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

Brady, M. C. et al. (2022) Dosage, intensity, and frequency of language therapy for aphasia: a systematic review–based, individual participant data network meta-analysis. Stroke, 53(3), pp. 956-967. (doi: 10.1161/STROKEAHA.121.035216) (PMID:34847708) (PMCID:PMC8884127)

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 Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected.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

• Item Type: Articles
• Additional Information: This study was supported by the National Institute for Health Research Health Services and Delivery Research (14/04/22); The Tavistock Trust for Aphasia, United Kingdom.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ali, Dr Myzoon and Hawkins, Professor Neil
• Authors: Brady, M. C., Ali, M., VandenBerg, K., Williams, L. J., Williams, L. R., Abo, M., Becker, F., Bowen, A., Brandenburg, C., Breitenstein, C., Bruehl, S., Copland, D. A., Cranfill, T. B., di Pietro-Bachmann, M., Enderby, P., Fillingham, J., Galli, F. L., Gandolfi, M., Glize, B., Godecke, E., Hawkins, N., Hilari, K., Hinckley, J., Horton, S., Howard, D., Jaecks, P., Jefferies, E., Jesus, L. M.T., Kambanaros, M., Kang, E. K., Khedr, E. M., Kong, A. P.-H., Kukkonen, T., Laganaro, M., Ralph, M. A. L., Laska, A. C., Leemann, B., Leff, A. P., Lima, R. R., Lorenz, A., MacWhinney, B., Marshall, R. S., Mattioli, F., Maviş, İ., Meinzer, M., Nilipour, R., Noé, E., Paik, N.-J., Palmer, R., Papathanasiou, I., Patricio, B., Martins, I. P., Price, C., Jakovac, T. P., Rochon, E., Rose, M. L., Rosso, C., Rubi-Fessen, I., Ruiter, M. B., Snell, C., Stahl, B., Szaflarski, J. P., Thomas, S. A., van de Sandt-Koenderman, M., van der Meulen, I., Visch-Brink, E., Worrall, L., and Wright, H. H.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628
• Published Online: 01 December 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Stroke 53(3): 956-967
• Publisher Policy: Reproduced under a Creative Commons License