{ "title": "UK aphasia treatment and service provision: consolidated evidence base", "compiled": "2026-10-16", "status": "internal working artefact; not published", "cards": { "L1": "t_5d9a6009", "L2": "t_4db1dbca", "L3": "t_7e7e7ab2", "V1": "t_592b3c4a", "synthesis": "t_8b26e97d" }, "source_count": { "registered_urls": 81, "distinct_works_estimate": 76 }, "sources": [ { "n": 1, "url": "https://www.nice.org.uk/guidance/ng236/chapter/Recommendations", "entered_through": "treatments", "title": "NICE NG236 Stroke rehabilitation in adults - Recommendations" }, { "n": 2, "url": "https://www.strokeguideline.org/chapter/communication-and-language", "entered_through": "treatments", "title": "National Clinical Guideline for Stroke (2023) - communication and language" }, { "n": 3, "url": "https://openaccess.city.ac.uk/id/eprint/35288", "entered_through": "treatments", "title": "ESO Guideline on Aphasia Rehabilitation 2025 (Brady et al.) - City OA full text (PDF at this record)" }, { "n": 4, "url": "https://journals.sagepub.com/doi/10.1177/23969873241311025", "entered_through": "treatments", "title": "Brady et al. 2025: ESO guideline on aphasia rehabilitation (publisher record)" }, { "n": 5, "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000425.pub4/full", "entered_through": "treatments", "title": "Brady et al. 2016 Cochrane review - SLT for aphasia following stroke" }, { "n": 6, "url": "https://pubmed.ncbi.nlm.nih.gov/36223438", "entered_through": "treatments", "title": "Brady et al. 2022 RELEASE IPD network meta-analysis (abstract)" }, { "n": 7, "url": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200096", "entered_through": "treatments", "title": "Palmer, Witts & Chater 2018 - SLT received by community-dwelling stroke survivors with aphasia (UK)" }, { "n": 8, "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/1460-6984.12918", "entered_through": "treatments", "title": "Monnelly et al. 2023 IJLCD - UK SLT survey of intensive/comprehensive aphasia therapy" }, { "n": 9, "url": "https://doi.org/10.1080/09638288.2023.2274877", "entered_through": "treatments", "title": "Monnelly et al. 2024 - systematic review of ICAPs (abstract)" }, { "n": 10, "url": "https://doi.org/10.1044/2025_jslhr-25-00519", "entered_through": "treatments", "title": "Monnelly et al. 2026 - provisional theory of change for ICAPs (abstract)" }, { "n": 11, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11178191", "entered_through": "treatments", "title": "Dipper et al. 2024 - remote LUNA feasibility RCT (PLOS ONE, full text)" }, { "n": 12, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6700375", "entered_through": "treatments", "title": "Palmer et al. 2019 Big CACTUS RCT (Lancet Neurology, full text)" }, { "n": 13, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12615849", "entered_through": "treatments", "title": "Vuong et al. 2025 TeleCHAT feasibility (Clin Rehabil, full text)" }, { "n": 14, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13366443", "entered_through": "treatments", "title": "TeleCHAT training package evaluation (full text)" }, { "n": 15, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13425045", "entered_through": "treatments", "title": "Volkmer et al. 2026 - Better Conversations intensive conversation groups (full text)" }, { "n": 16, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13475093", "entered_through": "treatments", "title": "Talbot et al. 2026 - BCPPA plus telehealth CPT protocol (full text)" }, { "n": 17, "url": "https://www.ucl.ac.uk/brain-sciences/pals/research/language-and-cognition/language-and-cognition-research/better-conversations-lab/better-conversations-research/better-conversations-aphasia-research", "entered_through": "treatments", "title": "UCL Better Conversations with Aphasia - research page" }, { "n": 18, "url": "https://www.ucl.ac.uk/brain-sciences/pals/research/language-and-cognition/language-and-cognition-research/better-conversations-lab/better-conversations-resources-and-downloads/better-conversations-aphasia", "entered_through": "treatments", "title": "UCL Better Conversations with Aphasia - resource/download page" }, { "n": 19, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10507993", "entered_through": "treatments", "title": "Ryan et al. 2023 - Aphasia ASK cluster RCT (full text)" }, { "n": 20, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6502036", "entered_through": "treatments", "title": "ASK fidelity protocol (full text)" }, { "n": 21, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8273536", "entered_through": "treatments", "title": "Hilari et al. 2021 - SUPERB peer-befriending feasibility RCT (full text)" }, { "n": 22, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8330561", "entered_through": "treatments", "title": "Behn et al. 2021 - SUPERB peer-befriending fidelity (full text)" }, { "n": 23, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8941719", "entered_through": "treatments", "title": "Flood et al. 2022 - SUPERB pilot economic evaluation (full text)" }, { "n": 24, "url": "https://doi.org/10.1044/2022_ajslp-22-00248", "entered_through": "treatments", "title": "Raymer & Roitsch 2023 - constraint-induced language therapy SR/MA (abstract)" }, { "n": 25, "url": "https://doi.org/10.1080/10749357.2023.2196765", "entered_through": "treatments", "title": "Pierce et al. 2024 - low-moderate intensity CIAT-Plus and M-MAT (abstract)" }, { "n": 26, "url": "https://doi.org/10.1044/2024_jslhr-24-00304", "entered_through": "treatments", "title": "Schwen Blackett et al. 2025 - semantic vs phonological treatment (abstract)" }, { "n": 27, "url": "https://www.stroke.org.uk/professionals/life-after-stroke-services/communication-support", "entered_through": "treatments", "title": "Stroke Association - Communication Support service" }, { "n": 28, "url": "https://www.stroke.org.uk/northern-ireland/support", "entered_through": "treatments", "title": "Stroke Association - support in Northern Ireland (communication groups, AOL)" }, { "n": 29, "url": "https://www.stroke.org.uk/stroke/effects/aphasia/communication-problems/treatment-tools", "entered_through": "treatments", "title": "Stroke Association - communication treatment and tools" }, { "n": 30, "url": "https://clinicaltrials.gov/study/NCT07386652", "entered_through": "treatments", "title": "NCT07386652 - UK ICAP RCT registry record (UCL/St George's)" }, { "n": 31, "url": "https://www.rcslt.org/wp-content/uploads/media/Project/RCSLT/aphasia-plus-intro.pdf", "entered_through": "treatments", "title": "RCSLT aphasia commissioning and planning resource manual" }, { "n": 32, "url": "https://www.rcslt.org/news/new-national-clinical-guideline-for-stroke", "entered_through": "treatments", "title": "RCSLT - response to new national clinical guideline for stroke" }, { "n": 33, "url": "https://sheffield.ac.uk/media/10435/download?attachment", "entered_through": "treatments", "title": "StepByStep computer therapy manual for the NHS (University of Sheffield)" }, { "n": 34, "url": "https://link.springer.com/article/10.1186/s40814-024-01589-y", "entered_through": "treatments", "title": "StarStep - supported self-management (Living with Aphasia) feasibility protocol" }, { "n": 35, "url": "https://www.tandfonline.com/doi/full/10.1080/02687038.2025.2499521", "entered_through": "treatments", "title": "Aphasia Therapy Finder implementation tool (Aphasiology 2025)" }, { "n": 36, "url": "https://www.hqip.org.uk/wp-content/uploads/2025/11/SSNAP-State-of-the-Nation-2025-FINALv2.pdf", "entered_through": "services", "title": "SSNAP State of the Nation Report 2025" }, { "n": 37, "url": "https://www.stroke.org.uk/about-us/our-policy-positions/ssnap-recalibration-2025", "entered_through": "services", "title": "Stroke Association SSNAP recalibration 2025" }, { "n": 38, "url": "https://www.rcslt.org/speech-and-language-therapy/workforce/vacancy-survey", "entered_through": "services", "title": "RCSLT Vacancy survey 2025" }, { "n": 39, "url": "https://www.sayaphasia.org/about-us", "entered_through": "services", "title": "Say Aphasia: About us (provider site)" }, { "n": 40, "url": "https://www.england.nhs.uk/publication/national-service-model-for-an-integrated-community-stroke-service", "entered_through": "services", "title": "NHS England: National Service Model for an Integrated Community Stroke Service (ICSS)" }, { "n": 41, "url": "https://researchbriefings.files.parliament.uk/documents/CDP-2025-0010/CDP-2025-0010.pdf", "entered_through": "services", "title": "House of Commons Library debate pack CDP-2025-0010 (SLT waiting lists, Jan 2025)" }, { "n": 42, "url": "https://www.stroke.org.uk/10-year-plan-response", "entered_through": "services", "title": "Stroke Association: response to the 10 Year Health Plan (2025)" }, { "n": 43, "url": "https://www.stroke.org.uk/10-Year-Health-Plan-accessible", "entered_through": "services", "title": "Stroke Association: 10 Year Health Plan, accessible summary" }, { "n": 44, "url": "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-466-SSNAP-Therapy-spotlight-report.pdf", "entered_through": "services", "title": "SSNAP Spotlight Report: Stroke Rehabilitation (therapy intensity by discipline)" }, { "n": 45, "url": "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-296-SSNAP-2021-Post-acute-Organisational-Audit-National-Report-Final.pdf", "entered_through": "services", "title": "SSNAP Post-acute Organisational Audit 2021, national report" }, { "n": 46, "url": "https://aphasiaalliance.org/members", "entered_through": "services", "title": "Aphasia Alliance: member organisations list" }, { "n": 47, "url": "https://www.england.nhs.uk/ourwork/clinical-policy/stroke", "entered_through": "services", "title": "NHS England: National Stroke Programme" }, { "n": 48, "url": "https://asltip.com/faqs", "entered_through": "services", "title": "ASLTIP: FAQs on independent speech and language therapy and fees" }, { "n": 49, "url": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0354353", "entered_through": "services", "title": "PLoS ONE: ethnicity and six-month review after stroke (SSNAP-linked analysis)" }, { "n": 50, "url": "https://openaccess.city.ac.uk/id/eprint/31858/10/Intl%20J%20Lang%20%20%20Comm%20Disor%20-%202023%20-%20Hilari%20-%20Telehealth%20practice%20in%20aphasia%20%20A%20survey%20of%20UK%20speech%20and%20language%20therapists_.pdf", "entered_through": "services", "title": "Hilari et al.: Telehealth practice in aphasia, a survey of UK SLTs" }, { "n": 51, "url": "https://dyscover.org.uk/support-groups", "entered_through": "services", "title": "Dyscover: support groups and services (Surrey)" }, { "n": 52, "url": "https://aphasiareconnect.org", "entered_through": "services", "title": "Aphasia Re-Connect (provider site)" }, { "n": 53, "url": "https://bmjopen.bmj.com/content/8/12/e023676", "entered_through": "services", "title": "BMJ Open (2018): ethnography of how SSNAP therapy intensity is audited" }, { "n": 54, "url": "https://spiral.imperial.ac.uk/server/api/core/bitstreams/3d12ce7a-e620-470c-a2b9-7180eaa3323e/content", "entered_through": "services", "title": "Imperial College: predictors of therapy amount after stroke" }, { "n": 55, "url": "https://www.nice.org.uk/guidance/ng236", "entered_through": "services", "title": "NICE NG236: Stroke rehabilitation in adults (guideline)" }, { "n": 56, "url": "https://www.stroke.org.uk/about-us/annual-report", "entered_through": "services", "title": "Stroke Association: Annual Report 2024-25" }, { "n": 57, "url": "https://register-of-charities.charitycommission.gov.uk/en/charity-search/-/charity-details/5089928", "entered_through": "services", "title": "Charity Commission register: Say Aphasia (CIO 1169933)" }, { "n": 58, "url": "https://www.chss.org.uk/wp-content/uploads/F011-Coms-NLHL-1in5-Aphasia-Report-v11.pdf", "entered_through": "services", "title": "Chest Heart & Stroke Scotland: 1 in 5 Aphasia report (Scotland survey, 2023)" }, { "n": 59, "url": "https://openaccess.city.ac.uk/id/eprint/14907/11/FURTHER%20REVISED%20SLT%20on-line%20survey%20paper%20AS%20RESUBMITTED.pdf", "entered_through": "services", "title": "Northcott et al.: UK SLT survey on psychosocial wellbeing in aphasia" }, { "n": 60, "url": "https://www.tandfonline.com/doi/full/10.1080/09638288.2021.1964626", "entered_through": "services", "title": "ICAP TIDieR scoping review (Disability and Rehabilitation); metadata only" }, { "n": 61, "url": "https://www.rcslt.org/news/vacancy-rates-in-speech-and-language-therapy-remain-troublingly-high-at-21", "entered_through": "services", "title": "RCSLT: vacancy rates remain troublingly high at 21 per cent (earlier survey wave)" }, { "n": 62, "url": "https://pubmed.ncbi.nlm.nih.gov/25889199", "entered_through": "barriers", "title": "Powell et al. 2015 ERIC refined compilation" }, { "n": 63, "url": "https://link.springer.com/content/pdf/10.1186/s13012-015-0295-0", "entered_through": "barriers", "title": "Waltz et al. 2015 ERIC concept mapping" }, { "n": 64, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10721253", "entered_through": "barriers", "title": "Douglas et al. 2022 Implementation Science in CSD scoping review" }, { "n": 65, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7447562", "entered_through": "barriers", "title": "Scobbie et al. 2020 G-AP deal breakers" }, { "n": 66, "url": "https://ora.ox.ac.uk/objects/uuid:de261fc2-8c2e-48da-9876-1c62fb499ead/files/rw6634564f", "entered_through": "barriers", "title": "Yu et al. 2025 mHealth stroke CFIR-ERIC scoping review" }, { "n": 67, "url": "https://pubmed.ncbi.nlm.nih.gov/36417196", "entered_through": "barriers", "title": "Shrubsole Power Halle 2023 CPT barriers systematic review" }, { "n": 68, "url": "https://www.rcslt.org/wp-content/uploads/2025/07/A-profession-under-pressure-SLT-retention-and-waiting-times.pdf", "entered_through": "barriers", "title": "RCSLT A profession under pressure 2025" }, { "n": 69, "url": "https://link.springer.com/article/10.1186/s13012-026-01490-7", "entered_through": "barriers", "title": "Meng et al. 2026 CFIR-ERIC matching tool scoping review" }, { "n": 70, "url": "https://www.hqip.org.uk/wp-content/uploads/2021/12/Ref.