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, Brandenburg, Caitlin ORCID: 0000-0002-6992-7790, Breitenstein, Caterina, Bruehl, Stefanie ORCID: 0000-0003-4826-1990, 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, 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 ORCID: 0000-0002-2335-7104, 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, Szaflarski, Jerzy P., Thomas, Shirley A., van de Sandt-Koenderman, Mieke, van der Meulen, Ineke, Visch-Brink, Evy, Worrall, Linda and Wright, Heather Harris (2022). Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis. Int. J. Stroke, 17 (10). S. 1067 - 1078. LONDON: SAGE PUBLICATIONS LTD. ISSN 1747-4949

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Abstract

Background: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. Aim: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. Methods: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including > 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (<=/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (<=/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. Results: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (<= 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants <= 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (<= 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; > 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for > 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (> 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (> 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over > 4 days/week. Conclusions: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

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
Brandenburg, CaitlinUNSPECIFIEDorcid.org/0000-0002-6992-7790UNSPECIFIED
Breitenstein, CaterinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruehl, StefanieUNSPECIFIEDorcid.org/0000-0003-4826-1990UNSPECIFIED
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, NeilUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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, RebeccaUNSPECIFIEDorcid.org/0000-0002-2335-7104UNSPECIFIED
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
Szaflarski, 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:38-699280
DOI: 10.1177/17474930221097477
Journal or Publication Title: Int. J. Stroke
Volume: 17
Number: 10
Page Range: S. 1067 - 1078
Date: 2022
Publisher: SAGE PUBLICATIONS LTD
Place of Publication: LONDON
ISSN: 1747-4949
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
DESIGNMultiple languages
Clinical Neurology; Peripheral Vascular DiseaseMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69928

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