title: Lost in translation: exploring therapists' experiences of providing stroke rehabilitation across a language barrier.
abstract: OBJECTIVE
  This study sought to explore English-speaking therapists' experiences of providing stroke rehabilitation to non-English speaking individuals in an urban area.
  
  
  METHODS
  This was a qualitative study using focus groups. Two focus groups were conducted. Participants included physiotherapists, occupational therapists, speech and language therapists and a psychotherapist (n = 13). A grounded theory approach was used to analyse data.
  
  
  RESULTS
  Factors affecting rehabilitation were categorised under themes of engagement, practicalities and social context. Subtle communication was identified as a core category that ran through all themes, illustrating therapists' use and interpretation of subtleties and nuances which a language barrier impeded. Providing rehabilitation across a language barrier was found to present significant challenges. Therapists perceived that assessment and treatment are likely to be delayed and limited in scope, especially regarding cognition and neurological communication disorders. A conceptual model of factors involved in rehabilitation across a language barrier was generated.
  
  
  CONCLUSIONS
  Therapists perceive that rehabilitation is affected by a language barrier. The conceptual model illustrates the interrelationship between factors affecting rehabilitation provision when there is a language barrier. Subtle communication was found to be an important therapeutic tool which was lost across a language barrier, and may have broader relevance to therapeutic relationships in the field of rehabilitation. Further research is needed to gain insights into experiences of individuals receiving rehabilitation across a language barrier and to identify how to enhance the efficacy of rehabilitation for them.
  
  
  CONCLUSIONS
  As it appears rehabilitation is affected by a language barrier, this is likely to impact on the outcome of an individual's rehabilitation. The concept of "subtle communication" should be recognised as a vital component of therapeutic skills. Improving access to formal interpreters, extending their role and introducing training could reduce practical barriers. The conceptual model could be utilised by clinicians as a tool for reflection or education.
authors.affiliation: Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London , London , UK and.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Taylor
authors.forename: Fiona
authors.initials: F
authors.lastname: Jones
mesh_terms: D003142:Communication; D003144:Communication Barriers; D003469:Culture; D003625:Data Collection; D003695:Delivery of Health Care; D005190:Family; D017144:Focus Groups; D006801:Humans; D011369:Professional-Patient Relations; D000071939:Stroke Rehabilitation
keywords: Communication; engagement; ethnicity; health inequalities; interpreters; language; stroke; therapy