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Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis

Brady, M. C., Ali, M., VandenBerg, K. , Williams, L. J., Williams, L. R. ORCID: 0000-0003-2430-1142, Abo, M., Becker, F., Bowen, A., Brandenburg, C., Breitenstein, C., Bruehl, S., Copland, D., Cranfill, T. B., di Pietro-Bachmann, M., Enderby, P., Fillingham, J., Galli, F. L., Gandolfi, M., Glize, B., Godecke, E., Hawkins, N., Hilari, K. ORCID: 0000-0003-2091-4849, Hinckley, J., Horton, S., Howard, D., Jaecks, P., Jefferies, E., Jesus, L. M. T., Kambanaros, M., Kang, E. K., Khedr, E. M., Kong, A. P., Kukkonen, T., Laganaro, M., Ralph, M. L., Laska, A-C., Leemann, B., Leff, A. P., Lima, R. R., Lorenz, A., MacWhinney, B., Marshall, R. S., Mattioli, F., Mavis, I., Meinzer, M., Nilipour, R., Noe, E., Paik, N-J., Palmer, R., Papathanasiou, I., Patrício, B., Martins, I., Price, C., Jakovac, T. P., Rochon, E., Rose, M. L., Rosso, C., Rubi-Fessen, I., Ruiter, M. B., Snell, C., Stahl, B., Szaflarski, J. P., Thomas, S., van de Sandt-Koenderman, M., van der Meulen, I., Worrall, L., Wright, H. H. & The REhabilitation and recovery of peopLE with Aphasia after Str, (2021). Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis. Stroke, doi: 10.1161/STROKEAHA.121.035216

Abstract

BACKGROUND AND PURPOSE: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia.

METHODS: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori-defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI).

RESULTS: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58-26.16] Western Aphasia Battery-Aphasia Quotient; 5.23 [1.51-8.95] Aachen Aphasia Test-Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3-5+ days/week), and comprehension (4-5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases.

CONCLUSIONS: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018110947.

Publication Type: Article
Additional Information: © 2021 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
Subjects: P Language and Literature > P Philology. Linguistics
R Medicine > RC Internal medicine
Departments: School of Health Sciences > Midwifery & Radiography
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