Qualitative study identifies barriers to guideline-based aphasia therapy in German-speaking care

Guideline-based speech and language therapy for people with aphasia is not consistently implemented in routine care in the German-speaking healthcare context, according to an exploratory qualitative study that examined barriers across the patient journey. Participants described fragmented care pathways, limited coordination, bureaucratic and financial obstacles, and insufficient access to specialized services, with the transition from inpatient treatment to self-organized outpatient follow-up emerging as a particularly vulnerable stage. The study involved people with aphasia, relatives, speech and language therapists, and other healthcare stakeholders recruited into a multiperspectival sample.

Researchers held two online focus group discussions using a semi-structured topic guide addressing barriers to guideline-based therapy, challenges along the patient journey, and possible solutions. Audio recordings were transcribed verbatim, anonymized, and analyzed in German using Kuckartz’s structured qualitative content analysis. This design was intended to explore experiences and identify recurring factors associated with barriers to guideline-recommended care.

It did not measure the prevalence of those barriers, determine their frequency in the wider aphasia population, or compare groups quantitatively. As an exploratory qualitative study, it was also not prospectively registered, limiting conclusions about how widely or consistently each reported issue occurs. The analysis produced six main categories describing factors that shape the provision of guideline-recommended speech and language therapy: societal and systemic conditions; access to care; the patient journey and continuity of care; relatives and the social environment; psychosocial factors; and therapy provision and interdisciplinary care.

Participants highlighted shortcomings in interdisciplinary and psychosocial care, as well as practical obstacles involving service access and coordination between inpatient and outpatient settings. The findings point to structural and organizational features of healthcare as prominent influences on implementation. The study does not establish that any single barrier caused a particular outcome, nor does it show that individual factors were unimportant.

Rather, the accounts indicate that the organization of services strongly shaped whether guideline-based treatment could be delivered in practice. Relatives occupied a dual role in the care system. They often compensated for gaps in formal support by taking on organizational responsibilities, helping patients communicate, and providing emotional support.

This assistance could sustain care after discharge, but it also contributed to inequalities in access because availability of ongoing support partly depended on privately available resources and the involvement of family members. Participants emphasized the need for earlier information, structured care pathways, improved coordination, and stronger implementation of evidence-based recommendations. The authors also identified communication-accessible pathways, stronger continuity between sectors, improved access to specialized and interdisciplinary services, and reduced reliance on informal family support as areas for service improvement, especially in outpatient care.

Overall, the study suggests that implementing aphasia rehabilitation recommendations requires coordinated action across the healthcare system rather than relying only on individual patients or families. The study was published as an accepted article in BMC Health Services Research, with the supplied version identified as open access and subject to later editorial changes before the Version of Record.

Subject of Research: Barriers to guideline-based aphasia therapy across the German-speaking patient journey

Article Title: “Then you are left on your own”: barriers to guideline-based speech and language therapy for aphasia along the patient journey in the German-speaking healthcare context

Article References: May, S., Muehlensiepen, F., Plotho, L., Ritschl, H., & Darkow, R. (2026). “Then you are left on your own”: barriers to guideline-based speech and language therapy for aphasia along the patient journey in the German-speaking healthcare context. BMC Health Services Research, 26(1), Article 1239. https://doi.org/10.1186/s12913-026-15523-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15523-w

Keywords: aphasia, speech and language therapy, outpatient care, care fragmentation, care continuity, patient journey, focus groups, qualitative research, family caregivers, interdisciplinary care, Then, left