Health Policy and Systems
Linda R. Archila, MD
Resident Physician
University of Toronto
toronto, Ontario, Canada
Vivian Weixuan Zhang, MASc
Medical Student
The University of British Columbia
Vancouver, British Columbia, Canada
Sophie Wagner, BHSc
Medical Student
University of Toronto
Toronto, Ontario, Canada
Amanda Mayo, MD MHSc FRCPC (she/her/hers)
Physiatrist
University of Toronto and Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
Patients with limited English proficiency (LEP) face challenges accessing and engaging with rehabilitation. While professional interpreters can mitigate these inequities, this is underexplored in outpatient settings. This scoping review explored the evidence on interpreter use for adults with LEP in predominantly English-speaking outpatient rehabilitation settings.
Design:
The design was guided by the Arksey & O’Malley and PRISMA frameworks, including preceding protocol registration on Open Science Framework. With assistance from a research librarian, EMBASE, Medline OVID, Cochrane central, Global Index Medicus, Psych info, CINAHL, EMCARE, and Web of Science were searched in January 2025. Studies were included if any part discussed: LEP adults/ families or providers caring for LEP adults; interpreter use; and outpatient rehabilitation in countries with English as an official language. Studies focused on mental health or justice related rehabilitation, translation, or without full text were excluded. Two reviewers independently screened articles, with consensus of three for conflicts. References of included studies were hand-searched. Study characteristics were charted, including interpreter type and LEP definition. Two reviewers independently charted the areas of focus and research gaps identified by the studies, with consensus of three for conflicts.
Results:
47 studies were included after deduplication, screening, and full text review of the 3116 studies and the hand-search. Most were observational, from the United States and Australia, and discussed both professional and untrained interpreters. Interpreter type was inconsistently stated and LEP definitions varied. A range of rehabilitation populations and types were studied, focusing on rehabilitation access, patient and/or family perspectives, provider perspectives, clinician preparedness, outcomes, common practices and challenges, and recommendations for working with interpreters. To date, research gaps have involved similar themes.
Conclusion: Language discordant care affects outpatient rehabilitation outcomes, access, and experiences. Further research that clearly identifies interpreter type is needed to understand the extent of impact and reduce inequities in rehabilitation practices.
