Dosage, intensity, and frequency of language therapy for aphasia: a systematic review–based, individual participant data network meta-analysis

Marian C. Brady*, Myzoon Ali, Kathryn VandenBerg, Linda J. Williams, Louise R. Williams, Masahiro Abo, Frank Becker, Audrey Bowen, Caitlin Brandenburg, Caterina Breitenstein, Stefanie Bruehl, David A. Copland, Tamara B. Cranfill, Marie di Pietro-Bachmann, Pamela Enderby, Joanne Fillingham, Federica Lucia Galli, Marialuisa Gandolfi, Bertrand Glize, Erin GodeckeNeil Hawkins, Katerina Hilari, Jacqueline Hinckley, Simon Horton, David Howard, Petra Jaecks, Elizabeth Jefferies, Luis M.T. Jesus, Maria Kambanaros, Eun Kyoung Kang, Eman M. Khedr, Anthony Pak-Hin Kong, Tarja Kukkonen, Marina Laganaro, Matthew A. Lambon Ralph, Ann Charlotte Laska, Béatrice Leemann, Alexander P. Leff, Roxele R. Lima, Antje Lorenz, Brian MacWhinney, Rebecca Shisler Marshall, Flavia Mattioli, İlknur Maviş, Marcus Meinzer, Reza Nilipour, Enrique Noé, Nam-Jong Paik, Rebecca Palmer, Ilias Papathanasiou, Brigida Patricio, Isabel Pavão Martins, Cathy Price, Tatjana Prizl Jakovac, Elizabeth Rochon, Miranda L. Rose, Charlotte Rosso, Ilona Rubi-Fessen, Marina B. Ruiter, Claerwen Snell, Benjamin Stahl, Jerzy P. Szaflarski, Shirley A. Thomas, Mieke van de Sandt-Koenderman, Ineke van der Meulen, Evy Visch-Brink, Linda Worrall, Heather Harris Wright, The RELEASE Collaborators

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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 Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected.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

Original languageEnglish
Number of pages12
JournalStroke
Early online date1 Dec 2021
DOIs
Publication statusE-pub ahead of print - 1 Dec 2021

Keywords

  • aphasia
  • big data
  • comprehension
  • language therapy
  • meta-analysis
  • stroke

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