-296-SSNAP-2021-Post-acute-Organisational-Audit-National-Report-Final.pdf", "entered_through": "barriers", "title": "SSNAP Post-acute Organisational Audit 2021" }, { "n": 71, "url": "https://journals.sagepub.com/doi/10.1177/0269215519847253", "entered_through": "barriers", "title": "Bird et al. 2019 Moving stroke rehabilitation evidence into practice" }, { "n": 72, "url": "https://pubmed.ncbi.nlm.nih.gov/27917691", "entered_through": "barriers", "title": "Wielaert et al. 2018 ImPACT multifaceted implementation CPT" }, { "n": 73, "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/1460-6984.12918", "entered_through": "barriers", "title": "Monnelly et al. 2023 UK SLT intensive comprehensive aphasia survey" }, { "n": 74, "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8095062", "entered_through": "barriers", "title": "Cahill et al. 2020 Cochrane implementation interventions stroke rehab" }, { "n": 75, "url": "https://www.cfirguide.org/choosing-strategies", "entered_through": "barriers", "title": "CFIR-ERIC Matching Tool cfirguide" }, { "n": 76, "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000259.pub3/full", "entered_through": "barriers", "title": "Ivers et al. 2012 Cochrane audit and feedback" }, { "n": 77, "url": "https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12996", "entered_through": "barriers", "title": "UK SLT telehealth practice in aphasia survey" }, { "n": 78, "url": "https://doi.org/10.1186/s13012-019-0892-4", "entered_through": "barriers", "title": "Waltz et al. 2019 CFIR-ERIC matching" }, { "n": 79, "url": "https://doi.org/10.1186/s43058-026-00901-6", "entered_through": "barriers", "title": "Nilsen 2026 Rethinking barriers and facilitators" }, { "n": 80, "url": "https://cfirguide.org/constructs", "entered_through": "verification", "title": "CFIR: construct list (cfirguide.org)" }, { "n": 81, "url": "https://kclpure.kcl.ac.uk/ws/files/194935792/Appendix_2_ERIC_Implementation_strategies.docx", "entered_through": "verification", "title": "ERIC implementation strategies appendix (the published 73-strategy set)" } ], "sources_crosswalk": { "treatments": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 ], "services": [ 36, 37, 38, 2, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 ], "barriers": [ 62, 63, 64, 65, 66, 67, 38, 68, 69, 70, 42, 71, 72, 7, 73, 74, 75, 76, 58, 77, 78, 79, 59 ], "verification": [ 36, 38, 7, 12, 11, 23, 19, 45, 41, 58, 49, 21, 15, 13, 16, 30, 5, 8, 1, 80, 22, 81, 56, 57, 39 ] }, "labels_preserved": [ "documented", "inferred", "validated_uk", "validated_other", "mapped_only", "untested", "[UNVERIFIED]", "metadata-only", "abstract-only", "full text", "charity self-report" ], "verification": { "card": "t_592b3c4a", "verification_date": "2026-10-16", "note": "Every KILLED or CORRECTED item from verification_log.md, with the replacement figure and the source that carries it. Verdicts are CONFIRMED / CORRECTED / KILLED / UNVERIFIABLE; only CORRECTED and KILLED appear here.", "killed": [ { "id": "V1", "claim": "Palmer et al. (2018) surveyed 114 community-dwelling stroke survivors with aphasia.", "where": "vault page synthesis-aphasia-therapy-evidence (carried into L1 as a flagged source anomaly)", "verdict": "KILLED", "reason": "The published paper reports 278 patients, not 114. No subset denominator of 114 is stated in the paper; the 114 appears to be a vault transcription error.", "replacement": "278 patients in 21 UK speech and language therapy departments, 2014-2016.", "source": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200096", "quote": "This paper revisits provision based on what was received by 278 patients in 21 UK speech and language therapy departments in 2014-2016." } ], "corrected": [ { "id": "V2", "claim": "Recommended SLT establishment in community teams: 0.4 WTE per unit.", "where": "L2 services_table.json, Community Rehabilitation Team / ICSS community therapy row", "verdict": "CORRECTED", "reason": "Unit wrong. The audit reports 0.4 WTE per 100 patients, not per service unit.", "replacement": "0.4 WTE per 100 patients (national median for community-based multidisciplinary teams).", "source": "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-296-SSNAP-2021-Post-acute-Organisational-Audit-National-Report-Final.pdf", "quote": "Speech and language therapist | 0.4 | 46.6% (41) | 29.1% (25) | 33.8% (24) | 0.45 | 0.3-0.7 (Table 3.3: Staffing levels: whole time equivalent of staff per 100 patients)" }, { "id": "V3", "claim": "BCPPA plus is delivered by a highly specialist HCPC-registered SLT (over 80%) or a trained assistant under supervision.", "where": "L1 treatments_table.json, BCPPA plus provider / TIDieR 'who provided' cell", "verdict": "CORRECTED", "reason": "The protocol's second deliverer is a local collaborator SLT, not a trained assistant. The 'trained assistant' wording is an inference the source does not support.", "replacement": "Delivered by a research assistant who is a highly specialist HCPC-registered SLT (majority, over 80% of delivery) or by a local collaborator SLT, under supervision from the chief investigator.", "source": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13475093", "quote": "An RA: a highly specialist, Health and Care Professions Council (HCPC)-registered SLT ...; the majority (over 80%) of the intervention will be delivered by the RA, or" }, { "id": "V4", "claim": "64 barriers stated in the vault's CFIR 2.0 vocabulary.", "where": "L3 t_7e7e7ab2 completion metadata and cfir_eric_map.csv construct column", "verdict": "CORRECTED", "reason": "The construct vocabulary is a CFIR 1.0 / CFIR 2.0 hybrid with non-CFIR (COM-B and TDF) labels, not uniformly CFIR 2.0. About 32 of the 64 rows use a construct label that is not a CFIR 2.0 construct name (for example 'Implementation Climate', 'Readiness for Implementation', 'Networks and Communications', 'Policy and Incentives', 'Patient Needs and Resources', 'Evidence Strength and Quality', 'Design Quality and Packaging', 'Executing', 'Knowledge and Beliefs', 'Self-efficacy and Confidence', 'Personal Attributes'), and some rows use invented COM-B hybrids not present in any CFIR version ('Deliverers: Capability (COM-B) / Knowledge', 'Deliverers: Capability / Skills', 'Recipients: Opportunity (COM-B)'). The underlying barriers are real and the ERIC side is clean; the defect is the labelling claim.", "replacement": "The map mixes CFIR 1.0 construct names, CFIR 2.0 construct names and non-CFIR (COM-B/TDF) labels. It should be described as a CFIR 1.0/2.0 hybrid vocabulary, not 'CFIR 2.0 vocabulary'. CFIR 2.0 renames the 1.0 constructs (Intervention Characteristics -> Innovation; Knowledge and Beliefs -> Capability; and so on).", "source": "https://cfirguide.org/constructs", "quote": "Updated CFIR Constructs ... A. Innovation Source ... B. Innovation Evidence-Base ... C. Innovation Relative Advantage ... (and the vault's own concept-cfir page carries the 1.0->2.0 rename table)" } ] }, "corrections_applied": [ { "id": "V3", "field": "treatments[BCPPA plus (Better Conversations with Primary Progressive Aphasia and other rare dementias), telehealth].provider and tidier.5_who_provided", "was": "or a trained assistant under supervision", "now": "or by a local collaborator SLT, under supervision", "source": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13475093" }, { "id": "V2", "field": "services[Community Rehabilitation Team / ICSS community therapy].figure_facts", "was": "0.4 WTE per unit", "now": "0.4 WTE per 100 patients", "source": "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-296-SSNAP-2021-Post-acute-Organisational-Audit-National-Report-Final.pdf" }, { "id": "V2", "field": "provision_gaps[BP5].evidence", "was": "0.4 WTE per unit", "now": "0.4 WTE per 100 patients", "source": "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-296-SSNAP-2021-Post-acute-Organisational-Audit-National-Report-Final.pdf" }, { "id": "V1", "field": "vault Palmer 2018 sample size", "was": "n=114", "now": "n=278 in 21 UK SLT departments, 2014 to 2016", "source": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200096" }, { "id": "V4", "field": "barrier map construct vocabulary claim", "was": "64 barriers stated in the vault's CFIR 2.0 vocabulary", "now": "CFIR 1.0/2.0 hybrid vocabulary with non-CFIR COM-B labels in about 32 of 64 rows", "source": "https://cfirguide.org/constructs" } ], "treatments": [ { "name": "Impairment-focused SLT: semantic therapy", "provider": "Qualified speech and language therapist (SLT); assistants for practice", "provider_type": "SLT", "format": "One-to-one, face-to-face (predominant); group possible", "setting": "NHS inpatient and community settings; own home", "dose_reported": "No dose for a named protocol; delivered within UK provision mean 128 min/week", "duration": "Not specified for a named package", "evidence_standing": "Supported by NICE NG236 and National Stroke Guideline for individualised impairment therapy; comparative semantic-vs-phonological evidence mixed (abstract only)", "uk_delivery_evidence": "Delivered by 70% of surveyed UK SLTs as impairment-based therapy [8]; routine dose low [7][8]", "tidier": { "1_brief_name": { "answer": "Semantic therapy (e.g. semantic feature analysis) for word retrieval in aphasia", "source": "[26]", "reported": true }, "2_why_rationale": { "answer": "Targets impaired semantic processing to improve word retrieval; rationale stated in treatment-comparison literature", "source": "[26]", "reported": "Partial" }, "3_what_materials": { "answer": "Not reported", "source": "[26]", "reported": false }, "4_what_procedures": { "answer": "Semantic tasks targeting word meaning; specific procedures not retrievable from abstract only", "source": "[26]", "reported": "Partial" }, "5_who_provided": { "answer": "Speech and language therapist", "source": "[26]", "reported": "Partial" }, "6_how_mode": { "answer": "Not reported", "source": "", "reported": false }, "7_where_setting": { "answer": "Not reported", "source": "", "reported": false }, "8_when_how_much": { "answer": "Three weeks of semantic treatment in the comparison trial (63 participants with chronic aphasia)", "source": "[26]", "reported": true }, "9_tailoring": { "answer": "Not reported", "source": "", "reported": false }, "10_modifications": { "answer": "Not reported", "source": "", "reported": false }, "11_how_well_planned": { "answer": "Not reported", "source": "", "reported": false }, "12_how_well_actual": { "answer": "Not reported", "source": "", "reported": false } }, "sources": [ "https://doi.org/10.1044/2024_jslhr-24-00304", "https://onlinelibrary.wiley.com/doi/full/10.1111/1460-6984.12918", "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200096", "https://www.nice.org.uk/guidance/ng236/chapter/Recommendations" ] }, { "name": "Impairment-focused SLT: phonological therapy", "provider": "Qualified speech and language therapist", "provider_type": "SLT", "format": "One-to-one, face-to-face", "setting": "NHS settings (not specified in retrieved source)", "dose_reported": "No dose for a named protocol", "duration": "Not specified for a named package", "evidence_standing": "Supported in guidance for individualised impairment therapy; head-to-head evidence limited (Cochrane)", "uk_delivery_evidence": "Within impairment-based therapy delivered by 70% of surveyed UK SLTs [8]", "tidier": { "1_brief_name": { "answer": "Phonological therapy (e.g. phonological components analysis) for word retrieval", "source": "[26]", "reported": true }, "2_why_rationale": { "answer": "Targets phonological processing to support word retrieval", "source": "[26]", "reported": "Partial" }, "3_what_materials": { "answer": "Not reported", "source": "", "reported": false }, "4_what_procedures": { "answer": "Phonological tasks; procedures not retrievable from abstract only", "source": "[26]", "reported": "Partial" }, "5_who_provided": { "answer": "Speech and language therapist", "source": "[26]", "reported": "Partial" }, "6_how_mode": { "answer": "Not reported", "source": "", "reported": false }, "7_where_setting": { "answer": "Not reported", "source": "", "reported": false }, "8_when_how_much": { "answer": "Three weeks of phonological treatment in the comparison trial", "source": "[26]", "reported": true }, "9_tailoring": { "answer": "Not reported", "source": "", "reported": false }, "10_modifications": { "answer": "Not reported", "source": "", "reported": false }, "11_how_well_planned": { "answer": "Not reported", "source": "", "reported": false }, "12_how_well_actual": { "answer": "Not reported", "source": "", "reported": false } }, "sources": [ "https://doi.org/10.1044/2024_jslhr-24-00304", "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000425.pub4/full" ] }, { "name": "Constraint-Induced Language Therapy (CILT / CIAT-Plus / ILAT)", "provider": "Speech and language therapist (group delivery)", "provider_type": "SLT", "format": "Small group (2-3 participants); barriers to block non-verbal communication; some variants one-to-one/shaping", "setting": "Not reported in Cochrane description; COMPARE variants delivered in clinical research settings", "dose_reported": "Yes: classic about 30 h over 2 weeks; COMPARE 15 h/week for 2 weeks; low-moderate variant 6 h/week for 5 weeks", "duration": "2 weeks (classic/COMPARE); 5 weeks (low-moderate)", "evidence_standing": "Contested: SRs positive descriptively, but meta-analyses show CILT often not superior to comparison treatments; intensity may be the active factor", "uk_delivery_evidence": "No national UK rollout found; UK doctoral feasibility study recommended further NHS research but called evidence still weak", "tidier": { "1_brief_name": { "answer": "Constraint-Induced Language Therapy (CILT); Constraint-Induced Aphasia Therapy (CIAT)/Plus; Intensive Language Action Therapy (ILAT)", "source": "[5][25][33]", "reported": true }, "2_why_rationale": { "answer": "Enhance rehabilitation via brain plasticity, adopting the model from motor rehabilitation; forced verbal use to counter learned non-use", "source": "[5][33]", "reported": true }, "3_what_materials": { "answer": "32 cards with 16 pictures x 2; barriers preventing participants seeing others' cards", "source": "[5]", "reported": true }, "4_what_procedures": { "answer": "Small groups (2-3) using barrier therapeutic games; all communication verbal; pointing or gestures not permitted; constraint introduced by materials, verbal instructions, shaping and reinforcement contingencies", "source": "[5]", "reported": true }, "5_who_provided": { "answer": "Speech and language therapist", "source": "[5]", "reported": true }, "6_how_mode": { "answer": "Group, face-to-face", "source": "[5]", "reported": true }, "7_where_setting": { "answer": "Not reported (Cochrane description)", "source": "[5]", "reported": false }, "8_when_how_much": { "answer": "About 30 h over 2 weeks (classic); COMPARE 15 h/week x 2 weeks; low-moderate 6 h/week x 5 weeks", "source": "[5][25][33]", "reported": true }, "9_tailoring": { "answer": "Not reported", "source": "", "reported": false }, "10_modifications": { "answer": "COMPARE low-moderate intensity was itself a deliberate modification of dose schedule (same dose, lower intensity)", "source": "[25]", "reported": true }, "11_how_well_planned": { "answer": "Not reported", "source": "", "reported": false }, "12_how_well_actual": { "answer": "Not reported", "source": "", "reported": false } }, "sources": [ "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000425.pub4/full", "https://doi.org/10.1044/2022_ajslp-22-00248", "https://doi.org/10.1080/10749357.2023.2196765", "https://sheffield.ac.uk/media/10435/download?attachment" ] }, { "name": "Intensive Comprehensive Aphasia Programme (ICAP), generic model", "provider": "Interdisciplinary team (SLTs, clinical psychologists, occupational therapists and others)", "provider_type": "Multidisciplinary team", "format": "Mixed: one-to-one and group; impairment, activity, participation and psychosocial components; family involvement", "setting": "Not standardised; content varies between programmes", "dose_reported": "Varies between programmes; commonly 3-5 h/day over 2-6 weeks; guidelines specify >=20 h total", "duration": "2-6 weeks (composite); delivers vary", "evidence_standing": "Weaker gold-standard RCT evidence than impairment-focused intensive therapy; first UK RCT (NCT07386652) not yet recruiting, primary completion 2030", "uk_delivery_evidence": "Not commissioned routinely; 50% of SLTs aware, 15 involved, 16.5% felt their service could deliver one [8]", "tidier": { "1_brief_name": { "answer": "Intensive Comprehensive Aphasia Programme (ICAP)", "source": "[9][10]", "reported": true }, "2_why_rationale": { "answer": "Address the comprehensive range of needs from language impairment and its consequences, per ICF; theory of change coconstructed with people with aphasia", "source": "[10]", "reported": true }, "3_what_materials": { "answer": "Not standardised; content and materials vary between ICAPs", "source": "[9]", "reported": "Partial" }, "4_what_procedures": { "answer": "Multiple intervention approaches across ICF domains in multiple formats, with education and family involvement", "source": "[9][10]", "reported": "Partial" }, "5_who_provided": { "answer": "Interdisciplinary team", "source": "[9]", "reported": true }, "6_how_mode": { "answer": "Multiple formats (individual and group)", "source": "[9]", "reported": true }, "7_where_setting": { "answer": "Varies (research clinic or healthcare setting); no standard", "source": "[9]", "reported": "Partial" }, "8_when_how_much": { "answer": "Commonly 3-5 h/day over 2-6 weeks; ESO specifies >=20 h total, >=3 h/week, >=4 days/week", "source": "[3][9]", "reported": true }, "9_tailoring": { "answer": "Individualised goals; ESO recommends tailoring by functional relevance and task difficulty", "source": "[3][9]", "reported": true }, "10_modifications": { "answer": "Not reported as a standard", "source": "", "reported": false }, "11_how_well_planned": { "answer": "Not standardised across programmes", "source": "", "reported": false }, "12_how_well_actual": { "answer": "Not standardised; only 8 of 21 studies had a design suitable for synthesis", "source": "[9]", "reported": "Partial" } }, "sources": [ "https://doi.org/10.1080/09638288.2023.2274877", "https://doi.org/10.1044/2025_jslhr-25-00519", "https://openaccess.city.ac.uk/id/eprint/35288/1/brady-et-al-2025-european-stroke-organisation-(eso)-guideline-on-aphasia-rehabilitation.pdf", "https://clinicaltrials.gov/study/NCT07386652" ] }, { "name": "Remote LUNA (Language Underpins Narrative in Aphasia) discourse therapy", "provider": "Speech and language therapist (remote)", "provider_type": "SLT", "format": "One-to-one, remote via videoconferencing (Zoom)", "setting": "Participant's own home (remote)", "dose_reported": "Yes: 20 h total, 2 sessions/week of 60 min, over 10 weeks", "duration": "10 weeks plus a 1-hour set-up week", "evidence_standing": "Phase II feasibility RCT: all progression criteria met; preliminary efficacy medium-large effect sizes; UK", "uk_delivery_evidence": "UK (London/City) trial; LUNA NIHR PDG adapting it for NHS implementation (vault)", "tidier": { "1_brief_name": { "answer": "LUNA (Language Underpins Narrative in Aphasia), remote delivery", "source": "[11]", "reported": true }, "2_why_rationale": { "answer": "Multi-level discourse treatment targeting words, sentences and discourse macrostructure in personal narratives; addresses discourse, which people with aphasia prioritise", "source": "[11]", "reported": true }, "3_what_materials": { "answer": "Manualised, theory-based, codesigned treatment; each participant's chosen narrative transcribed, analysed and deconstructed to identify targets before session 1", "source": "[11]", "reported": true }, "4_what_procedures": { "answer": "Word, utterance and discourse-macrostructure level activities applied to personal storytelling", "source": "[11]", "reported": true }, "5_who_provided": { "answer": "Speech and language therapist", "source": "[11]", "reported": "Partial" }, "6_how_mode": { "answer": "One-to-one, remote via Zoom", "source": "[11]", "reported": true }, "7_where_setting": { "answer": "Participant's home (remote delivery)", "source": "[11]", "reported": true }, "8_when_how_much": { "answer": "20 h: 2 sessions/week of 60 min for 10 weeks", "source": "[11]", "reported": true }, "9_tailoring": { "answer": "Personalised: participant chooses the narrative and goals; narrative deconstructed to set targets", "source": "[11]", "reported": true }, "10_modifications": { "answer": "Adapted for remote delivery (COVID-19 context)", "source": "[11]", "reported": true }, "11_how_well_planned": { "answer": "Fidelity assessed; 92% adherence to manual", "source": "[11]", "reported": true }, "12_how_well_actual": { "answer": "87% of sessions delivered as scheduled; 79% completed >=80% of programme; fidelity 92%", "source": "[11]", "reported": true } }, "sources": [ "https://pmc.ncbi.nlm.nih.gov/articles/PMC11178191/" ] }, { "name": "Better Conversations with Aphasia (BCA) communication partner training", "provider": "Speech and language therapist (dyadic: person with aphasia + key partner)", "provider_type": "SLT", "format": "One-to-one dyadic sessions; video feedback; free online e-learning resource for SLTs", "setting": "Not specified in retrieved sources (clinical/community)", "dose_reported": "Yes: 8 x 1-hour sessions, once weekly", "duration": "8 weeks", "evidence_standing": "UK conversation-analysis-based CPT; original 8-dyad study showed facilitator increase for 3 dyads and barrier decrease for 5; free resource widely available", "uk_delivery_evidence": "Most commonly completed CPT programme among APT WP1 survey respondents (vault); UCL free resource [17][18]", "tidier": { "1_brief_name": { "answer": "Better Conversations with Aphasia (BCA)", "source": "[15][17][18]", "reported": true }, "2_why_rationale": { "answer": "Train conversation skills directly and help partners use strategies, so dyads have more complex and enjoyable conversations; underpinned by conversation analysis", "source": "[17]", "reported": true }, "3_what_materials": { "answer": "Free UCL resource: 8 lessons in 3 modules with printable session plans and dyad handouts; SLT e-learning materials", "source": "[18]", "reported": true }, "4_what_procedures": { "answer": "Dyad identifies barriers and facilitators to their own conversation using video feedback, then chooses and practises strategies; outcome from videos of everyday conversations", "source": "[17]", "reported": true }, "5_who_provided": { "answer": "Speech and language therapist (programme delivered to the dyad)", "source": "[17]", "reported": "Partial" }, "6_how_mode": { "answer": "Dyadic one-to-one sessions with video feedback", "source": "[17]", "reported": true }, "7_where_setting": { "answer": "Not reported", "source": "", "reported": false }, "8_when_how_much": { "answer": "8 x 1-hour sessions, once weekly", "source": "[15]", "reported": true }, "9_tailoring": { "answer": "Individualised goal setting within the dyad; strategies chosen by the dyad", "source": "[17]", "reported": true }, "10_modifications": { "answer": "Not reported", "source": "", "reported": false }, "11_how_well_planned": { "answer": "Not reported", "source": "", "reported": false }, "12_how_well_actual": { "answer": "Not reported", "source": "", "reported": false } }, "sources": [ "https://www.ucl.ac.uk/brain-sciences/pals/research/language-and-cognition/language-and-cognition-research/better-conversations-lab/better-conversations-research/better-conversations-aphasia-research", "https://www.ucl.ac.uk/brain-sciences/pals/research/language-and-cognition/language-and-cognition-research/better-conversations-lab/better-conversations-resources-and-downloads/better-conversations-aphasia", "https://pmc.ncbi.nlm.nih.gov/articles/PMC13425045/" ] }, { "name": "Better Conversations intensive conversation groups (non-progressive aphasia and PPA)", "provider": "Qualified SLTs, student SLTs and an artist-researcher", "provider_type": "SLT-led, mixed skills team", "format": "Group of 4-5 family dyads; 4 days face-to-face plus 4 days remote (Zoom)", "setting": "University clinic (service improvement project)", "dose_reported": "Yes: 26 h total, 2.5-3 h/day, 4 days/week over 2 weeks", "duration": "2 weeks (plus pre-assessment to 3-month follow-up = 15 weeks participation)", "evidence_standing": "Service improvement project; acceptable, goal attainment and increased confidence reported; PPA participants found it too intensive; no control group", "uk_delivery_evidence": "UK (UCL) university-clinic delivery; not routine NHS provision", "tidier": { "1_brief_name": { "answer": "Better Conversations (BC) intensive conversation group for family dyads", "source": "[15]", "reported": true }, "2_why_rationale": { "answer": "Deliver the high dose needed for effective intervention through an intensive group format; BC informed by conversation analysis and behaviour change theory", "source": "[15]", "reported": true }, "3_what_materials": { "answer": "Not reported explicitly (design by A.V. and S.B. with PPI advisor input)", "source": "[15]", "reported": "Partial" }, "4_what_procedures": { "answer": "Understanding how conversation works; identifying dyad facilitators and barriers using video feedback; practising strategies in the group and across dyads; psychological support", "source": "[15]", "reported": true }, "5_who_provided": { "answer": "Two student SLTs, four qualified SLTs, one artist-researcher", "source": "[15]", "reported": true }, "6_how_mode": { "answer": "Group; 4 days face-to-face and 4 days remote synchronous (Zoom)", "source": "[15]", "reported": true }, "7_where_setting": { "answer": "University clinic", "source": "[15]", "reported": true }, "8_when_how_much": { "answer": "26 h total; 2.5-3 h/day, 4 days/week over 2 weeks", "source": "[15]", "reported": true }, "9_tailoring": { "answer": "Separate programmes for non-progressive aphasia and PPA; individualised goal setting", "source": "[15]", "reported": true }, "10_modifications": { "answer": "Dosage was variably tolerated; PPA group found it too long/intensive; format adaptation implied but not stated as protocol change", "source": "[15]", "reported": "Partial" }, "11_how_well_planned": { "answer": "Not reported", "source": "", "reported": false }, "12_how_well_actual": { "answer": "Not reported", "source": "", "reported": false } }, "sources": [ "https://pmc.ncbi.nlm.nih.gov/articles/PMC13425045/" ] }, { "name": "BCPPA plus (Better Conversations with Primary Progressive Aphasia and other rare dementias), telehealth", "provider": "Delivered by a research assistant who is a highly specialist HCPC-registered SLT (over 80% of delivery) or by a local collaborator SLT, under supervision from the chief investigator.", "provider_type": "SLT (research SLT or local collaborator SLT)", "format": "Dyadic sessions; telehealth; video feedback; video-recorded natural conversation", "setting": "NHS sites; delivered remotely (telehealth)", "dose_reported": "Yes: 4-6 x 1-hour sessions, session number jointly decided", "duration": "4-6 weeks", "evidence_standing": "Protocol/feasibility study of a UK NHS-embedded deferred-entry randomised design; prior BCPPA delivered 4 x 1 h face-to-face", "uk_delivery_evidence": "UK (UCL and NHS sites); the only intervention found that explicitly covers PPA", "tidier": { "1_brief_name": { "answer": "BCPPA plus: Better Conversations with PPA and other rare dementias, telehealth", "source": "[16]", "reported": true }, "2_why_rationale": { "answer": "Support people with PPA/rare dementia and their key partners with individualised conversation strategies; extends BC to PPA and rare dementias", "source": "[16]", "reported": true }, "3_what_materials": { "answer": "TiDIER description in online supplemental appendix; video-recorded natural conversation; video clips for feedback", "source": "[16]", "reported": true }, "4_what_procedures": { "answer": "SLT video-records a conversation; four intervention sessions covering how conversation works, dyad reflection, viewing 2-3 clips, video feedback, and strategy practice", "source": "[16]", "reported": true }, "5_who_provided": { "answer": "Delivered by a research assistant who is a highly specialist HCPC-registered SLT (over 80% of delivery) or by a local collaborator SLT, under supervision from the chief investigator.", "source": "[16]", "reported": true }, "6_how_mode": { "answer": "Dyadic; telehealth", "source": "[16]", "reported": true }, "7_where_setting": { "answer": "NHS sites; remote delivery to participants", "source": "[16]", "reported": true }, "8_when_how_much": { "answer": "4-6 x 1-hour sessions over 4-6 weeks; session number decided by person, partner and SLT", "source": "[16]", "reported": true }, "9_tailoring": { "answer": "Number of sessions jointly decided based on progress; dyad-specific strategies and goals", "source": "[16]", "reported": true }, "10_modifications": { "answer": "Extended from the prior 4-session BCPPA to 4-6 sessions for this study", "source": "[16]", "reported": true }, "11_how_well_planned": { "answer": "Fidelity rating planned (consent to video recording for fidelity rating)", "source": "[16]", "reported": true }, "12_how_well_actual": { "answer": "Not reported (protocol stage)", "source": "", "reported": false } }, "sources": [ "https://pmc.ncbi.nlm.nih.gov/articles/PMC13475093/" ] }, { "name": "Self-managed computerised speech and language therapy (Big CACTUS / StepByStep)", "provider": "Qualified SLT (tailors exercises and sets the plan); volunteers or therapy assistants (regular support visits)", "provider_type": "SLT-led with volunteer/assistant support", "format": "Self-managed computer practice at home; brief professional/volunteer support", "setting": "Participant's own home", "dose_reported": "Yes: 20-30 min of daily practice over 6 months; volunteers/assistants >=1 h per month", "duration": "6 months", "evidence_standing": "UK multicentre RCT (n=278): clinically significant word-finding improvement, no benefit for conversation or quality of life", "uk_delivery_evidence": "Delivered in 21 UK NHS SLT departments; the strongest UK-delivered technology intervention evidence found", "tidier": { "1_brief_name": { "answer": "Self-managed computerised speech and language therapy (CSLT) plus usual care, using StepByStep software", "source": "[12][33]", "reported": true }, "2_why_rationale": { "answer": "Provide more therapy than usual care alone; ongoing face-to-face SLT is costly and unavailable beyond the first months post-stroke", "source": "[12][33]", "reported": true }, "3_what_materials": { "answer": "StepByStep specialist aphasia computer software; exercises tailored to the individual; written therapy manual", "source": "[12][33]", "reported": true }, "4_what_procedures": { "answer": "Component 1 SLT assessment and tailoring of exercises; Component 2 daily independent word-finding practice on the computer; Component 3 volunteer/assistant support to enhance adherence and encourage daily-life use", "source": "[33]", "reported": true }, "5_who_provided": { "answer": "Qualified SLT sets the plan; volunteers or therapy assistants visit to support", "source": "[12][33]", "reported": true }, "6_how_mode": { "answer": "Self-managed computer practice at home, supported by occasional in-person visits", "source": "[12][33]", "reported": true }, "7_where_setting": { "answer": "Participants' own homes", "source": "[12]", "reported": true }, "8_when_how_much": { "answer": "20-30 min practice daily over 6 months; volunteers/assistants visit >=1 h once per month", "source": "[12][33]", "reported": true }, "9_tailoring": { "answer": "Exercises individually tailored by the SLT to the specific language deficit", "source": "[12][33]", "reported": true }, "10_modifications": { "answer": "Not reported", "source": "", "reported": false }, "11_how_well_planned": { "answer": "TIDieR template used to describe the intervention", "source": "[12]", "reported": true }, "12_how_well_actual": { "answer": "Self-managed practice enabled increased therapy amounts; adherence reported as feasible and acceptable", "source": "[12]", "reported": "Partial" } }, "sources": [ "https://pmc.ncbi.nlm.nih.gov/articles/PMC6700375/", "https://sheffield.ac.uk/media/10435/download?attachment" ] }, { "name": "SUPERB peer-befriending", "provider": "Trained peer-befrienders (people at least 1 year post-stroke), trained 4-6 h; regular supervision", "provider_type": "Trained peer/volunteer", "format": "One-to-one home visits", "setting": "Community; participant's home", "dose_reported": "Yes: six 1-hour visits over 3 months, plus two optional transition sessions", "duration": "3 months", "evidence_standing": "UK feasibility RCT; fidelity formally evaluated; pilot economic evaluation ~£57.24/visit, cost-effective in 39-66% of simulations; underpowered with GHQ-12 CI touching the null (vault caveat confirmed)", "uk_delivery_evidence": "UK (City St George's, London), Stroke Association-funded; community peer befriending", "tidier": { "1_brief_name": { "answer": "SUPERB peer-befriending for