Guideline adherence in speech and language therapy in stroke aftercare. A health insurance claims data analysis.

BACKGROUND: Impairments to comprehension and production of speech (aphasia, dysarthria) and swallowing disorders (dysphagia) are common sequelae of stroke, reducing patients' quality of life and social participation. Treatment oriented on evidence-based guidelines seems likely to improve outcomes. Currently, little is known about guideline adherence in stroke aftercare for the above-mentioned sequelae. This study aims to analyse guideline adherence in the treatment of aphasia, dysarthria and dysphagia after stroke, based on suitable test parameters, and to determine factors that influence the implementation of recommended therapies. METHODS: Six test parameters were defined, based on systematic study of guidelines for the treatment of speech impairments and swallowing disorders (e.g. comprehensive diagnostics, early initiation and continuity). Guideline adherence in treatment was tested using claims data from four statutory health insurance companies. Multivariate logistic and linear regression analyses were performed in order to test the outcomes. RESULTS: 4,486 stroke patients who were diagnosed with specific disorders or received speech therapy were included in the study. The median age was 78 years; the proportion of women was 55.9%. Within the first year after the stroke, 90.3% of patients were diagnosed with speech impairments and swallowing disorders. Overall, 44.1% of patients received outpatient speech and language therapy aftercare. Women were less frequently diagnosed with specific disorders (OR 0.70 [95%CI:0.55/0.88], p = 0.003) and less frequently received longer therapy sessions (OR 0.64 [95%CI:0.43/0.94], p = 0.022). Older age and longer hospitalization duration increased the likelihood of guideline recommendations being implemented and of earlier initiation of stroke aftercare measures. CONCLUSIONS: Our observations indicate deficits in the implementation of guideline recommendations in stroke aftercare. At the same time, they underscore the need for regular monitoring of implementation measures in stroke aftercare to address group-based disparities in care.

[Quality of German-Language Guidelines for Post-Stroke Rehabilitation of Aphasia and Dysarthria - Results of a Systematic Review and of an International Comparison]. / Deutschsprachige Leitlinien für die Aphasie- und Dysarthriebehandlung nach Schlaganfall.

AIM: Evaluation of German-language guidelines for aphasia and dysarthria rehabilitation, and comparison with international guidelines. METHODS: The quality of the 6 included guidelines, as found through a comprehensive literature search, was sytematically evaluated using AGREE II. Quality ratings were compared to the results of a systematic review of 19 English-language guidelines. RESULTS: The quality of German-language guidelines was heterogeneous. In 2 out of 6 evaluation domains and in the overall assessment, no German-language guideline reached the cut-off of 66,67% for good guideline quality. Apart from the domain Editorial Independence, results remained behind those of the international reference guidelines. CONCLUSION: In some cases, quality can be improved by simple means. It is more resource-intensive, but crucial to document search strategies and how evidence was used in guideline development. A harmonization of the German-language guidelines seems desirable.