Comparing inpatient stroke rehabilitation care and outcomes for people with and without aphasia in Australia

Objective To investigate whether presence of aphasia is associated with differences in inpatient stroke rehabilitation care and outcomes. Design Observational study of cross-sectional data from hospitals participating in the biennial National Stroke Audit – Rehabilitation Services (Stroke Foundation, 2016, 2018 and 2020). Descriptive statistics and multi-level multi-variable logistic regression were used to examine associations between aphasia status, processes of care, and patient outcomes, with level defined as hospital. Setting Australian inpatient rehabilitation hospitals. Participants All patients with stroke who had aphasia status recorded. Main measures Adherence to processes of care recommended in the Australian and New Zealand Clinical Guidelines for Stroke Management. In-hospital outcomes included complications, independence, survival, and discharge destination. Results Overall, 9960 audits were included; 3160 (33%) patients had aphasia (56% male; median age 75; no aphasia: 56% male; median age 76). Patients with aphasia were more likely to have a mood impairment (54% vs. 44%) and less likely to be assessed by a psychologist (40% vs. 49%). Fewer patients with aphasia were involved in goal setting (84% vs. 88%) or development of care plans (91% vs. 96%); or asked about returning to work (67% vs. 74%) or driving (41% vs. 45%). Patients with aphasia had a longer length of stay (median 26 vs. 21 days, p≤0.001) and were less independent on discharge (adjusted odds ratio (aOR) 0.80, 95% CI 0.71, 0.90). Conclusions Identified differences in stroke rehabilitation highlight the need for equitable access to care and effective patient-provider communication enabling people with aphasia to more fully participate in their rehabilitation.