Dosage, intensity and frequency of language therapy for aphasia: an 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,

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose
Optimizing speech-language therapy (SLT) regimens for maximal aphasia recovery is a clinical-research priority. We examined associations between SLT intensity (hours/weekly), dosage (total hours), frequency (days/weekly), duration (weeks), delivery (face-to-face, computer-supported, individual-tailoring, home-practice), content, and language outcomes for people with aphasia.
Methods
Databases including MEDLINE and Embase were searched (inception-09/2015). Published, unpublished and emerging trials including SLT and ≥10 Individual Participants’ Data (IPD) on aphasia, language outcomes and time post-onset were selected.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 IPD 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 post-stroke, baseline aphasia severity), reporting estimates of mean change scores (95% CI).
Results
Data from 959 IPD (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 2-4 and 9+ SLT hours/weekly. Greatest clinical gains were associated with frequent SLT for overall-language, functional-communication (3-5+ days/weekly) and comprehension (4-5 days/weekly). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/weekly and ≤3 days/weekly. Mixed receptive-expressive therapy, functionally-tailored, with prescribed home-practice was associated with 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
PROSPERO CRD42018110947
Original languageEnglish
JournalStroke
Publication statusAccepted/In press - 30 Jul 2021

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