Marika Schütz: Feasibility of introducing intensive comprehensive rehabilitation of aphasia and apraxia of speech in Swedish healthcare: A multicentre study of clinical practice, stakeholder experience and outcome trends

Abstract

Introduction: Aphasia and apraxia of speech (AOS) are common consequences of stroke that significantly impact communication, social participation, and quality of life. While intensive aphasia rehabilitation has demonstrated efficacy and is recommended in the Swedish stroke guidelines, a gap exists between this evidence and regular clinical practice in Sweden. This study investigates the feasibility of introducing a modified intensive comprehensive aphasia programme (mICAP) into the Swedish healthcare system.

Methods: Speech-language pathologists (SLPs) were recruited across Sweden to deliver the mICAP programme. Current clinical practices were investigated via questionnaire before the trial. SLPs underwent training in ICAP delivery. A pilot randomised controlled trial was conducted, with patients assigned to either immediate or delayed intervention. Feasibility was assessed through recruitment rates, treatment fidelity, data completeness, and stakeholder experiences. Preliminary efficacy was explored using language assessments, functional communication measures, and patient/proxy-reported outcomes. Mixed methods were employed to comprehensively understand patient and SLP experiences.

Results: Current practice before the trial was characterised by low-intensity rehabilitation with significant organisational barriers to delivering high-dose therapy. In the feasibility trial, the MIRAA programme achieved the target treatment intensity. Outcomes were heterogeneous, with no clear group-level effects but strong individual gains for some. Patients reported overwhelming satisfaction, valuing the programme structure and psychosocial benefits. SLPs endorsed the programme but were constrained by systemic barriers, which resulted in a large dropout rate and difficulties to form cohorts. Successful implementation requires system-level changes, including increased SLP staffing, organisational reforms, and a shift towards pre planned comprehensive rehabilitation.

Conclusions: While the MIRAA programme is highly acceptable to patients and SLPs, its implementation is constrained by organisational barriers. Future research should focus on large-scale trials to identify predictors of individual treatment response.