TY - JOUR
T1 - Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis
AU - Brady, Marian C.
AU - Ali, Myzoon
AU - Berg, Kathryn Vanden
AU - Williams, Linda J.
AU - Williams, Louise R.
AU - Abo, Masahiro
AU - Becker, Frank
AU - Bowen, Audrey
AU - Brandenburg, Caitlin
AU - Breitenstein, Caterina
AU - Bruehl, Stefanie
AU - Copland, David A.
AU - Cranfill, Tamara B.
AU - Di Pietro-Bachmann, Marie
AU - Enderby, Pamela
AU - Fillingham, Joanne
AU - Galli, Federica Lucia
AU - Gandolfi, Marialuisa
AU - Glize, Bertrand
AU - Godecke, Erin
AU - Hawkins, Neil
AU - Hilari, Katerina
AU - Hinckley, Jacqueline
AU - Horton, Simon
AU - Howard, David
AU - Jaecks, Petra
AU - Jefferies, Elizabeth
AU - Jesus, Luis M.T.
AU - Kambanaros, Maria
AU - Kang, Eun Kyoung
AU - Khedr, Eman M.
AU - Kong, Anthony Pak Hin
AU - Kukkonen, Tarja
AU - Laganaro, Marina
AU - Lambon Ralph, Matthew A.
AU - Laska, Ann Charlotte
AU - Leemann, Béatrice
AU - Leff, Alexander P.
AU - Lima, Roxele R.
AU - Lorenz, Antje
AU - Macwhinney, Brian
AU - Marshall, Rebecca Shisler
AU - Mattioli, Flavia
AU - Mavi̧s, Ilknur
AU - Meinzer, Marcus
AU - Nilipour, Reza
AU - Noé, Enrique
AU - Paik, Nam Jong
AU - Palmer, Rebecca
AU - Papathanasiou, Ilias
AU - Patrício, Brígida F.
AU - Martins, Isabel Pavão
AU - Price, Cathy
AU - Jakovac, Tatjana Prizl
AU - Rochon, Elizabeth
AU - Rose, Miranda L.
AU - Rosso, Charlotte
AU - Rubi-Fessen, Ilona
AU - Ruiter, Marina B.
AU - Snell, Claerwen
AU - Stahl, Benjamin
AU - Szaflarski, Jerzy P.
AU - Thomas, Shirley A.
AU - Van De Sandt-Koenderman, Mieke
AU - Van Der Meulen, Ineke
AU - Visch-Brink, Evy
AU - Worrall, Linda
AU - Wright, Heather Harris
AU - The RELEASE Collaborators
N1 - ed in full in Health and Social Care Delivery Research; Vol. 10, No. 28. See the NIHR Journals Library website for further project information. Funding was also provided Funding Information:
Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be publishby The Tavistock Trust for Aphasia.
Funding Information:
The research reported in this issue of the journal was funded by the HSDR programme or one of its preceding programmes as project number 14/04/22. The contractual start date was in December 2018. The final report began editorial review in March 2019 and was accepted for publication in April 2020. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HSDR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.
Funding Information:
Declared competing interests of authors: Marian C Brady reports grants from the Chief Scientist Office, the Scottish Government Health and Social Care Directorates, the European Union Cooperation in Science and Technology (COST)-funded Collaboration of Aphasia Scientists [IS1208, www.aphasiatrials.org (accessed 5 June 2020)] and The Tavistock Trust for Aphasia, during the conduct of the study, and is a member of the Royal College of Speech and Language Therapists. Audrey Bowen reports that data from her research is included in the analyses in the REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE) report. Her post at the University of Manchester is partly funded by research grants and personal awards from the National Institute for Health and Care Research (NIHR) and the Stroke Association. Caterina Breitenstein reports grants from the German Federal Ministry of Education and Research during the conduct of the study. Erin Godecke reports Western Australian State Health Research Advisory Council Research Translation Project grants RSD-02720; 2008/9, during the conduct of the study. Neil Hawkins reports grants from NIHR during the conduct of the study. Katerina Hilari reports grants from the Stroke Association, from the European Social Fund and Greek National Strategic Reference Framework, and from The Tavistock Trust for Aphasia, outside the submitted work. Petra Jaecks reports a PhD grant from Weidmüller Stiftung. Anthony Pak-Hin Kong reports funding from the National Institutes of Health (NIH). Brian MacWhinney reports grants from the National Institutes of Health (NIH). Rebecca Marshall reports grants from the National Institute of Deafness and Other Communication Disorders and NIH during the conduct of the study. Rebecca Palmer reports grants from the NIHR senior clinical academic lectureship, from the NIHR Health Technology Assessment programme and from The Tavistock Trust for Aphasia outside the submitted work.
Funding Information:
T his project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (project number 14/04/22) and the Tavistock Trust for Aphasia. The scientific content was reviewed and informed by discussion with the NIHR Complex Reviews Support Unit, also funded by NIHR (project number 14/178/29; project in progress). The study also received infrastructural support from its location in the NMAHP Research Unit, which is funded by the Chief Scientist Office, Scottish Government Health and Social Care Directorates.
