治疗的提供量。最常提供的治疗方法是功能性语言治疗和基于损伤的治疗。认知障碍和疲劳是候选治疗的关注点。障碍包括缺乏资源和对问题解决能力的低水平乐观。50%的受访者知道 ICAP，15 人参与过 ICAP 的提供。只有 16.5%的人认为他们的服务可以重新配置以提供 ICAP。
本电子调查证明了 SLT 对强度的概念与临床指南/研究所倡导的概念之间存在不匹配。强度方面的地域差异令人担忧。尽管提供了广泛的治疗方法，但某些失语症治疗方法的提供频率更高。对 ICAP 的认识相对较高，但很少有受访者有这种模式的经验，也不认为在他们的环境中可以执行这种模式。如果要将服务从低剂量或非全面的提供模式转变，就需要采取进一步的措施。这些举措可能包括但不限于更广泛地采用 ICAP。鉴于这种模式在英国占主导地位，务实的研究也可以探索哪种治疗方法具有低剂量的疗效。讨论中提出了这些临床和研究意义。
