Brady, Marian C., Ali, Myzoon ORCID: 0000-0001-5899-2485, VandenBerg, Kathryn ORCID: 0000-0001-5035-9650, Williams, Linda J., Williams, Louise R., Abo, Masahiro ORCID: 0000-0001-6701-4974, Becker, Frank ORCID: 0000-0002-0857-0628, Bowen, Audrey ORCID: 0000-0003-4075-1215, Branden-burg, Caitlin, Breitenstein, Caterina, Bruehl, Stefanie, Copland, David A., Cranfill, Tamara B., Di Pietro-Bachmann, Marie, Enderby, Pamela ORCID: 0000-0002-4371-9053, Fillingham, Joanne, Galli, Federica Lucia, Gandolfi, Marialuisa, Glize, Bertrand, Godecke, Erin ORCID: 0000-0002-7210-1295, Hawkins, Neil ORCID: 0000-0003-3199-221X, Hilari, Katerina ORCID: 0000-0003-2091-4849, Hinckley, Jacqueline, Horton, Simon, Howard, David, Jaecks, Petra, Jefferies, Elizabeth, Jesus, Luis M. T., Kambanaros, Maria, Kang, Eun Kyoung, Khedr, Eman M., Kong, Anthony Pak-Hin, Kukkonen, Tarja, Laganaro, Marina, Ralph, Matthew A. Lambon, Laska, Ann Charlotte, Leemann, Beatrice, Leff, Alexander P., Lima, Roxele R., Lorenz, Antje, MacWhinney, Brian, Marshall, Rebecca Shisler, Mattioli, Flavia, MaviS, ilknur, Meinzer, Marcus, Nilipour, Reza, Noe, Enrique, Paik, Nam-Jong, Palmer, Rebecca, Papathanasiou, Ilias, Patricio, Brigida, Martins, Isabel Pavao, Price, Cathy, Jakovac, Tatjana Prizl, Rochon, Elizabeth ORCID: 0000-0001-5521-0513, Rose, Miranda L., Rosso, Charlotte, Rubi-Fessen, Ilona, Ruiter, Marina B. ORCID: 0000-0001-6147-5235, Snell, Claerwen, Stahl, Benjamin, Szaf-larski, Jerzy P., Thomas, Shirley A., Van de Sandt-Koenderman, Mieke, van der Meulen, Ineke, Visch-Brink, Evy, Worrall, Linda and Wright, Heather Harris (2022). Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis. Stroke, 53 (3). S. 956 - 968. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1524-4628

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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 Published, unpublished, and emerging trials including SLT and 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. Registration: URL: ; Unique identifier: CRD42018110947.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Brady, Marian C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ali, MyzoonUNSPECIFIEDorcid.org/0000-0001-5899-2485UNSPECIFIED
VandenBerg, KathrynUNSPECIFIEDorcid.org/0000-0001-5035-9650UNSPECIFIED
Williams, Linda J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Williams, Louise R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abo, MasahiroUNSPECIFIEDorcid.org/0000-0001-6701-4974UNSPECIFIED
Becker, FrankUNSPECIFIEDorcid.org/0000-0002-0857-0628UNSPECIFIED
Bowen, AudreyUNSPECIFIEDorcid.org/0000-0003-4075-1215UNSPECIFIED
Branden-burg, CaitlinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Breitenstein, CaterinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruehl, StefanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Copland, David A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cranfill, Tamara B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Di Pietro-Bachmann, MarieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Enderby, PamelaUNSPECIFIEDorcid.org/0000-0002-4371-9053UNSPECIFIED
Fillingham, JoanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Galli, Federica LuciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gandolfi, MarialuisaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Glize, BertrandUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Godecke, ErinUNSPECIFIEDorcid.org/0000-0002-7210-1295UNSPECIFIED
Hawkins, NeilUNSPECIFIEDorcid.org/0000-0003-3199-221XUNSPECIFIED
Hilari, KaterinaUNSPECIFIEDorcid.org/0000-0003-2091-4849UNSPECIFIED
Hinckley, JacquelineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horton, SimonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Howard, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jaecks, PetraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jefferies, ElizabethUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jesus, Luis M. T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kambanaros, MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kang, Eun KyoungUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Khedr, Eman M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kong, Anthony Pak-HinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kukkonen, TarjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Laganaro, MarinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ralph, Matthew A. LambonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Laska, Ann CharlotteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Leemann, BeatriceUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Leff, Alexander P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lima, Roxele R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lorenz, AntjeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
MacWhinney, BrianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marshall, Rebecca ShislerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mattioli, FlaviaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
MaviS, ilknurUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meinzer, MarcusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nilipour, RezaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Noe, EnriqueUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Paik, Nam-JongUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palmer, RebeccaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Papathanasiou, IliasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patricio, BrigidaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Martins, Isabel PavaoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Price, CathyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jakovac, Tatjana PrizlUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rochon, ElizabethUNSPECIFIEDorcid.org/0000-0001-5521-0513UNSPECIFIED
Rose, Miranda L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rosso, CharlotteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rubi-Fessen, IlonaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ruiter, Marina B.UNSPECIFIEDorcid.org/0000-0001-6147-5235UNSPECIFIED
Snell, ClaerwenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stahl, BenjaminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Szaf-larski, Jerzy P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thomas, Shirley A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Van de Sandt-Koenderman, MiekeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van der Meulen, InekeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Visch-Brink, EvyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Worrall, LindaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wright, Heather HarrisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-699307
DOI: 10.1161/STROKEAHA.121.035216
Journal or Publication Title: Stroke
Volume: 53
Number: 3
Page Range: S. 956 - 968
Date: 2022
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 1524-4628
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RANDOMIZED CONTROLLED-TRIAL; TRANSCRANIAL MAGNETIC STIMULATION; ACUTE STROKE PATIENTS; POSTSTROKE APHASIA; LIMB APRAXIA; USUAL CARE; REHABILITATION; SPEECH; EFFICACY; PEOPLEMultiple languages
Clinical Neurology; Peripheral Vascular DiseaseMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69930

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