Speech-Language pathologists’ experiences introducing a modified Intensive comprehensive aphasia programme (mICAP) in regular healthcare: a multicentre mixed method study

Abstract

Background There is limited knowledge of Speech-Language Pathologists’ (SLPs) experiences of delivering modified Intensive Comprehensive Aphasia Programmes (mICAPs) in regular healthcare. While such programmes show clinical promise, their feasibility in routine practice remains unclear.Aim This study investigated SLPs perspectives on feasibility, acceptability and engagement following the introduction of a six-week mICAP called MIRAA Multimodal Intensive Rehabilitation of Aphasia and Apraxia of speech (MIRAA) across 13 clinics in regular Swedish healthcare.Method Using a convergent mixed-methods design, quantitative data from 21 questionnaires were analysed and triangulated with qualitative findings from content analysis of the questionnaire’s free-text responses and a thematic analysis of semi-structured interviews with a subgroup of five SLPs.Results Quantitative data provided strong support for the intervention, particularly in collaborative goal setting, satisfaction, and willingness to recommend the mICAP to others. SLPs noted improvements in speech-language, functional communication and motivation, and most SLPs found the intervention suitable even for patients with severe language deficits. SLPs acknowledged the role of patient motivation and fatigue when delivering an mICAP, but few had systematic strategies to address them. Content analysis of free text responses identified tension between the intensity and structure of the mICAP and limitations in regular healthcare settings. Thematic analysis of interviews generated six themes: (1) the mICAP resulted in positive communication outcomes and improved psychosocial well-being; (2) a fun and time-efficient format; (3) the SLPs’ knowledge and clinical role evolved; (4) challenging to integrate the mICAP in regular care; (5) a high initial workload; and (6) shared clinical responsibility is facilitating programme delivery. The integration of qualitative and quantitative data provided a deeper understanding of the results, highlighting a central tension: while the mICAP demonstrated clear clinical value, its feasibility in practice was constrained by staff shortages, excessive workload demands, and scheduling difficulties. Key facilitators for mICAP delivery included greater patient readiness when entering the chronic phase after stroke, shorter programme length, team support, flexible delivery, access to ready-made materials, and the use of technology such as computer-based training and telerehabilitation. Consequently, concerns about long-term sustainability persisted due to organisational barriers and work burden. Engagement was noted to depend on collaborative goal-setting and patient motivation, though structured strategies to maintain motivation and manage fatigue were often lacking.Conclusion Moving forward, the successful integration of mICAPs into regular care requires real-world adaptability by directly addressing resource limitations, leveraging identified facilitators, and optimising patient engagement strategies.