Background: Communicative ability after stroke influences patient outcomes. Limited research has explored the impact of aphasia when it intersects with cultural or linguistic differences on receiving stroke care and patient outcomes. We investigated associations between requiring an interpreter and the provision of evidence-based stroke care and outcomes for people with aphasia in the inpatient rehabilitation setting. Methods: Patient-level data from people with aphasia were aggregated from the Australian Stroke Foundation National Stroke Audit - Rehabilitation Services (2016-2020). Multivariable regression models compared adherence to processes of care (e.g. home assessment complete, type of aphasia management) and in-hospital outcomes (e.g. length of stay, discharge destination) by requirement of an interpreter. Outcome models were adjusted for sex, stroke type, hospital size, year, and stroke severity factors. Results: Among 3160 people with aphasia (median age 76, 56% male), 208 (7%) required an interpreter (median age 77, 52% male). The interpreter group had more severe disability on admission, reflected by reduced cognitive (6% vs 12%, p<0.0000) and motor FIM scores (6% vs 12%, p<0.009). The interpreter group were less likely to have phonological and semantic interventions for their aphasia (OR 0.56, 95% CI 0.40, 0.78) compared to people not requiring an interpreter. They more often had a carer (OR 2.03, 95% CI 1.41, 2.96) and were less likely to have a home assessment prior to discharge (OR 0.34, 95% CI 0.12, 0.95) despite increased likelihood of discharging home with supports (OR 1.49, 95% CI 1.08, 2.05). The interpreter group had longer lengths of stay (median 31 vs 26 days, p=0.005). Conclusion: Some processes of care and outcomes differed in inpatient rehabilitation for people with post-stroke aphasia who required an interpreter compared with those who did not. Equitable access to therapy is imperative and greater support for cultural/linguistic minorities during rehabilitation is indicated.

The authors have declared no competing interest.

MLR acknowledges a National Health and Medical Research Council (NMHRC) Centers of Research Excellence Grant (GNT1153236).

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics approval for data used in this project was granted through the Human Research Ethics Committee from Monash University (Project ID 35037).

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All data referred to in the manuscript is accessible stored and accessible by contacring The Stroke Foundation (Australia). Reports on the audit cycles and their respective data a freely available on The Stroke Foundation Website

https://informme.org.au/stroke-data/rehabilitation-audits