The Role of Speech and Language Therapists (SLTs) in International Stroke Teams: A Systematic Review

Current published guidelines suggest that speech and language therapists (SLTs) should be part of stroke teams, but their involvement and roles according to country income are unknown.

This review aims to (1) investigate the level of involvement of SLTs in acute stroke management, rehabilitation, and long-term care, and (2) examine whether the roles and contributions of SLTs in stroke care vary according to a country's income level.

A systematic review methodology was conducted by an expert librarian and three independent researchers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review was registered on the PROSPERO website. The search strategy involved using MESH Terms 'speech and language therapy' AND stroke AND team* across six databases as follows: MEDLINE Complete, APA PsycInfo, CINAHL Plus, PubMed, Embase, and Scopus. The review was conducted using the Covidence software.

Out of 1142 titles identified, 42 studies met the criteria: 34 studies (80%) were from high-income countries, five (12%) were from upper-middle-income countries, and three (8%) were from low-middle-income countries. No studies were published in low-income countries.

Lack of SLTs reported in stroke and rehabilitation teams in low- and low-middle-income countries raises concern for patients' access to specialized SLT services. Healthcare policy should highlight the need for greater investment in SLT resources and the role of SLTs in managing aphasia, dysphagia, and chronic rehabilitation needs to improve patient outcomes.

What is already known on the subject Stroke is a leading cause of acquired disability with rehabilitation requiring a multidisciplinary approach. Speech and language therapists (SLTs) play a significant role in stroke care, addressing communication, swallowing, and cognitive disorders. Despite the recognized importance, SLTs' involvement in stroke care teams varies significantly across healthcare systems, especially in lower-income countries. What this paper adds to existing knowledge This study reveals global discrepancies in SLT involvement in stroke care, with high-income countries benefiting from structured, specialized roles across all phases of rehabilitation, while low- and middle-income countries face ad hoc, limited involvement due to systemic changes. The findings highlight the need for standardized protocols and greater investment in SLT resources to ensure equitable stroke rehabilitation services worldwide. What are the potential or actual clinical implications of this work? The clinical implications of this study are as follows: (a) integrating SLTs in stroke teams, especially in underrepresented regions, is essential to improve rehabilitation outcomes, (b) advocacy efforts prioritize equal access to SLT services globally, supported by policy changes and education and (c) participatory research must involve patients as equal partners to address community-specific rehabilitation priorities as involving stroke survivors and caregivers in the design of rehabilitation services has been shown to identify local barriers to access and shape more culturally appropriate interventions.