people with aphasia and their significant others", "source": "[21][22]", "reported": true }, "2_why_rationale": { "answer": "Support wellbeing and reduce isolation after stroke through trained peer support", "source": "[21][22]", "reported": true }, "3_what_materials": { "answer": "Training programme for peer-befrienders; supervision; fidelity checklist", "source": "[22]", "reported": true }, "4_what_procedures": { "answer": "Trained peer-befrienders visit at home to provide befriending; regular supervision; optional transition sessions", "source": "[21]", "reported": true }, "5_who_provided": { "answer": "10 peer-befrienders, >=1 year post-stroke, trained 4-6 h", "source": "[21][22]", "reported": true }, "6_how_mode": { "answer": "One-to-one, in person, at home", "source": "[21]", "reported": true }, "7_where_setting": { "answer": "Community / participant's home", "source": "[21]", "reported": true }, "8_when_how_much": { "answer": "Six 1-hour visits over 3 months, plus two optional sessions", "source": "[21]", "reported": true }, "9_tailoring": { "answer": "Pairings took account of preferences (e.g. interests)", "source": "[21]", "reported": true }, "10_modifications": { "answer": "Not reported", "source": "", "reported": false }, "11_how_well_planned": { "answer": "Fidelity evaluated across all areas of the Behaviour Change Consortium framework", "source": "[22]", "reported": true }, "12_how_well_actual": { "answer": "Fidelity reported; median 14 of 25 group supervision sessions and 7.5 of 8 individual sessions attended", "source": "[22]", "reported": true } }, "sources": [ "https://pmc.ncbi.nlm.nih.gov/articles/PMC8273536/", "https://pmc.ncbi.nlm.nih.gov/articles/PMC8330561/", "https://pmc.ncbi.nlm.nih.gov/articles/PMC8941719/" ] }, { "name": "Aphasia ASK (Aphasia Action Success Knowledge)", "provider": "Trained speech pathologists (each trained to deliver one trial intervention only)", "provider_type": "Speech pathologist (SLT equivalent)", "format": "Manualised individual/family sessions; location convenient to participants", "setting": "Usually hospital or home; community", "dose_reported": "Manualised over 6-8 weeks then monthly telephone calls; minimum intended dose set a priori", "duration": "6-8 weeks plus 12-month follow-up", "evidence_standing": "Australian cluster RCT: NULL for mood; only 41 of 171 who received treatment met minimum dose", "uk_delivery_evidence": "Australian; no UK equivalent found", "tidier": { "1_brief_name": { "answer": "Action Success Knowledge (ASK) mood intervention", "source": "[19][20]", "reported": true }, "2_why_rationale": { "answer": "Prevent depression in people with aphasia and their family members", "source": "[19]", "reported": true }, "3_what_materials": { "answer": "Standardised manual describing each treatment; aphasia-friendly participant information", "source": "[19][20]", "reported": true }, "4_what_procedures": { "answer": "Manualised psychosocial intervention delivered by trained speech pathologists", "source": "[19]", "reported": "Partial" }, "5_who_provided": { "answer": "Speech pathologists trained 5-6 h (in person or online) by trial managers; trained to deliver one intervention only", "source": "[19]", "reported": true }, "6_how_mode": { "answer": "Not fully reported; delivered at a location convenient to participants, usually hospital or home", "source": "[19]", "reported": "Partial" }, "7_where_setting": { "answer": "Usually hospital or home", "source": "[19]", "reported": true }, "8_when_how_much": { "answer": "Manualised over 6-8 weeks followed by monthly telephone calls", "source": "[19]", "reported": true }, "9_tailoring": { "answer": "Tailored intervention programme", "source": "[19]", "reported": "Partial" }, "10_modifications": { "answer": "Not reported", "source": "", "reported": false }, "11_how_well_planned": { "answer": "Fidelity protocol developed; sessions video-recorded and reviewed by a fidelity monitor; dose set a priori", "source": "[19][20]", "reported": true }, "12_how_well_actual": { "answer": "Only 41 of 171 who received treatment met the prescribed minimum dose", "source": "[19]", "reported": true } }, "sources": [ "https://pmc.ncbi.nlm.nih.gov/articles/PMC10507993/", "https://pmc.ncbi.nlm.nih.gov/articles/PMC6502036/" ] }, { "name": "Stroke Association Communication Support Service (incl. Northern Ireland 8-week groups and AOL)", "provider": "Stroke Association communication support coordinators; in Northern Ireland, SLT-led service", "provider_type": "Charity staff/coordinator; SLT-led in Northern Ireland", "format": "One-to-one, peer support networks, workshops, community education; NI 8-week groups and fortnightly online (Zoom) peer group", "setting": "Community; home visits, group meetings, online", "dose_reported": "Partly: NI 8-week communication groups; fortnightly AOL peer group; other components reported without dose", "duration": "8 weeks (NI groups); ongoing fortnightly peer group", "evidence_standing": "No independent evaluation found; provider self-description only", "uk_delivery_evidence": "UK-wide charity service commissioned locally; NI service is SLT-led", "tidier": { "1_brief_name": { "answer": "Stroke Association Communication Support Service", "source": "[27][28]", "reported": true }, "2_why_rationale": { "answer": "Enable stroke survivors to reach their best communication, improve confidence and independence, and reduce isolation", "source": "[27]", "reported": true }, "3_what_materials": { "answer": "Not reported", "source": "", "reported": false }, "4_what_procedures": { "answer": "One-to-one support, peer support networks, focused workshop sessions, signposting, carer support and education, community education, regular reviews; NI: 8-week communication groups, one-to-one support, family information sessions, AOL online peer group", "source": "[27][28]", "reported": true }, "5_who_provided": { "answer": "Communication support coordinators; NI service SLT-led", "source": "[27][28]", "reported": true }, "6_how_mode": { "answer": "One-to-one, group, workshop, online (Zoom)", "source": "[27][28]", "reported": true }, "7_where_setting": { "answer": "Community; home visits, group meetings, online", "source": "[27][28]", "reported": true }, "8_when_how_much": { "answer": "Not reported in full; NI 8-week groups; AOL fortnightly", "source": "[28]", "reported": "Partial" }, "9_tailoring": { "answer": "Service driven by identified needs and desired outcomes of survivor and carer; personalised review", "source": "[27]", "reported": true }, "10_modifications": { "answer": "Not reported", "source": "", "reported": false }, "11_how_well_planned": { "answer": "Not reported", "source": "", "reported": false }, "12_how_well_actual": { "answer": "Not reported", "source": "", "reported": false } }, "sources": [ "https://www.stroke.org.uk/professionals/life-after-stroke-services/communication-support", "https://www.stroke.org.uk/northern-ireland/support" ] } ], "tidier_gaps": { "note": "TIDieR gap analysis. 'reported' False = 'Not reported' in the retrieved source. Strings mark Partial.", "treatments_with_no_retrievable_intervention_description": [ "Semantic therapy as a standalone named manualised package (only treatment-comparison papers retrieved, no protocol)", "Phonological therapy as a standalone named manualised package (only treatment-comparison papers retrieved, no protocol)", "Generic ICAP model (a composite whose content varies between programmes; no single manual)", "Stroke Association Communication Support Service (provider description only; no published intervention description, dose or fidelity)" ], "tidier_items_missing_across_the_set_counts": { "10_modifications": 8, "11_how_well_planned": 7, "12_how_well_actual": 7, "7_where_setting": 4, "3_what_materials": 3, "9_tailoring": 3, "6_how_mode": 2, "1_brief_name": 0, "2_why_rationale": 0, "4_what_procedures": 0, "5_who_provided": 0, "8_when_how_much": 0 }, "n_treatments": 12, "tidier_complete_treatments": [ "Remote LUNA (Language Underpins Narrative in Aphasia) discourse therapy" ], "tidier_mostly_absent_treatments": [] }, "services": [ { "service_type": "Acute / inpatient stroke unit SLT assessment", "provider": "NHS hospital stroke team (SLT)", "population": "Adults admitted with stroke requiring communication or swallowing assessment", "setting": "Hyperacute / acute stroke unit, inpatient", "access_route": "Automatic referral on admission through the stroke team; SSNAP indicator 4.5 measures SLT assessment within 72 hours of clock start", "referral_required": "No; expected as part of the admitted stroke pathway", "cost_to_user": "Free at point of use (NHS)", "national_or_local": "National standard, locally delivered", "coverage_evidence": "SSNAP audits every stroke admission; 92,414 admissions across 250 hospitals in 2024/25", "figure_facts": [ { "fact": "Stroke admissions audited by SSNAP", "value": "92,414", "date": "2024/25", "source": "[1] SSNAP State of the Nation 2025 (national audit)" }, { "fact": "SLT assessment within 72 hours of clock start [UNVERIFIED at primary source]", "value": "46.8%", "date": "2024/25 (via vault, verified Apr 2026)", "source": "[1][10] indicator definition; vault source-ssnap-apt-synthesis-2026 for value" }, { "fact": "SLT assessment within 24 hours [UNVERIFIED at primary source]", "value": "24.8%", "date": "2024/25 (via vault)", "source": "vault source-ssnap-apt-synthesis-2026" }, { "fact": "No SLT assessment for organisational reasons", "value": "7.6%", "date": "2024/25 (via vault)", "source": "vault source-ssnap-apt-synthesis-2026" } ], "sources": [ "https://www.hqip.org.uk/wp-content/uploads/2025/11/SSNAP-State-of-the-Nation-2025-FINALv2.pdf", "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-466-SSNAP-Therapy-spotlight-report.pdf", "https://www.strokeguideline.org/chapter/communication-and-language/" ] }, { "service_type": "Inpatient stroke unit SLT therapy (dose and intensity)", "provider": "NHS hospital stroke team (SLT, sometimes therapy assistants)", "population": "Adults with communication difficulty on a stroke unit", "setting": "Stroke unit, inpatient", "access_route": "Follows the SLT assessment; therapy delivered by the SLT team", "referral_required": "No; internal to the stroke team", "cost_to_user": "Free at point of use (NHS)", "national_or_local": "National guideline standard, locally delivered", "coverage_evidence": "SSNAP therapy intensity and frequency indicators; NB SLT benchmark assumes only 50% of caseload requires SLT", "figure_facts": [ { "fact": "Patients receiving the NICE target total therapy dose (128 min/day) [UNVERIFIED at primary source]", "value": "35.4%", "date": "2024/25 (via vault)", "source": "vault source-ssnap-apt-synthesis-2026" }, { "fact": "SLT benchmark caseload coverage used in SSNAP scoring", "value": "50% of patients (OT 80%, PT 85%)", "date": "2018 (audit methodology paper)", "source": "[19] BMJ Open therapy-intensity ethnography" }, { "fact": "Decline in the standard of receiving 45 minutes of therapy five days per week, in SLT specifically, since 2022/23", "value": "decline: other disciplines unchanged", "date": "2023/24", "source": "[10] SSNAP Therapy Spotlight Report; [8] Stroke Association 10 Year Health Plan response" }, { "fact": "Mean daily SLT delivered after first 72 hours (older audit cycle)", "value": "20.9 min/day", "date": "April 2018 to March 2019", "source": "[26] ICAP scoping review (metadata only; figure not re-fetched)" } ], "sources": [ "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-466-SSNAP-Therapy-spotlight-report.pdf", "https://bmjopen.bmj.com/content/8/12/e023676", "https://www.tandfonline.com/doi/full/10.1080/09638288.2021.1964626" ] }, { "service_type": "Early Supported Discharge (ESD)", "provider": "NHS specialist stroke multidisciplinary team, as part of the Integrated Community Stroke Service", "population": "Stroke survivors assessed as able to leave hospital early and rehabilitate at home at equivalent intensity", "setting": "Patient's home / community", "access_route": "From hospital at discharge, via the stroke team; ICSS can also be entered from the community", "referral_required": "Internal referral at discharge; needs-based triage", "cost_to_user": "Free at point of use (NHS)", "national_or_local": "National service model (ICSS), locally commissioned", "coverage_evidence": "SSNAP discharge destination measure; guideline requires treatment at home within 24 hours of discharge", "figure_facts": [ { "fact": "Patients discharged to a stroke/neurology specific ESD and/or CRT service", "value": "66.6%", "date": "2024/25", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "Of those, proportion transferred to a combined ESD-CRT service", "value": "23.1%", "date": "2024/25", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "Growth in ESD/CRT discharge over the audit series", "value": "41% (2013/14) to 66.5% (2024/25)", "date": "2013/14 to 2024/25", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "Hospitals in England, Scotland and Wales said not to offer an ESD service (charity claim, cited to a 2020 evidence review; not verified)", "value": "around one fifth", "date": "stated 2025", "source": "[8] Stroke Association 10 Year Health Plan response" } ], "sources": [ "https://www.hqip.org.uk/wp-content/uploads/2025/11/SSNAP-State-of-the-Nation-2025-FINALv2.pdf", "https://www.england.nhs.uk/publication/national-service-model-for-an-integrated-community-stroke-service/", "https://www.stroke.org.uk/10-year-plan-response" ] }, { "service_type": "Community Rehabilitation Team / ICSS community therapy", "provider": "NHS community stroke rehabilitation teams (ICSS model)", "population": "Stroke survivors with ongoing rehabilitation needs after discharge", "setting": "Home and community; intended to be 7 days per week", "access_route": "Discharge from hospital or referral from community; needs-based", "referral_required": "Yes, from hospital teams, GP or community services depending on local pathway", "cost_to_user": "Free at point of use (NHS)", "national_or_local": "National ICSS service model; commissioned locally by ICBs", "coverage_evidence": "SSNAP community measures plus 2021 Post-acute Organisational Audit of 664 services; only 17% have appropriate access to all core disciplines", "figure_facts": [ { "fact": "Community services participating in SSNAP", "value": "195", "date": "2024/25", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "Community-based services with appropriate access to all core disciplines (PT, OT, SLT)", "value": "17%", "date": "1 April 2021 snapshot", "source": "[8][11] Stroke Association response; SSNAP Post-acute Organisational Audit 2021" }, { "fact": "Community-based services meeting recommended staffing levels per patient", "value": "fewer than one third", "date": "1 April 2021", "source": "[11] SSNAP Post-acute Organisational Audit 2021" }, { "fact": "Recommended SLT establishment in community teams", "value": "0.4 WTE per 100 patients", "date": "1 April 2021", "source": "[11] SSNAP Post-acute Organisational Audit 2021" }, { "fact": "Post-acute services participating in the organisational audit (591 England, 42 Wales)", "value": "664 services; over 6,700 WTE staff", "date": "1 April 2021", "source": "[11] SSNAP Post-acute Organisational Audit 2021" } ], "sources": [ "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-296-SSNAP-2021-Post-acute-Organisational-Audit-National-Report-Final.pdf", "https://www.england.nhs.uk/publication/national-service-model-for-an-integrated-community-stroke-service/", "https://www.stroke.org.uk/10-year-plan-response" ] }, { "service_type": "Outpatient / clinic-based SLT", "provider": "NHS community or hospital SLT teams; also independent therapists where the NHS route is