Funding Information:
Ilias Papathanasiou reports funding from the European Social Fund and Greek National Strategic Reference Framework. Jerzy Szaflarski reports personal fees from SK Life Sciences (Fair Lawn, NJ, USA), LivaNova Inc. (Houston, TX, USA), Lundbeck (Deerfield, IL, USA), NeuroPace Inc. (Mountain View, CA, USA), Upsher-Smith Laboratories, LLC (Maple Grove, MN, USA). He also reports grants and personal fees from Sage Therapeutics, Inc. (Cambridge, MA, USA) and Union Chimique Belge (UCB) S.A. (Brussels, Belgium), grants from Biogen Inc. (Cambridge, MA, USA) and Eisai Co., Ltd (Tokyo, Japan), and other from GW Pharmaceuticals plc (Cambridge, UK) outside the submitted work. Shirley Thomas reports research grants from NIHR and The Stroke Association outside the submitted work. Ineke van der Meulen reports grants from Stichting Rotterdams Kinderrevalidatiefonds Adriaanstichting and others from Stichting Afasie Nederland, Stichting Coolsingel and Bohn Stafleu van Loghum during the conduct of the study. Linda Worrall reports a grant from the National Health and Medical Research Council of Australia.
Publisher Copyright:
© King’s Printer and Controller of HMSO 2022.
PY - 2022/10
Y1 - 2022/10
N2 - Background: People with language problems following stroke (aphasia) benefit from speech and language therapy. Optimising speech and language therapy for aphasia recovery is a research priority. Objectives: The objectives were to explore patterns and predictors of language and communication recovery, optimum speech and language therapy intervention provision, and whether or not effectiveness varies by participant subgroup or language domain. Design: This research comprised a systematic review, a meta-analysis and a network meta-analysis of individual participant data. Setting: Participant data were collected in research and clinical settings. Interventions: The intervention under investigation was speech and language therapy for aphasia after stroke. Main outcome measures: The main outcome measures were absolute changes in language scores from baseline on overall language ability, auditory comprehension, spoken language, reading comprehension, writing and functional communication. Data sources and participants: Electronic databases were systematically searched, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Linguistic and Language Behavior Abstracts and SpeechBITE (searched from inception to 2015). The results were screened for eligibility, and published and unpublished data sets (randomised controlled trials, non-randomised controlled trials, cohort studies, case series, registries) with at least 10 individual participant data reporting aphasia duration and severity were identified. Existing collaborators and primary researchers named in identified records were invited to contribute electronic data sets. Individual participant data in the public domain were extracted. Review methods: Data on demographics, speech and language therapy interventions, outcomes and quality criteria were independently extracted by two reviewers, or available as individual participant data data sets. Meta-analysis and network meta-analysis were used to generate hypotheses. Results: We retrieved 5928 individual participant data from 174 data sets across 28 countries, comprising 75 electronic (3940 individual participant data), 47 randomised controlled trial (1778 individual participant data) and 91 speech and language therapy intervention (2746 individual participant data) data sets. The median participant age was 63 years (interquartile range 53-72 years). We identified 53 unavailable, but potentially eligible, randomised controlled trials (46 of these appeared to include speech and language therapy). Relevant individual participant data were filtered into each analysis. Statistically significant predictors of recovery included age (functional communication, individual participant data: 532, n = 14 randomised controlled trials) and sex (overall language ability, individual participant data: 482, n = 11 randomised controlled trials; functional communication, individual participant data: 532, n = 14 randomised controlled trials). Older age and being a longer time since aphasia onset predicted poorer recovery. A negative relationship between baseline severity score and change from baseline (p < 0.0001) may reflect the reduced improvement possible from high baseline scores. The frequency, duration, intensity and dosage of speech and language therapy were variously associated with auditory comprehension, naming and functional communication recovery. There were insufficient data to examine spontaneous recovery. The greatest overall gains in language ability [14.95 points (95% confidence interval 8.7 to 21.2 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.78 points (95% confidence interval 0.48 to 1.1 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with receiving speech and language therapy 4 to 5 days weekly; for auditory comprehension [5.86 points (95% confidence interval 1.6 to 10.0 points) on the Aachen Aphasia Test-Token Test], the greatest gains were associated with receiving speech and language therapy 3 to 4 days weekly. The greatest overall gains in language ability [15.9 points (95% confidence interval 8.0 to 23.6 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.77 points (95% confidence interval 0.36 to 1.2 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with speech and language therapy participation from 2 to 4 (and more than 9) hours weekly, whereas the highest auditory comprehension gains [7.3 points (95% confidence interval 4.1 to 10.5 points) on the Aachen Aphasia Test-Token Test] were associated with speech and language therapy participation in excess of 9 hours weekly (with similar gains notes for 4 hours weekly). While clinically similar gains were made alongside different speech and language therapy intensities, the greatest overall gains in language ability [18.37 points (95% confidence interval 10.58 to 26.16 points) on the Western Aphasia Battery-Aphasia Quotient] and auditory comprehension [5.23 points (95% confidence interval 1.51 to 8.95 points) on the Aachen Aphasia Test-Token Test] were associated with 20-50 hours of speech and language therapy. Network meta-analyses on naming and the duration of speech and language therapy interventions across language outcomes were unstable. Relative variance was acceptable (< 30%). Subgroups may benefit from specific interventions. Limitations: Data sets were graded as being at a low risk of bias but were predominantly based on highly selected research participants, assessments and interventions, thereby limiting generalisability. Conclusions: Frequency, intensity and dosage were associated with language gains from baseline, but varied by domain and subgroup.
