Impact case study database

Introduction

Prof Brady’s aphasia research significantly impacted international stroke rehabilitation policies and practice across 23 countries (including Australia, Brazil, Canada, Croatia, Germany, Italy, Lithuania, Norway, Portugal, South Korea, Spain, Sweden, the US and UK). People with stroke-related aphasia, therapists and national health services benefited from high-quality evidence of SLT-related recovery, particularly early, intensive therapy, informing rehabilitation guidelines, driving clinical standards, delivery, (and internationally) reimbursement and the foundation of new aphasia services.

Impact 1: International Stroke-Related Aphasia Rehabilitation Policy

Brady’s ground-breaking Cochrane systematic review evidence, that SLT benefits stroke-related aphasia recovery compared to no therapy [R1], continues to underpin international multidisciplinary rehabilitation guidelines, informing service provision in Korea and the USA [C1]. Prior to Brady’s research, this high-quality evidence was absent.

The Action Plan for Stroke in Europe 2018-2030 [C2] by the Stroke Alliance for Europe (international stroke survivor voluntary groups) and multidisciplinary European Stroke Organization, utilised expanded Cochrane evidence [R2] demonstrating the benefits of SLT across multiple language modalities (everyday communication, reading and writing) to establish new aphasia rehabilitation “targets for implementation of evidence based … stroke services to 2030” [C2 p309]. Evidence of SLT benefits, particularly high intensity treatment, was endorsed by several country-specific multidisciplinary stroke clinical guidelines (Australia, Canada, Norway, Republic of Korea, Sweden, USA [C1- pages numbers in section 5]). A Norwegian Stroke Guideline Working Group Lead confirmed that Prof Brady’s research [R2] was ‘highly influential’ in changing their 2017 aphasia rehabilitation policy which was consequently “more informed, offered more practical advice to healthcare professionals” [C3].

Impact 2: International aphasia rehabilitation practice

Internationally, SLT is an emerging profession. Aphasia rehabilitation improvements reflect evidence-informed innovation [R3,4] and multidisciplinary decision-making across disparate service environments [C1]. Professional resources including the Australian Rehabilitation Best Practice Statements, direct therapists to optimal practice and the underpinning evidence [C1, R1,2]. Globally, informed by Brady’s research, BMJ Best Practice and Cochrane Clinical Answers are accessible, trustworthy, up-to-date rehabilitation evidence-summaries supporting evolving services [C4-5, R2]. In March 2019, neurologists and linguists in Iran, used Brady’s research findings to inform the design of a “new aphasia service providing aphasia therapy for all stroke patients with aphasia”, reporting that “high intensity therapy has been critical in the recovery of our patients to communicate clearly.” [C6, R2,5].

International survey respondents (including speech and language therapists, doctors, psychologists and neurolinguists) indicated that GCU-led research findings [R1,2] contributed to changes in aphasia rehabilitation between August 2013 and July 2020, which is consequently initiated earlier after stroke (Australia, Croatia, Germany, Ireland, Italy, Lithuania, Morocco, Norway, Portugal, Spain, the Netherlands and UK) at a higher intensity (Australia, Brazil, Canada, Croatia, Cyprus, Germany, Morocco, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, UK), at a higher dosage (Brazil, Cyprus, Italy, Morocco, Norway, Spain, Sweden, UK) and over a longer duration (Brazil, Canada, Croatia, Cyprus, Morocco, Spain, UK) [C7]. A clinical director described how the 2016 Cochrane review [R2] was instrumental in changing how Norwegian therapists “deliver aphasia therapy, from typically 1 hr/week every second week … to at least 3 weeks of intensive therapy”, resulting in “improvements in aphasia rehabilitation services, more focused therapy sessions… the opportunity for more group therapy and peer support leading to language improvements and better experience for these patients” [C3].

UK Stroke-Related Aphasia Rehabilitation Policy

Brady’s aphasia research underpinned UK rehabilitation guidelines, whose recommendations directly inform NHS SLT service delivery standards. The 2016 Intercollegiate Stroke Working Party guideline, drawing on updated Cochrane review meta-analyses [R2], highlighted the multi-modality language benefits of SLT and the clinical equipoise relating to optimal theoretical therapeutic approach and the effectiveness of alternative therapy delivery models [C8 p65]. Intensive SLT benefits (for those <3 months after stroke) were emphasized, with therapists urged to consider the acceptability of high-intensity interventions for some stroke survivors [R2, C8 p65]. Prior to Brady’s review, this high-quality evidence was absent.

Brady’s “excellent quality” Cochrane review [R1], highly praised in the 2014 Royal College of Speech and Language Therapists’ resource manual for Clinical Commissioning and Planning Services [C9 p16], supports investment in NHS SLT services. The 2019 National Institute for Health and Care Excellence (NICE) evidence surveillance determined that Brady’s 2016 research [R2] was likely to change existing NICE recommendations (2013) which “makes no recommendations on the intensity of SLT” and the acceptability of high intensity or dose regimens “may need consideration” [C10 p21]. Recently, UK survey respondents (speech and language therapists) indicated that following the GCU-led Cochrane review findings [R2], SLT was now delivered earlier, at a higher intensity, dosage and over a longer duration [C7].