exhausted", "population": "Adults with aphasia or other communication/swallowing needs not on an inpatient or home pathway", "setting": "Community clinic, hospital outpatient department", "access_route": "Referral from GP, stroke team or community services; local self-referral routes vary; NHS community health services waiting lists apply", "referral_required": "Yes (usually)", "cost_to_user": "Free (NHS); paid if taken privately", "national_or_local": "Locally commissioned; no ringfenced central SLT funding", "coverage_evidence": "NHS England Community Health Services Waiting Lists (monthly); whole adult SLT, not aphasia-specific", "figure_facts": [ { "fact": "Adults waiting for speech and language therapy in England", "value": "23,590", "date": "end November 2024", "source": "[7] House of Commons Library CDP-2025-0010, citing NHS England Community Health Services Waiting Lists" }, { "fact": "Of those, waiting more than 12 weeks", "value": "7,281 (30.9%)", "date": "end November 2024", "source": "[7] House of Commons Library CDP-2025-0010" }, { "fact": "Waiting over 12 weeks, London", "value": "37.8%", "date": "November 2024", "source": "[7] House of Commons Library CDP-2025-0010" }, { "fact": "Waiting over 12 weeks, East of England", "value": "18.7%", "date": "November 2024", "source": "[7] House of Commons Library CDP-2025-0010" }, { "fact": "Ringfenced central funding for speech and language therapy", "value": "none; ICBs and local authorities decide spend", "date": "January 2025", "source": "[7] House of Commons Library CDP-2025-0010" } ], "sources": [ "https://researchbriefings.files.parliament.uk/documents/CDP-2025-0010/CDP-2025-0010.pdf" ] }, { "service_type": "NHS aphasia group therapy (community/outpatient)", "provider": "NHS community or hospital SLT teams (SLT-led or SLT-supervised groups)", "population": "Adults with post-stroke aphasia", "setting": "Clinic, community venue, occasionally hospital", "access_route": "Via the treating SLT; availability varies by local service", "referral_required": "Yes, via SLT caseload", "cost_to_user": "Free (NHS)", "national_or_local": "Local; not separately audited by SSNAP", "coverage_evidence": "No national count of NHS aphasia groups located; qualitative evidence that provision varies markedly between areas", "figure_facts": [ { "fact": "SLT-reported view that addressing social participation is part of their role", "value": "99% (survey n=124)", "date": "2016", "source": "[25] Northcott et al. UK SLT survey" }, { "fact": "SLTs who considered 70-100% of their clients with aphasia experience psychological difficulties", "value": "50% of respondents (n=124)", "date": "2016", "source": "[25] Northcott et al. UK SLT survey" } ], "sources": [ "https://openaccess.city.ac.uk/id/eprint/14907/11/FURTHER%20REVISED%20SLT%20on-line%20survey%20paper%20AS%20RESUBMITTED.pdf", "https://www.strokeguideline.org/chapter/communication-and-language/" ] }, { "service_type": "Third-sector aphasia drop-in groups (e.g. Say Aphasia)", "provider": "Aphasia charities and local support groups, run by and for people with aphasia", "population": "Adults with aphasia after stroke, brain injury or brain tumour, and their families/carers", "setting": "Community venues and online; drop-in format", "access_route": "Open access drop-in; no clinical referral required; signposted by the NHS and by charities", "referral_required": "No", "cost_to_user": "Free to the user (donation funded)", "national_or_local": "Local and regional; Aphasia Alliance is a signposting network with no central office", "coverage_evidence": "Provider websites and Charity Commission records; no national audit of aphasia group coverage", "figure_facts": [ { "fact": "Say Aphasia charity number and objects", "value": "CIO 1169933; relief of persons with aphasia including provision of therapy, support and information", "date": "current registration", "source": "[23] Charity Commission register" }, { "fact": "Say Aphasia drop-in group frequency and format", "value": "weekly to monthly groups across the UK plus a weekly online group", "date": "accessed October 2026", "source": "[5] Say Aphasia About us; Say Aphasia drop-in groups" }, { "fact": "Illustrative Say Aphasia donation levels", "value": "£10 communication tools per group; £20 volunteer aphasia communication training", "date": "accessed October 2026", "source": "[5] Say Aphasia" } ], "sources": [ "https://www.sayaphasia.org/about-us", "https://register-of-charities.charitycommission.gov.uk/en/charity-search/-/charity-details/5089928", "https://aphasiaalliance.org/members/" ] }, { "service_type": "Charity peer befriending, communication support and local co-ordinators (Stroke Association, Aphasia Re-Connect)", "provider": "Stroke Association; Aphasia Re-Connect; regional aphasia charities", "population": "Stroke survivors with communication difficulty and their families; long-term and lonely or isolated", "setting": "Home visits, community, telephone, online; local support services", "access_route": "Self-referral, helpline, or referral from NHS/community teams; some services commissioned by local systems", "referral_required": "No (self-referral available), though local services may accept clinician referral", "cost_to_user": "Free to the user (charity funded)", "national_or_local": "Mix: UK-wide (Stroke Association), regional/local (others)", "coverage_evidence": "Charity self-reported reach (interested party, not independent)", "figure_facts": [ { "fact": "People reached through all Stroke Association support services in 2024-25 (charity self-reported)", "value": "over 66,000", "date": "2024-25", "source": "[22] Stroke Association Annual Report 2024-25 landing page" }, { "fact": "People reached through Stroke Association local support services (charity self-reported)", "value": "nearly 38,000", "date": "2024-25", "source": "[22] Stroke Association Annual Report 2024-25 landing page" }, { "fact": "Stroke Support Helpline enquiries (charity self-reported)", "value": "around 15,000", "date": "2024-25", "source": "[22] Stroke Association Annual Report 2024-25 landing page" }, { "fact": "Stroke Association research investment (charity self-reported)", "value": "£2.4 million", "date": "2024-25", "source": "[22] Stroke Association Annual Report 2024-25 landing page" }, { "fact": "Stroke Association support groups and people reached (metadata-level, from Charity Commission filing description; not fetched)", "value": "434 groups; around 13,000 people; interpreting support for 480 people in 17+ languages", "date": "year ending 31 March 2025", "source": "[22] context; Charity Commission annual report description (metadata only)" } ], "sources": [ "https://www.stroke.org.uk/about-us/annual-report", "https://aphasiareconnect.org/", "https://aphasiaalliance.org/members/" ] }, { "service_type": "Online / digital peer-led aphasia support groups", "provider": "Aphasia Re-Connect; Say Aphasia; regional charities", "population": "Adults with aphasia able and willing to use online groups", "setting": "Online (video platform)", "access_route": "Self-referral or charity signposting; no clinical referral", "referral_required": "No", "cost_to_user": "Free to the user (charity funded)", "national_or_local": "National reach from local charities", "coverage_evidence": "Provider statements; useful in reducing isolation but digital exclusion is a documented barrier", "figure_facts": [ { "fact": "Say Aphasia online drop-in group", "value": "weekly, Wednesdays 10am", "date": "accessed October 2026", "source": "[5] Say Aphasia" }, { "fact": "Digital inclusion risk: aphasia itself is a barrier to digital inclusion, particularly for older people with lower education", "value": "qualitative finding", "date": "2023-2024 studies", "source": "[16] FATE-A / Hilari telehealth work" } ], "sources": [ "https://aphasiareconnect.org/", "https://www.sayaphasia.org/about-us", "https://openaccess.city.ac.uk/id/eprint/31858/10/Intl%20J%20Lang%20%20%20Comm%20Disor%20-%202023%20-%20Hilari%20-%20Telehealth%20practice%20in%20aphasia%20%20A%20survey%20of%20UK%20speech%20and%20language%20therapists_.pdf" ] }, { "service_type": "Telerehabilitation / remotely delivered SLT", "provider": "NHS SLT teams; independent therapists; commercial platforms", "population": "Adults with aphasia who can engage with remote delivery; guideline says not an alternative to in-person", "setting": "Home, using video platforms (Zoom, Microsoft Teams, Attend Anywhere)", "access_route": "Via the treating SLT service; availability uneven across England and the UK", "referral_required": "Yes, via SLT", "cost_to_user": "Free (NHS) or paid (private)", "national_or_local": "Locally implemented; inconsistent across England (per the studies cited)", "coverage_evidence": "Survey and review evidence of feasibility and acceptability; national audit does not report remote SLT delivery volumes", "figure_facts": [ { "fact": "UK SLTs who used telehealth during the COVID-19 pandemic", "value": "more than 80%", "date": "survey 2021", "source": "[16] Hilari et al., telehealth practice in aphasia survey" }, { "fact": "UK SLTs planning to continue telehealth after the pandemic", "value": "more than 90%", "date": "survey 2021", "source": "[16] Hilari et al." }, { "fact": "Guideline position on telerehabilitation for aphasia", "value": "should be personalised, monitored, supplemented with face-to-face reviews, and NOT used as an alternative to in-person rehabilitation", "date": "2023 guideline", "source": "[4] National Clinical Guideline for Stroke 2023, communication and language chapter" } ], "sources": [ "https://openaccess.city.ac.uk/id/eprint/31858/10/Intl%20J%20Lang%20%20%20Comm%20Disor%20-%202023%20-%20Hilari%20-%20Telehealth%20practice%20in%20aphasia%20%20A%20survey%20of%20UK%20speech%20and%20language%20therapists_.pdf", "https://www.strokeguideline.org/chapter/communication-and-language/" ] }, { "service_type": "Private / self-funded independent SLT", "provider": "Independent HCPC-registered SLTs listed by ASLTIP and similar directories", "population": "Adults (and children) able to pay, or with insurance cover; commonly stroke survivors with aphasia", "setting": "Clinic, home or online", "access_route": "Direct contact with the therapist; no referral required; insurance claims may need GP confirmation", "referral_required": "No (unless claiming on insurance)", "cost_to_user": "Self-funded; therapist-set fees", "national_or_local": "National market, locally variable", "coverage_evidence": "Directory listings and commercial guidance; no authoritative fee schedule or volume data", "figure_facts": [ { "fact": "ASLTIP fee model", "value": "therapists set their own fees; ASLTIP takes no commission and is free to search", "date": "accessed October 2026", "source": "[14] ASLTIP FAQ" }, { "fact": "Private SLT session cost (commercial-directory estimate, NOT authoritative)", "value": "about £70 to £150 per session; initial assessment up to about £250", "date": "2025-2026 listings", "source": "[14] ASLTIP FAQ context; commercial directory guides (Bark, STAMMA, guides) - third-party estimates" }, { "fact": "Stroke survivors paying for rehabilitation out of their own funds (charity claim)", "value": "reported, not quantified", "date": "2025", "source": "[8] Stroke Association 10 Year Health Plan response" } ], "sources": [ "https://asltip.com/faqs/", "https://www.stroke.org.uk/10-year-plan-response" ] }, { "service_type": "Six-month review / long-term follow-up", "provider": "NHS community stroke services / ICSS (often coordinated with voluntary sector)", "population": "All stroke survivors at six months; SSNAP measures against applicable patients", "setting": "In person, telephone, post, online", "access_route": "Coordinator- or service-led tracking after discharge; not patient-triggered in most services", "referral_required": "No; should be automatic where a service runs it", "cost_to_user": "Free (NHS)", "national_or_local": "National expectation (National Stroke Programme), locally delivered", "coverage_evidence": "SSNAP six-month follow-up measure; Stroke Association campaign; PLOS ONE ethnicity analysis", "figure_facts": [ { "fact": "Applicable patients receiving a six-month review", "value": "35.1%", "date": "2024/25", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "Six-month review rate the previous year", "value": "39% in 2023/24", "date": "2023/24", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "Six-month review delivery by mode", "value": "14.7% in person, 18.8% telephone, 0.4% post, 0% online", "date": "2024/25", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "Patients reporting moderate to severe mood issues at six months", "value": "approximately one fifth", "date": "2024/25", "source": "[1] SSNAP State of the Nation 2025" }, { "fact": "National Stroke Programme target for six-month reviews", "value": "from 29% to 90%", "date": "Long Term Plan commitment", "source": "[13] NHS England stroke programme page" }, { "fact": "Discrepant Stroke Association figure for the same measure (source anomaly, not to be reused)", "value": "\"39% of stroke survivors received a six-month review in 2024-25\"", "date": "2025", "source": "[8] Stroke Association 10 Year Health Plan response (contradicts [1] and [2])" }, { "fact": "Six-month review attendance rate in SSNAP-linked analysis (inception to Aug 2023)", "value": "80,413 of 307,054 (26.2%)", "date": "inception to August 2023", "source": "[15] PLOS ONE ethnicity and six-month care" } ], "sources": [ "https://www.hqip.org.uk/wp-content/uploads/2025/11/SSNAP-State-of-the-Nation-2025-FINALv2.pdf", "https://www.england.nhs.uk/ourwork/clinical-policy/stroke/", "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0354353", "https://www.stroke.org.uk/10-year-plan-response" ] }, { "service_type": "Care-home resident stroke/aphasia provision", "provider": "NHS community services in-reach; care-home staff; some voluntary sector", "population": "Stroke survivors living in care homes; may be older and more disabled than the community average", "setting": "Care home", "access_route": "Depends on local in-reach arrangements; not a distinct national pathway", "referral_required": "Usually via GP or community therapy service", "cost_to_user": "NHS element free; care costs separate", "national_or_local": "Local; recognised as a separate access problem in the 2021 organisational audit (Section 4.5)", "coverage_evidence": "SSNAP Post-acute Organisational Audit 2021 has a dedicated care-home section; specific figures not extracted in this run", "figure_facts": [ { "fact": "Care-home treatment examined in the post-acute organisational audit", "value": "dedicated section (4.5) exists; figures not extracted", "date": "1 April 2021", "source": "[11] SSNAP Post-acute Organisational Audit 2021 [UNVERIFIED figure level]" } ], "sources": [ "https://www.hqip.org.uk/wp-content/uploads/2026/03/Ref.