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

Author:

Brady Marian C.1ORCID,Ali Myzoon1ORCID,VandenBerg Kathryn1ORCID,Williams Linda J.2ORCID,Williams Louise R.1ORCID,Abo Masahiro3ORCID,Becker Frank4ORCID,Bowen Audrey5ORCID,Brandenburg Caitlin6ORCID,Breitenstein Caterina7ORCID,Bruehl Stefanie8ORCID,Copland David A.6ORCID,Cranfill Tamara B.9ORCID,di Pietro-Bachmann Marie10ORCID,Enderby Pamela11ORCID,Fillingham Joanne12ORCID,Galli Federica Lucia13ORCID,Gandolfi Marialuisa14ORCID,Glize Bertrand15ORCID,Godecke Erin16ORCID,Hawkins Neil17ORCID,Hilari Katerina18ORCID,Hinckley Jacqueline19ORCID,Horton Simon20ORCID,Howard David21ORCID,Jaecks Petra22ORCID,Jefferies Elizabeth23ORCID,Jesus Luis M.T.24ORCID,Kambanaros Maria25ORCID,Kang Eun Kyoung26ORCID,Khedr Eman M.27ORCID,Kong Anthony Pak-Hin28ORCID,Kukkonen Tarja29ORCID,Laganaro Marina10ORCID,Ralph Matthew A. Lambon30ORCID,Laska Ann Charlotte31ORCID,Leemann Béatrice32ORCID,Leff Alexander P.33ORCID,Lima Roxele R.34ORCID,Lorenz Antje35ORCID,MacWhinney Brian36ORCID,Marshall Rebecca Shisler37ORCID,Mattioli Flavia38ORCID,Maviş İlknur39ORCID,Meinzer Marcus40ORCID,Nilipour Reza41ORCID,Noé Enrique42ORCID,Paik Nam-Jong43ORCID,Palmer Rebecca11ORCID,Papathanasiou Ilias44ORCID,Patricio Brigida45ORCID,Martins Isabel Pavão46ORCID,Price Cathy33ORCID,Jakovac Tatjana Prizl47ORCID,Rochon Elizabeth48ORCID,Rose Miranda L.49ORCID,Rosso Charlotte50ORCID,Rubi-Fessen Ilona51ORCID,Ruiter Marina B.52ORCID,Snell Claerwen53ORCID,Stahl Benjamin54ORCID,Szaflarski Jerzy P.55ORCID,Thomas Shirley A.56ORCID,van de Sandt-Koenderman Mieke57ORCID,van der Meulen Ineke58ORCID,Visch-Brink Evy58ORCID,Worrall Linda6ORCID,Wright Heather Harris59ORCID

Affiliation:

1. Glasgow Caledonian University, United Kingdom

2. University of Edinburgh, United Kingdom

3. Jikei University School of Medicine, Japan

4. University of Oslo, Sunnaas Rehabilitation Hospital, Norway

5. MAHSC, University of Manchester, United Kingdom

6. The University of Queensland, Australia

7. University of Muenster, Germany

8. MAHSC, University of Manchester, United Kingdom; St. Mauritius Rehabilitation Centre and RWTH Aachen University, Germany

9. Eastern Kentucky University

10. University Hospital and University of Geneva, Switzerland

11. University of Sheffield, United Kingdom

12. NHS Improvement, London, United Kingdom

13. Marche Polytechnic University, Italy

14. University of Verona, Italy

15. University of Bordeaux, France

16. Edith Cowan University, Australia

17. University of Glasgow, United Kingdom

18. City, University of London, United Kingdom

19. Nova Southeastern University

20. University of East Anglia, United Kingdom

21. Newcastle University, Unitd Kingdom

22. Bielefeld University, Germany

23. University of York, United Kingdom

24. University of Aveiro, Portugal

25. Cyprus University of Technology, Cyprus

26. Kangwon National University Hospital, Republic of Korea

27. Assiut University Hospital, Egypt

28. University of Central Florida

29. Tampere University Hospital, Finland

30. University of Cambridge, United Kingdom

31. Karolinska Institutet, Sweden

32. Hôpitaux Universitaires de Genève, Switzerland

33. University College London, United Kingdom

34. Educational Association Bom Jesus–IELUSC, Brazil

35. Humboldt University Berlin, Germany

36. Carnegie Mellon University

37. University of Georgia

38. Azienda Socio Sanitaria Territoriale, Italy

39. Anadolu University, Turkey

40. University Medicine Greifswald, Germany

41. University of Social Welfare and Rehabilitation Sciences, Iran

42. NEURORHB-Hospitales Vithas, Spain

43. Seoul National University College of Medicine, Republic of Korea

44. Technological Educational Institute of Western Greece, Greece

45. School of Polytechnic Institute of Porto, Portugal

46. Universidade de Lisboa, Portugal

47. University of Zagreb, Croatia

48. University of Toronto, Canada

49. La Trobe University, Australia

50. Sorbonne Université and Hôpital Salpetriere, France

51. RehaNova Rehabilitation Hospital and University of Cologne, Germany

52. Sint Maartenskliniek and Radboud University, Netherlands

53. Warrington and Halton NHS Foundation Trust, United Kingdom

54. Charité Universitätsmedizin Berlin, Germany

55. University of Alabama at Birmingham

56. University of Nottingham, United Kingdom

57. University Medical Center Rotterdam, the Netherlands

58. Erasmus University Medical Center, the Netherlands

59. North Carolina University

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

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