AB - Background: People with language problems following stroke (aphasia) benefit from speech and language therapy. Optimising speech and language therapy for aphasia recovery is a research priority. Objectives: The objectives were to explore patterns and predictors of language and communication recovery, optimum speech and language therapy intervention provision, and whether or not effectiveness varies by participant subgroup or language domain. Design: This research comprised a systematic review, a meta-analysis and a network meta-analysis of individual participant data. Setting: Participant data were collected in research and clinical settings. Interventions: The intervention under investigation was speech and language therapy for aphasia after stroke. Main outcome measures: The main outcome measures were absolute changes in language scores from baseline on overall language ability, auditory comprehension, spoken language, reading comprehension, writing and functional communication. Data sources and participants: Electronic databases were systematically searched, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Linguistic and Language Behavior Abstracts and SpeechBITE (searched from inception to 2015). The results were screened for eligibility, and published and unpublished data sets (randomised controlled trials, non-randomised controlled trials, cohort studies, case series, registries) with at least 10 individual participant data reporting aphasia duration and severity were identified. Existing collaborators and primary researchers named in identified records were invited to contribute electronic data sets. Individual participant data in the public domain were extracted. Review methods: Data on demographics, speech and language therapy interventions, outcomes and quality criteria were independently extracted by two reviewers, or available as individual participant data data sets. Meta-analysis and network meta-analysis were used to generate hypotheses. Results: We retrieved 5928 individual participant data from 174 data sets across 28 countries, comprising 75 electronic (3940 individual participant data), 47 randomised controlled trial (1778 individual participant data) and 91 speech and language therapy intervention (2746 individual participant data) data sets. The median participant age was 63 years (interquartile range 53-72 years). We identified 53 unavailable, but potentially eligible, randomised controlled trials (46 of these appeared to include speech and language therapy). Relevant individual participant data were filtered into each analysis. Statistically significant predictors of recovery included age (functional communication, individual participant data: 532, n = 14 randomised controlled trials) and sex (overall language ability, individual participant data: 482, n = 11 randomised controlled trials; functional communication, individual participant data: 532, n = 14 randomised controlled trials). Older age and being a longer time since aphasia onset predicted poorer recovery. A negative relationship between baseline severity score and change from baseline (p < 0.0001) may reflect the reduced improvement possible from high baseline scores. The frequency, duration, intensity and dosage of speech and language therapy were variously associated with auditory comprehension, naming and functional communication recovery. There were insufficient data to examine spontaneous recovery. The greatest overall gains in language ability [14.95 points (95% confidence interval 8.7 to 21.2 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.78 points (95% confidence interval 0.48 to 1.1 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with receiving speech and language therapy 4 to 5 days weekly; for auditory comprehension [5.86 points (95% confidence interval 1.6 to 10.0 points) on the Aachen Aphasia Test-Token Test], the greatest gains were associated with receiving speech and language therapy 3 to 4 days weekly. The greatest overall gains in language ability [15.9 points (95% confidence interval 8.0 to 23.6 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.77 points (95% confidence interval 0.36 to 1.2 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with speech and language therapy participation from 2 to 4 (and more than 9) hours weekly, whereas the highest auditory comprehension gains [7.3 points (95% confidence interval 4.1 to 10.5 points) on the Aachen Aphasia Test-Token Test] were associated with speech and language therapy participation in excess of 9 hours weekly (with similar gains notes for 4 hours weekly). While clinically similar gains were made alongside different speech and language therapy intensities, the greatest overall gains in language ability [18.37 points (95% confidence interval 10.58 to 26.16 points) on the Western Aphasia Battery-Aphasia Quotient] and auditory comprehension [5.23 points (95% confidence interval 1.51 to 8.95 points) on the Aachen Aphasia Test-Token Test] were associated with 20-50 hours of speech and language therapy. Network meta-analyses on naming and the duration of speech and language therapy interventions across language outcomes were unstable. Relative variance was acceptable (< 30%). Subgroups may benefit from specific interventions. Limitations: Data sets were graded as being at a low risk of bias but were predominantly based on highly selected research participants, assessments and interventions, thereby limiting generalisability. Conclusions: Frequency, intensity and dosage were associated with language gains from baseline, but varied by domain and subgroup.
U2 - 10.3310/RTLH7522
DO - 10.3310/RTLH7522
M3 - Article
AN - SCOPUS:85140089684
SN - 2755-0060
VL - 10
JO - Health and Social Care Delivery Research
JF - Health and Social Care Delivery Research
IS - 28
ER -