-296-SSNAP-2021-Post-acute-Organisational-Audit-National-Report-Final.pdf" ] } ], "provision_gaps": [ { "id": "BP1", "name": "Acute SLT assessment missing for over half of patients", "stage": "Inpatient stroke unit, first 72 hours", "documented_or_inferred": "documented", "evidence": [ { "claim": "Only 46.8% of stroke patients assessed by an SLT within 72 hours of clock start [UNVERIFIED at primary source]", "source": "vault source-ssnap-apt-synthesis-2026; indicator definition confirmed in [1][10]", "access": "vault full text; indicator definition full text" }, { "claim": "7.6% receive no assessment for organisational reasons [UNVERIFIED at primary source]", "source": "vault source-ssnap-apt-synthesis-2026", "access": "vault full text" }, { "claim": "Guideline requires early assessment by an SLT", "source": "[4] National Clinical Guideline for Stroke 2023, communication and language chapter", "access": "full text" } ], "inference": "The gap arises before therapy dose is even in question: the audited gateway itself is missed for over half. This is stated, not inferred.", "confidence": "high (guideline and indicator definition); medium (exact percentage, not re-derived)" }, { "id": "BP2", "name": "Inpatient SLT therapy dose below the guideline standard, and uniquely declining", "stage": "Inpatient stroke unit therapy", "documented_or_inferred": "documented", "evidence": [ { "claim": "Only 35.4% receive the NICE target total therapy dose (128 min/day) [UNVERIFIED at primary source]", "source": "vault source-ssnap-apt-synthesis-2026", "access": "vault full text" }, { "claim": "There has been a decline in the standard of receiving 45 minutes of therapy five days per week since 2022/23 in speech and language therapy, whilst the other disciplines remain unchanged", "source": "[10] SSNAP Therapy Spotlight Report; [8] Stroke Association 10 Year Health Plan response", "access": "full text" }, { "claim": "SSNAP SLT coverage benchmark is 50% of caseload vs OT 80% and PT 85%", "source": "[19] BMJ Open ethnography of SSNAP therapy-intensity auditing", "access": "abstract/full text page" } ], "inference": "Because SLT alone is reported to be declining while OT and PT hold, the shortfall is SLT-specific rather than a general therapy capacity shortfall, though both may share causes.", "confidence": "high (direction); medium (magnitude)" }, { "id": "BP3", "name": "Hospital discharge without a stroke-specific community rehabilitation service", "stage": "Transition, hospital to community", "documented_or_inferred": "documented", "evidence": [ { "claim": "66.6% discharged to a stroke/neurology specific community rehabilitation service in 2024/25, so about one third are not", "source": "[1] SSNAP State of the Nation 2025", "access": "full text" }, { "claim": "23.1% of discharges went to a combined ESD-CRT team", "source": "[1] SSNAP State of the Nation 2025", "access": "full text" } ], "inference": "The residual third is a population of stroke survivors, including people with aphasia, who leave hospital without specialist community rehabilitation. The aphasia-specific share of that third is not measured (that is an inference).", "confidence": "high (headline); low (aphasia-specific split)" }, { "id": "BP4", "name": "ESD not universally available", "stage": "Early supported discharge", "documented_or_inferred": "documented (charity claim)", "evidence": [ { "claim": "Around one fifth of hospitals in England, Scotland and Wales do not yet offer an ESD service", "source": "[8] Stroke Association 10 Year Health Plan response, citing a 2020 evidence review", "access": "full text; underlying count not verified" } ], "inference": "Absence of ESD forces some patients into either a longer hospital stay or a discharge with no specialist home rehabilitation. Stated by the source; not independently counted here.", "confidence": "medium (interested-party claim, basis a 2020 review)" }, { "id": "BP5", "name": "Community teams under-resourced against recommended staffing and discipline access", "stage": "Community rehabilitation (ICSS)", "documented_or_inferred": "documented", "evidence": [ { "claim": "Only 17% of community-based services have appropriate access to all the core disciplines (physiotherapy, occupational therapy, speech and language therapy)", "source": "[8][11] Stroke Association response; SSNAP Post-acute Organisational Audit 2021", "access": "full text" }, { "claim": "Fewer than one third of community-based teams meet recommended staffing levels per patient; fewer than 50% of inpatient services do", "source": "[11] SSNAP Post-acute Organisational Audit 2021", "access": "full text" }, { "claim": "Recommended SLT establishment in community teams is 0.4 WTE per 100 patients", "source": "[11] SSNAP Post-acute Organisational Audit 2021", "access": "full text" } ], "inference": "Even where a patient reaches a community stroke team, the SLT input available depends on that team's staffing, so aphasia therapy reach depends on postcode. Stated by sources plus direct inference.", "confidence": "high (structure); the exact SLT ratio proportion is provisional (two unreconciled tabulations in [11])" }, { "id": "BP6", "name": "Persistent SLT workforce vacancy constraining supply", "stage": "Whole pathway (workforce)", "documented_or_inferred": "documented", "evidence": [ { "claim": "14% of SLT posts vacant across NHS and independent sectors; 14% in NHS adult services; 23% in the independent sector", "source": "[3] RCSLT Workforce and Vacancy Survey 2025", "access": "full text" }, { "claim": "21% overall vacancy with adult services at 23% in an earlier survey wave", "source": "[27] RCSLT news item", "access": "full text" }, { "claim": "32% of non-NHS SLT services turned down new or extended contracts because of recruitment problems (spring 2024 survey)", "source": "[7] House of Commons Library CDP-2025-0010", "access": "full text" } ], "inference": "The workforce shortfall is a supply-side constraint on any expansion of aphasia therapy, and cannot be closed by pathway redesign alone. This inference is mine; the vacancy figures are documented.", "confidence": "high (figures); caveat: voluntary self-selecting surveys, not a census" }, { "id": "BP7", "name": "Six-month review decline, far below the national ambition", "stage": "Long-term follow-up", "documented_or_inferred": "documented", "evidence": [ { "claim": "35.1% of applicable patients received a six-month review in 2024/25, down from 39% in 2023/24", "source": "[1] SSNAP State of the Nation 2025", "access": "full text" }, { "claim": "National Stroke Programme target was to raise six-month reviews from 29% to 90%", "source": "[13] NHS England stroke programme page", "access": "full text" }, { "claim": "Approximately one fifth of patients report moderate to severe mood issues at six months", "source": "[1] SSNAP State of the Nation 2025", "access": "full text" } ], "inference": "The review is the only structured checkpoint after community rehabilitation, so the decline removes the main detection route for unmet aphasia and mood need. Documented direction plus inference.", "confidence": "high" }, { "id": "BP8", "name": "No structured checkpoint after six months; long-term support is voluntary-sector dependent", "stage": "Long-term / life after stroke", "documented_or_inferred": "inferred (from an absence of infrastructure, corroborated by qualitative evidence)", "evidence": [ { "claim": "SLTs report the lack of long-term community support as a particular concern and that knowing there was no long-term support made discharge difficult", "source": "[25] Northcott et al. UK SLT survey (n=124)", "access": "abstract/metadata" }, { "claim": "Charity provision is welcomed but variable across the country, with little available in some areas at the end of rehabilitation", "source": "[25] Northcott et al.", "access": "abstract/metadata" }, { "claim": "50% of people with aphasia in Scotland said there was support they needed but were unable to access; 24% of that unmet need was more speech and language therapy", "source": "[24] CHSS 1 in 5 Aphasia Report (n=250, summer 2023)", "access": "full text" } ], "inference": "That the UK has no national long-term aphasia pathway artefact is an inference from its absence, not from an audit of pathway documents. The comparator (82 Australian best-practice statements across eight care areas) is evidence about Australia, not the UK.", "confidence": "medium (absence-based; the Australian comparator is not UK evidence)" }, { "id": "BP9", "name": "Provision varies by geography (waiting times, vacancies, commissioning)", "stage": "Whole pathway", "documented_or_inferred": "documented", "evidence": [ { "claim": "Waiting over 12 weeks for adult SLT: London 37.8%, South East 37.2%, East of England 18.7%", "source": "[7] House of Commons Library CDP-2025-0010", "access": "full text" }, { "claim": "SLT vacancy: England 17%, London 21%, Scotland 12%, Northern Ireland 13%, NHS Wales 6%", "source": "[3] RCSLT Vacancy Survey 2025", "access": "full text" }, { "claim": "Thrombectomy access 9% in Thames Valley vs about 2% in parts of the North East and North Cumbria and West Yorkshire (different pathway stage, shown as the general access pattern)", "source": "[8] Stroke Association 10 Year Health Plan response", "access": "full text" }, { "claim": "No ringfenced central SLT funding; ICBs and local authorities decide spend", "source": "[7] House of Commons Library CDP-2025-0010", "access": "full text" } ], "inference": "Because funding is local, geographic variation in aphasia provision is expected; the waiting and vacancy figures corroborate it. The waiting figures are all-adult SLT, not aphasia-specific.", "confidence": "high (variation exists); medium (that it is aphasia-specific)" }, { "id": "BP10", "name": "No aphasia-specific tariff, commissioning currency or ringfenced funding", "stage": "Commissioning", "documented_or_inferred": "inferred (from absence)", "evidence": [ { "claim": "There is no ringfenced central funding for speech and language therapy; ICBs and local authorities decide", "source": "[7] House of Commons Library CDP-2025-0010", "access": "full text" } ], "inference": "No aphasia-specific tariff or commissioning currency was located in this run. That aphasia therapy has no separate line in the money is my inference from not finding one, and is weaker evidence than finding an explicit statement. Search was limited to the sources listed; a national tariff document would settle it.", "confidence": "low-medium (absence-based)" }, { "id": "BP11", "name": "Psychological and emotional support almost absent for people with aphasia", "stage": "Whole pathway, worst after rehabilitation", "documented_or_inferred": "documented", "evidence": [ { "claim": "52% of people with aphasia said their condition affects their mental health, but only 8% had accessed psychological or emotional support", "source": "[24] CHSS 1 in 5 Aphasia Report (Scotland, n=250)", "access": "full text" }, { "claim": "Mental health services are often inaccessible to those with moderate to severe communication disability and are seen as under-skilled in working with aphasia", "source": "[25] Northcott et al. UK SLT survey", "access": "abstract/metadata" }, { "claim": "SLTs reported time and caseload pressures, feeling under-skilled, and lack of specialist ongoing support as the main barriers to delivering psychosocial support", "source": "[25] Northcott et al.", "access": "abstract/metadata" }, { "claim": "The guideline requires monitoring and assessment for depression and other mood disorders using validated tools, with tailored psychological interventions", "source": "[4] National Clinical Guideline for Stroke 2023", "access": "full text" } ], "inference": "The 52% vs 8% gap is the clearest quantified unmet-need finding in this lane, though it is Scotland-only and from a charity survey (interested party for CHSS services).", "confidence": "medium-high (Scotland); unknown for England, Wales, NI" }, { "id": "BP12", "name": "Care-home residents are a distinct and under-measured access problem", "stage": "Long-term / residential care", "documented_or_inferred": "documented (existence of the problem); inferred (its size)", "evidence": [ { "claim": "The SSNAP Post-acute Organisational Audit 2021 devotes a section (4.5) to treatment of patients in care homes", "source": "[11] SSNAP Post-acute Organisational Audit 2021", "access": "full text (section located, figures not extracted)" } ], "inference": "A dedicated audit section is evidence that care-home provision was recognised as a separate problem in 2021; the size of the gap today is not established here.", "confidence": "low (size); the section's existence is documented" }, { "id": "BP13", "name": "Aphasia-specific inequity by ethnicity and deprivation is not measured", "stage": "Whole pathway (equity)", "documented_or_inferred": "documented (the general inequity); inferred (the aphasia-specific part)", "evidence": [ { "claim": "People from all ethnic minorities received less therapy than white patients; men received more physical and speech therapy than women", "source": "[20] Imperial College therapy-predictor analysis", "access": "abstract/metadata" }, { "claim": "Non-White patients were significantly more likely to attend a six-month review (Black OR 1.29, Asian OR 1.10) but still had worse outcomes and lower secondary prevention use", "source": "[15] PLOS ONE ethnicity and six-month care", "access": "full text abstract" }, { "claim": "People from poorer backgrounds have their first stroke about seven years earlier", "source": "[9] Stroke Association accessible 10 Year Health Plan summary", "access": "full text" } ], "inference": "No source located measures aphasia-specific provision by ethnicity or deprivation; the general inequities are documented, the aphasia-specific ones are inferred. The two ethnicity findings point in different directions and are not averaged.", "confidence": "medium (general); low (aphasia-specific)" } ], "barrier_map": [ { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Relative Advantage", "barrier_statement": "CPT / conversation-focused therapy is not recognised in workload or as direct intervention; 'gold standard but not essential', deprioritised against dysphagia.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 1; concept-cpt-identity-problem (vault)", "eric_strategy": "Inform local opinion leaders", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Level-1-mapped strategy only; no effectiveness evidence located for opinion leaders in UK aphasia provision." }, { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Relative Advantage", "barrier_statement": "Current community provision is below any effective dose (~6.3 h per 3 months; mean 128 min/week against a 45 min/day x 5 day guideline), so the innovation's advantage is not demonstrable in the status quo.", "documented_or_inferred": "documented", "evidence": "Palmer 2018; Monnelly 2023", "eric_strategy": "Promote adaptability", "eric_cluster": "Adapt and tailor to context", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Dose shortfall documented; strategy mapped only." }, { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Complexity", "barrier_statement": "No standardised approach: 'different SLTs mean different things by CPT'; no structured manual; conceptual confusion about what CPT is.