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

A Systematic Review-Based, Individual Participant Data Network Meta-Analysis
Authors: Marian C. Brady; Myzoon Ali; Kathryn VandenBerg; Linda J. Williams; Louise R. Williams; Masahiro Abo; Frank Becker; +61 Authors

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

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 Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected.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.

Keywords

stroke rehabilitation/methods, aphasia/etiology, 515 Psychology, Original Contributions, Network Meta-Analysis, Clinical Neurology, 610, Communication Sciences and Disorders, Clinical sciences, Therapeutics, language therapy, Language and Speech, Learning and Therapy, 515, big data, stroke/complications, Medicine and Health Sciences, Aphasia, Cardiology (incl. cardiovascular diseases), Humans, Advanced and Specialised Nursing, humans, network meta-analysis, info:eu-repo/classification/ddc/610, Diagnostic and Therapeutic Techniques and Equipment, Neurosciences, Stroke Rehabilitation, Public health not elsewhere classified, 401, Analytical, Speech Pathology and Audiology, stroke, Language & Communication, aphasia, P1, meta-analysis, Stroke, Language Therapy, comprehension, language therapy/methods, Cardiology and Cardiovascular Medicine, RC

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
54
Top 1%
Top 10%
Top 1%
Green
hybrid