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 2; WP2 conceptual clarity", "eric_strategy": "Develop a formal implementation blueprint", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Manual/blueprint is a plausible match; not evaluated in aphasia." }, { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Complexity", "barrier_statement": "ICAP/comprehensive therapy is operationally difficult to configure within mainstream services; only 16.5% of services felt able to deliver an ICAP.", "documented_or_inferred": "documented", "evidence": "Monnelly 2023", "eric_strategy": "Promote adaptability", "eric_cluster": "Adapt and tailor to context", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Cost", "barrier_statement": "Cost-effectiveness of intensive/comprehensive aphasia therapy is not established; a 100-hour multidisciplinary programme is resource-intensive.", "documented_or_inferred": "documented", "evidence": "Kellar 2026 comprehensive rehab argument (open counter-argument)", "eric_strategy": "Fund and contract for the clinical innovation", "eric_cluster": "Utilize financial strategies", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "The strategy (commissioning/contracting) has no located effectiveness evidence as an implementation strategy." }, { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Evidence Strength and Quality", "barrier_statement": "Uncertainty about the effectiveness of comprehensive models weakens the case for investment (first definitive ICAP RCT reports 2030).", "documented_or_inferred": "documented", "evidence": "Kellar 2026 comprehensive rehab argument", "eric_strategy": "Capture and share local knowledge", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Outer Setting", "cfir_construct": "Policy and Incentives", "barrier_statement": "Lack of national and/or local funding due to ICB deficits is the top reported challenge to delivering stroke rehabilitation.", "documented_or_inferred": "documented", "evidence": "Stroke Association 2025 (Aug-2024 survey, 300+ professionals)", "eric_strategy": "Access new funding", "eric_cluster": "Utilize financial strategies", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "Funding strategies are in the published ERIC set but carry no located effectiveness evidence as implementation strategies." }, { "cfir_domain": "Outer Setting", "cfir_construct": "Policy and Incentives", "barrier_statement": "Only one third of ICSs prioritised stroke in their Joint Forward plans; ISDNs are not consistently funded by their ICB.", "documented_or_inferred": "documented", "evidence": "Stroke Association 2025", "eric_strategy": "Involve executive boards", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Outer Setting", "cfir_construct": "Policy and Incentives", "barrier_statement": "CPT is invisible in the national stroke audit (SSNAP does not distinguish CPT from impairment-based therapy or dysphagia), so there is no national measurement or feedback loop.", "documented_or_inferred": "documented", "evidence": "SSNAP/APT synthesis (vault); SSNAP 2024/25", "eric_strategy": "Develop and organize quality monitoring systems", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "The A&F literature (Ivers 2012) supports feedback generally; the specific measurement-infrastructure strategy is untested here." }, { "cfir_domain": "Outer Setting", "cfir_construct": "Policy and Incentives", "barrier_statement": "Aphasia is undercounted nationally: SSNAP records presence/absence on NIHSS item 9 (~72% sensitivity) with no severity, type or standardised screener.", "documented_or_inferred": "documented", "evidence": "Kellar 2026 UK evidence gap (vault)", "eric_strategy": "Develop and implement tools for quality monitoring", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Outer Setting", "cfir_construct": "Policy and Incentives", "barrier_statement": "The six-month cliff-edge: only 35% of stroke survivors received a six-month review in 2024/25 (39% in 2023/24), leaving ~60,000/yr with no formal review.", "documented_or_inferred": "documented", "evidence": "SSNAP/APT synthesis; concept-six-month-cliff-edge (vault)", "eric_strategy": "Change record systems", "eric_cluster": "Change infrastructure", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Coded under a measurement/records record; the six-month review is a policy lever, not an ERIC strategy." }, { "cfir_domain": "Outer Setting", "cfir_construct": "External Pressure", "barrier_statement": "Resources are skewed towards acute provision, leaving community rehabilitation under-resourced; there is variation in access and some survivors pay privately.", "documented_or_inferred": "documented", "evidence": "Stroke Association 2025", "eric_strategy": "Alter incentive/allowance structures", "eric_cluster": "Utilize financial strategies", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "" }, { "cfir_domain": "Outer Setting", "cfir_construct": "Local Conditions", "barrier_statement": "Geographical variation in therapy intensity (c.60-180 min/week by region) and in service capacity raises equity concerns.", "documented_or_inferred": "documented", "evidence": "Monnelly 2023", "eric_strategy": "Tailor strategies", "eric_cluster": "Adapt and tailor to context", "evidence_standing": "validated_other", "standing_source": "Bird et al. 2019, Clin Rehabil 33(11), doi:10.1177/0269215519847253 (systematic review, 16 RCTs, 250 sites, 14,689 patients; education alone ineffective; multicomponent incl. site facilitation + tailoring effective, GRADE moderate, OR 1.63-4.9)", "notes": "Tailoring + site facilitation effective in multicomponent stroke-rehab trials (Bird 2019); not UK-aphasia specific and certainty graded low overall." }, { "cfir_domain": "Outer Setting", "cfir_construct": "Local Conditions", "barrier_statement": "Transport and geography (rural/remote access) restrict face-to-face attendance; pre-pandemic UK data show ~1 h 23 min/week post-discharge in the North West.", "documented_or_inferred": "documented", "evidence": "Bowen 2012 via Monnelly 2023; telepractice rationale (vault)", "eric_strategy": "Change service sites", "eric_cluster": "Change infrastructure", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "" }, { "cfir_domain": "Outer Setting", "cfir_construct": "Local Conditions", "barrier_statement": "Digital exclusion: telehealth access depends on a carer/relative being present and capable, excluding people with aphasia who live alone.", "documented_or_inferred": "documented", "evidence": "UK SLT telehealth survey, doi:10.1111/1460-6984.12996", "eric_strategy": "Prepare patients/consumers to be active participants", "eric_cluster": "Engage consumers", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Outer Setting", "cfir_construct": "Patient Needs and Resources", "barrier_statement": "Half of people with aphasia (50%) report support they needed but could not access, the top unmet need being more speech and language therapy (24%).", "documented_or_inferred": "documented", "evidence": "CHSS '1 in 5 Aphasia' (1,886 responses)", "eric_strategy": "Conduct local needs assessment", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Outer Setting", "cfir_construct": "Patient Needs and Resources", "barrier_statement": "Two thirds (67%) of people with aphasia report some difficulty accessing services.", "documented_or_inferred": "documented", "evidence": "CHSS '1 in 5 Aphasia'", "eric_strategy": "Involve patients/consumers and family members", "eric_cluster": "Engage consumers", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Level-1-mapped (87.3% expert endorsement, Waltz 2019) but no located effectiveness evidence in this context." }, { "cfir_domain": "Outer Setting", "cfir_construct": "Local Attitudes", "barrier_statement": "Cultural and linguistic barriers: only 23% of the national workforce feels confident adapting CPT for non-English speakers; materials are absent in other languages and interpreters are unreliable.", "documented_or_inferred": "documented", "evidence": "concept-cultural-linguistic-barriers (vault, WP1/WP2)", "eric_strategy": "Tailor strategies", "eric_cluster": "Adapt and tailor to context", "evidence_standing": "validated_other", "standing_source": "Bird et al. 2019, Clin Rehabil 33(11), doi:10.1177/0269215519847253 (systematic review, 16 RCTs, 250 sites, 14,689 patients; education alone ineffective; multicomponent incl. site facilitation + tailoring effective, GRADE moderate, OR 1.63-4.9)", "notes": "Tailoring evidence is generic, not language-equity specific." }, { "cfir_domain": "Outer Setting", "cfir_construct": "Local Attitudes", "barrier_statement": "Societal attitudes and stigma: 48% of people with aphasia report loneliness (vs 34% of all stroke survivors); friends disappear.", "documented_or_inferred": "documented", "evidence": "CHSS '1 in 5 Aphasia'", "eric_strategy": "Use mass media", "eric_cluster": "Engage consumers", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Structural Characteristics", "barrier_statement": "Fewer than a third of community-based rehabilitation teams meet recommended staffing levels; less than 50% of inpatient services meet any core-discipline level.", "documented_or_inferred": "documented", "evidence": "SSNAP Post-acute Organisational Audit 2021", "eric_strategy": "Revise professional roles", "eric_cluster": "Support clinicians", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Structural Characteristics", "barrier_statement": "Only 17% of community-based services have appropriate access to all core disciplines (PT, OT, SLT).", "documented_or_inferred": "documented", "evidence": "Stroke Association 2025 citing SSNAP 2021 audit", "eric_strategy": "Recruit, designate, and train for leadership", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Structural Characteristics", "barrier_statement": "SLT workforce shortage: 14% overall vacancy, 14% in NHS adult services, 21% in London; 23% in the independent sector.", "documented_or_inferred": "documented", "evidence": "RCSLT 2025 vacancy survey", "eric_strategy": "Access new funding", "eric_cluster": "Utilize financial strategies", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Structural Characteristics", "barrier_statement": "Under-represented disciplines (psychology, dietetics, social work, family/carer support) and a lack of band-4/assistant staff in stroke rehabilitation teams.", "documented_or_inferred": "documented", "evidence": "SSNAP PAOA 2021", "eric_strategy": "Create new clinical teams", "eric_cluster": "Support clinicians", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Networks and Communications", "barrier_statement": "No standardised referral pathway for CPT; inconsistent referral/recruitment (ImPACT recruited 41 of 504 pooled dyads).", "documented_or_inferred": "documented", "evidence": "APT WP2; Wielaert 2018 (ImPACT)", "eric_strategy": "Build a coalition", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Networks and Communications", "barrier_statement": "Interpreters are not always available for the critical first session and lack aphasia training.", "documented_or_inferred": "documented", "evidence": "concept-cultural-linguistic-barriers (vault, WP2)", "eric_strategy": "Develop resource sharing agreements", "eric_cluster": "Support clinicians", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Culture", "barrier_statement": "Competing priorities and deprioritisation: CPT is not recognised in workload and is squeezed by dysphagia and impairment targets.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 1; cpt-deprioritisation (vault)", "eric_strategy": "Conduct local consensus discussions", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Culture", "barrier_statement": "Staff moral injury: clinicians experience distress and overwhelm at knowing the standard but being unable to deliver it.", "documented_or_inferred": "documented", "evidence": "APT WP2 (vault); concept-staff-moral-injury", "eric_strategy": "Provide ongoing consultation", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Implementation Climate", "barrier_statement": "Time and caseload pressures are the most frequent barrier to delivering psychosocial/family work (72% of surveyed UK SLTs).", "documented_or_inferred": "documented", "evidence": "UK SLT psychosocial survey (n=124)", "eric_strategy": "Facilitation", "eric_cluster": "Provide interactive assistance", "evidence_standing": "validated_other", "standing_source": "Bird et al. 2019, Clin Rehabil 33(11), doi:10.1177/0269215519847253 (systematic review, 16 RCTs, 250 sites, 14,689 patients; education alone ineffective; multicomponent incl. site facilitation + tailoring effective, GRADE moderate, OR 1.63-4.9)", "notes": "Site facilitation is effective within multicomponent stroke-rehab interventions (Bird 2019); not UK-aphasia specific." }, { "cfir_domain": "Inner Setting", "cfir_construct": "Implementation Climate", "barrier_statement": "Staff turnover and loss of a local champion derailed implementation in some teams; change fatigue reported.", "documented_or_inferred": "documented", "evidence": "Scobbie 2020 (G-AP); CPT implementation trial, doi:10.1080/09638288.2025.2534525", "eric_strategy": "Identify and prepare champions", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Champion strategies are Level-1-mapped (92.7% endorsement, Waltz 2019) but no located effectiveness evidence in aphasia." }, { "cfir_domain": "Inner Setting", "cfir_construct": "Implementation Climate", "barrier_statement": "Poor 'fit' between the innovation and the team's organisational structure; simultaneous delivery of other systems (e.g. parallel goal-setting tools) impeded adoption.", "documented_or_inferred": "documented", "evidence": "Scobbie 2020 (G-AP)", "eric_strategy": "Model and simulate change", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Readiness for Implementation", "barrier_statement": "Limited leadership engagement from team leaders/managers is a documented barrier to implementation.", "documented_or_inferred": "documented", "evidence": "Scobbie 2020 (G-AP)", "eric_strategy": "Recruit, designate, and train for leadership", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Readiness for Implementation", "barrier_statement": "Practice changes were not sustained: short-term CPT provision improved but gains were not maintained due to organisational barriers.", "documented_or_inferred": "documented", "evidence": "CPT implementation trial, doi:10.1080/09638288.2025.2534525", "eric_strategy": "Purposefully reexamine the implementation", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Resources (Access to Knowledge and Information)", "barrier_statement": "Only 23% of community-based teams offered stroke-specific training for all disciplines.", "documented_or_inferred": "documented", "evidence": "SSNAP PAOA 2021", "eric_strategy": "Conduct ongoing training", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Resources", "barrier_statement": "Funding, printing and materials constraints: most SLTs lack access to resources; no time to prepare materials.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 10", "eric_strategy": "Develop resource sharing agreements", "eric_cluster": "Support clinicians", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Deliverers: Knowledge and Beliefs", "barrier_statement": "Most SLTs had received no CPT training at all; knowledge gaps about the intervention.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 3; Shrubsole 2023 ('Skills')", "eric_strategy": "Conduct educational meetings", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "validated_other", "standing_source": "Bird et al. 2019, Clin Rehabil 33(11), doi:10.1177/0269215519847253 (systematic review, 16 RCTs, 250 sites, 14,689 patients; education alone ineffective; multicomponent incl. site facilitation + tailoring effective, GRADE moderate, OR 1.63-4.9)", "notes": "Education in isolation is evidence-INeffective (Bird 2019; Cahill 2020 low certainty) - recorded as negative-direction evidence, not support." }, { "cfir_domain": "Individuals", "cfir_construct": "Deliverers: Knowledge and Beliefs", "barrier_statement": "The video-feedback component is rated essential by almost all SLTs but very few use it: the largest single evidence-practice gap.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 4; concept-video-feedback-in-cpt", "eric_strategy": "Make training dynamic", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Shrubsole 2023 suggests interactive/persuasive training; not itself evidence of effectiveness." }, { "cfir_domain": "Individuals", "cfir_construct": "Deliverers: Self-efficacy and Confidence", "barrier_statement": "Only 42% of surveyed UK SLTs felt confident addressing clients' psychological needs.", "documented_or_inferred": "documented", "evidence": "UK SLT psychosocial survey (n=124)", "eric_strategy": "Provide clinical supervision", "eric_cluster": "Provide interactive assistance", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Deliverers: Self-efficacy and Confidence", "barrier_statement": "Just over half of SLTs feel they have the skills to manage emotional/relationship issues; fewer than half are confident using video.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 3 (WP1)", "eric_strategy": "Provide ongoing consultation", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Deliverers: Capability (COM-B) / Knowledge", "barrier_statement": "77% of the workforce does not feel equipped to adapt CPT for non-English speakers.", "documented_or_inferred": "documented", "evidence": "concept-cultural-linguistic-barriers (vault, WP1)", "eric_strategy": "Conduct ongoing training", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Deliverers: Capability / Skills", "barrier_statement": "SLT scope is heavily oriented to impairment-level work (naming, repetition, comprehension) with little family involvement, psychosocial support, employment or participation work.", "documented_or_inferred": "documented", "evidence": "Monnelly 2023; Kellar 2026 comprehensive rehab argument", "eric_strategy": "Work with educational institutions", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Deliverers: Motivation / Personal Attributes", "barrier_statement": "Existing clinician knowledge shapes how training is 'heard'; operationalisation drift means the same strategy is enacted differently by different clinicians.", "documented_or_inferred": "documented", "evidence": "APT WP2; concept-operationalisation-drift (vault); Nilsen 2026", "eric_strategy": "Conduct local consensus discussions", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Recipients (Patients/Clients): Characteristics", "barrier_statement": "Many people with aphasia have no consistent communication partner; family attendance at therapy is often low.", "documented_or_inferred": "documented", "evidence": "Shrubsole 2023 (Environmental context / Social influences); APT convergent barrier 6", "eric_strategy": "Involve patients/consumers and family members", "eric_cluster": "Engage consumers", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Recipients: Motivation / Beliefs about Consequences", "barrier_statement": "Family and client preference for direct therapy; CPT can be read as 'giving up' or 'no hope for improvement'.", "documented_or_inferred": "documented", "evidence": "Shrubsole 2023 (Beliefs about consequences); APT convergent barrier 7", "eric_strategy": "Intervene with patients/consumers to enhance uptake and adherence", "eric_cluster": "Engage consumers", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Recipients (Families): Characteristics", "barrier_statement": "Carer burden and unmet carer need: 81% of people with aphasia are cared for by a family member or friend; communication partners are not assessed at all.", "documented_or_inferred": "documented", "evidence": "CHSS '1 in 5 Aphasia'; SSNAP/APT synthesis", "eric_strategy": "Prepare patients/consumers to be active participants", "eric_cluster": "Engage consumers", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Recipients: Opportunity (COM-B)", "barrier_statement": "Equity gap: people without an advocate 'fall by the wayside'; access is shaped by financial and cognitive capacity to push for services.", "documented_or_inferred": "documented", "evidence": "concept-cultural-linguistic-barriers (vault, WP2); APT WP2", "eric_strategy": "Increase demand", "eric_cluster": "Engage consumers", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Barrier documented in co-design; the demand-generation strategy is untested here." }, { "cfir_domain": "Implementation Process", "cfir_construct": "Planning", "barrier_statement": "Training is not coupled to implementation planning: staff were prepared to deliver the innovation but not to plan, monitor and tailor its local implementation.", "documented_or_inferred": "documented", "evidence": "Scobbie 2020 (G-AP)", "eric_strategy": "Develop a formal implementation blueprint", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Planning / Assessing Context", "barrier_statement": "No formal context/readiness assessment before implementation: services adopt innovations without evaluating inner/outer setting readiness.", "documented_or_inferred": "documented", "evidence": "Scobbie 2020 (G-AP); CFIR 2.0 'Assessing Context' (vault source-damschroder-2022)", "eric_strategy": "Assess for readiness and identify barriers and facilitators", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "Level-1-mapped (94.5% endorsement, Waltz 2019); no located effectiveness evidence in aphasia." }, { "cfir_domain": "Implementation Process", "cfir_construct": "Planning", "barrier_statement": "Delays between training and implementation (staged referral, waiting lists) let momentum dissipate before delivery begins.", "documented_or_inferred": "documented", "evidence": "Scobbie 2020 (G-AP)", "eric_strategy": "Stage implementation scale up", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Engaging", "barrier_statement": "No co-design or coproduction with people with aphasia and families in service design; recipients are consulted late or not at all.", "documented_or_inferred": "documented", "evidence": "BMJ Open 2021;11:e047398; APT WP2 reframing", "eric_strategy": "Involve patients/consumers and family members", "eric_cluster": "Engage consumers", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Engaging", "barrier_statement": "Information and education gaps: aphasia education is delivered but the purpose and value of CPT are not understood by communication partners.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 12", "eric_strategy": "Develop educational materials", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "validated_other", "standing_source": "Bird et al. 2019, Clin Rehabil 33(11), doi:10.1177/0269215519847253 (systematic review, 16 RCTs, 250 sites, 14,689 patients; education alone ineffective; multicomponent incl. site facilitation + tailoring effective, GRADE moderate, OR 1.63-4.9)", "notes": "Materials alone fall within 'education in isolation', which is evidence-INeffective in stroke rehab (Bird 2019)." }, { "cfir_domain": "Implementation Process", "cfir_construct": "Engaging", "barrier_statement": "Goal-setting difficulties: goal tools 'don't get to the heart of it'; families want to be told what to do; goals change between sessions.", "documented_or_inferred": "documented", "evidence": "APT convergent barrier 9", "eric_strategy": "Conduct local consensus discussions", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Executing", "barrier_statement": "SLT assistants are underutilised: 88% of SLTs deliver CPT alone; Band 3/4 staff lack CPT-specific training and supervision.", "documented_or_inferred": "documented", "evidence": "vault concept-slta-role (WP1/WP2)", "eric_strategy": "Revise professional roles", "eric_cluster": "Support clinicians", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Executing", "barrier_statement": "Follow-up and continuity are not executed: no long-term follow-up pathway exists after the six-week block; ~3 h total therapy over 6 weeks.", "documented_or_inferred": "documented", "evidence": "APT WP2 (vault); concept-six-week-cliff", "eric_strategy": "Change service sites", "eric_cluster": "Change infrastructure", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Reflecting and Evaluating", "barrier_statement": "Lack of ongoing local monitoring, evaluation and tailoring of implementation; no site-specific performance feedback.", "documented_or_inferred": "documented", "evidence": "Scobbie 2020 (G-AP recommendations)", "eric_strategy": "Develop and organize quality monitoring systems", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Reflecting and Evaluating", "barrier_statement": "The CFIR-ERIC cascade: across 53 studies using the matching tool, 96.23% formulated strategies but only 15.69% validated them and 7.84% evaluated effectiveness.", "documented_or_inferred": "documented", "evidence": "Meng et al. 2026 scoping review", "eric_strategy": "Purposefully reexamine the implementation", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "This is the field-level evidence standing of the whole mapping exercise, and is quoted in barriers.md." }, { "cfir_domain": "Implementation Process", "cfir_construct": "Reflecting and Evaluating", "barrier_statement": "Matched strategies are selected from a taxonomy without mechanism specification, so failure is undiagnosable and nothing specific is validated.", "documented_or_inferred": "documented", "evidence": "Meng 2026; Waltz 2019 (1-20 strategy recommendations per barrier); Nilsen 2026", "eric_strategy": "Audit and provide feedback", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "validated_other", "standing_source": "Ivers et al. 2012, Cochrane Database Syst Rev 6:CD000259, doi:10.1002/14651858.CD000259.pub3 (audit and feedback, 140 trials; weighted median 4.3% absolute improvement in compliance; small-moderate)", "notes": "A&F has small-moderate effectiveness generically (Ivers 2012); the aphasia identification problem it feeds is not itself tested." }, { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Cost", "barrier_statement": "INFERRED: the true economic case is likely understated because SSNAP's health-economics methodology was not built around communication outcomes.", "documented_or_inferred": "inferred", "evidence": "Pattern across SSNAP health-economics programme (vault entity-ssnap) - no study found on aphasia-specific costing.", "eric_strategy": "Fund and contract for the clinical innovation", "eric_cluster": "Utilize financial strategies", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "Inferred from the absence of aphasia-specific outcome measurement, not stated in a source." }, { "cfir_domain": "Outer Setting", "cfir_construct": "Local Conditions", "barrier_statement": "INFERRED: outer-setting funding and inner-setting capacity interact non-linearly (a funded service still fails without staff), a pattern CFIR's interaction deletion cannot represent.", "documented_or_inferred": "inferred", "evidence": "Nilsen 2026 (interaction/dynamics critique); concept-cfir deletion diagnostic (vault).", "eric_strategy": "Tailor strategies", "eric_cluster": "Adapt and tailor to context", "evidence_standing": "validated_other", "standing_source": "Bird et al. 2019, Clin Rehabil 33(11), doi:10.1177/0269215519847253 (systematic review, 16 RCTs, 250 sites, 14,689 patients; education alone ineffective; multicomponent incl. site facilitation + tailoring effective, GRADE moderate, OR 1.63-4.9)", "notes": "Interaction is inferred; the modelling framework (CFIR) does not specify it." }, { "cfir_domain": "Outer Setting", "cfir_construct": "External Pressure", "barrier_statement": "INFERRED: commissioning cycles and contract durations may be misaligned with intervention timeframes, sustaining a revolving-door pattern of short programmes.", "documented_or_inferred": "inferred", "evidence": "Pattern across APT WP2 7-month re-referral wait and 6-week programme; no source states a causal link.", "eric_strategy": "Alter incentive/allowance structures", "eric_cluster": "Utilize financial strategies", "evidence_standing": "untested", "standing_source": "searched 2026-10-16: no effectiveness evidence located", "notes": "" }, { "cfir_domain": "Inner Setting", "cfir_construct": "Implementation Climate", "barrier_statement": "INFERRED: deprioritisation and time pressure compound, so the constraint is not any single barrier but their conjunction ('deal breakers' interact).", "documented_or_inferred": "inferred", "evidence": "Scobbie 2020 explicitly argues barriers act collectively as deal breakers; extrapolated to aphasia provision.", "eric_strategy": "Conduct cyclical small tests of change", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Individuals", "cfir_construct": "Recipients: Motivation", "barrier_statement": "INFERRED: patient and carer readiness is dynamically shaped by relationship and timing, not a fixed trait, so a single pre-implementation assessment will misclassify dyads.", "documented_or_inferred": "inferred", "evidence": "APT convergent barrier 7 (readiness shaped by relationships); Nilsen 2026 (temporal dynamics flattened).", "eric_strategy": "Assess for readiness and identify barriers and facilitators", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Planning", "barrier_statement": "INFERRED: because determinants are measured at baseline only, teams cannot tell which barrier was consequential when, and so target the wrong strategy.", "documented_or_inferred": "inferred", "evidence": "concept-cfir temporality deletion (vault); Nilsen 2026 challenge 5.", "eric_strategy": "Conduct local needs assessment", "eric_cluster": "Use evaluative and iterative strategies", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Implementation Process", "cfir_construct": "Engaging", "barrier_statement": "INFERRED: equity of reach is not modelled by any implementation plan, so improvement in aggregate uptake can mask worsening inequality of access.", "documented_or_inferred": "inferred", "evidence": "Palmer 2018 and Monnelly 2023 both note equity was not stratified; inference from that gap.", "eric_strategy": "Capture and share local knowledge", "eric_cluster": "Develop stakeholder interrelationships", "evidence_standing": "mapped_only", "standing_source": "CFIR-ERIC Matching Tool, cfirguide.org/choosing-strategies (Waltz et al. 2019 mapping; 39 CFIR barriers to 73 ERIC strategies)", "notes": "" }, { "cfir_domain": "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "cfir_construct": "Design Quality and Packaging", "barrier_statement": "INFERRED: the paucity of aphasia-accessible trial materials/consent is itself a barrier to the evidence base that would justify provision.", "documented_or_inferred": "inferred", "evidence": "Shiggins 2022 exclusion (vault UK-gap paper); inference from participation gap.", "eric_strategy": "Develop educational materials", "eric_cluster": "Train and educate stakeholders", "evidence_standing": "validated_other", "standing_source": "Bird et al. 2019, Clin Rehabil 33(11), doi:10.1177/0269215519847253 (systematic review, 16 RCTs, 250 sites, 14,689 patients; education alone ineffective; multicomponent incl. site facilitation + tailoring effective, GRADE moderate, OR 1.63-4.9)", "notes": "" } ], "coverage": { "generated_utc": "2026-10-16", "map_sha256_16": "32d97f41464dab22", "total_rows": 64, "barriers": 64, "documented": 56, "inferred": 8, "by_cfir_domain": { "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)": 8, "Outer Setting": 15, "Inner Setting": 16, "Individuals": 12, "Implementation Process": 13 }, "by_eric_cluster": { "Use evaluative and iterative strategies": 14, "Provide interactive assistance": 2, "Adapt and tailor to context": 5, "Develop stakeholder interrelationships": 12, "Train and educate stakeholders": 9, "Support clinicians": 5, "Engage consumers": 8, "Utilize financial strategies": 6, "Change infrastructure": 3 }, "evidence_standing_counts": { "validated_uk": 0, "validated_other": 8, "mapped_only": 47, "untested": 9 }, "distinct_eric_strategies_used": 40, "cfir_domains_reference": [ "Innovation Characteristics (CFIR 1.0: Intervention Characteristics)", "Outer Setting", "Inner Setting", "Individuals", "Implementation Process" ], "eric_clusters_reference": [ "Use evaluative and iterative strategies", "Provide interactive assistance", "Adapt and tailor to context", "Develop stakeholder interrelationships", "Train and educate stakeholders", "Support clinicians", "Engage consumers", "Utilize financial strategies", "Change infrastructure" ], "note": "Counts are computed from cfir_eric_map.csv by build_map.py." } }