Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis

被引:54
|
作者
Brady, Marian C. [1 ]
Ali, Myzoon [1 ]
VandenBerg, Kathryn [1 ]
Williams, Linda J. [2 ]
Williams, Louise R. [1 ]
Abo, Masahiro [3 ]
Becker, Frank [4 ]
Bowen, Audrey [5 ]
Branden-burg, Caitlin [6 ]
Breitenstein, Caterina [7 ]
Bruehl, Stefanie [5 ,8 ,9 ]
Copland, David A. [6 ]
Cranfill, Tamara B. [10 ]
Di Pietro-Bachmann, Marie [11 ,12 ]
Enderby, Pamela [13 ]
Fillingham, Joanne [14 ]
Galli, Federica Lucia [15 ]
Gandolfi, Marialuisa [16 ]
Glize, Bertrand [17 ]
Godecke, Erin [18 ]
Hawkins, Neil [19 ]
Hilari, Katerina [20 ]
Hinckley, Jacqueline [21 ]
Horton, Simon [22 ]
Howard, David [23 ]
Jaecks, Petra [24 ]
Jefferies, Elizabeth [25 ]
Jesus, Luis M. T. [26 ]
Kambanaros, Maria [27 ]
Kang, Eun Kyoung [28 ]
Khedr, Eman M. [29 ]
Kong, Anthony Pak-Hin [30 ]
Kukkonen, Tarja [31 ]
Laganaro, Marina [11 ,12 ]
Ralph, Matthew A. Lambon [32 ]
Laska, Ann Charlotte [33 ]
Leemann, Beatrice [34 ]
Leff, Alexander P. [35 ]
Lima, Roxele R. [36 ]
Lorenz, Antje [37 ]
MacWhinney, Brian [38 ]
Marshall, Rebecca Shisler [39 ]
Mattioli, Flavia [40 ]
MaviS, ilknur [41 ]
Meinzer, Marcus [42 ]
Nilipour, Reza [43 ]
Noe, Enrique [44 ]
Paik, Nam-Jong [45 ]
Palmer, Rebecca [13 ]
Papathanasiou, Ilias [46 ]
机构
[1] Glasgow Caledonian Univ, Glasgow G4 0BA, Lanark, Scotland
[2] Univ Edinburgh, Edinburgh, Midlothian, Scotland
[3] Jikei Univ, Sch Med, Tokyo, Japan
[4] Univ Oslo, Sunnaas Rehabil Hosp, Oslo, Norway
[5] Univ Manchester, MAHSC, Manchester, Lancs, England
[6] Univ Queensland, Brisbane, Qld, Australia
[7] Univ Munster, Munster, Germany
[8] St Mauritius Rehabil Ctr, Aachen, Germany
[9] Rhein Westfal TH Aachen, Aachen, Germany
[10] Eastern Kentucky Univ, Richmond, KY 40475 USA
[11] Univ Hosp Geneva, Geneva, Switzerland
[12] Univ Geneva, Geneva, Switzerland
[13] Univ Sheffield, Sheffield, S Yorkshire, England
[14] NHS Improvement, London, England
[15] Marche Polytech Univ, Ancona, Italy
[16] Univ Verona, Verona, Italy
[17] Univ Bordeaux, Bordeaux, France
[18] Edith Cowan Univ, Joondalup, WA, Australia
[19] Univ Glasgow, Glasgow, Lanark, Scotland
[20] City Univ London, London, England
[21] Nova Southeastern Univ, Ft Lauderdale, FL 33314 USA
[22] Univ East Anglia, Norwich, Norfolk, England
[23] Newcastle Univ, Newcastle Upon Tyne, Tyne & Wear, England
[24] Bielefeld Univ, Bielefeld, Germany
[25] Univ York, York, N Yorkshire, England
[26] Univ Aveiro, Aveiro, Portugal
[27] Cyprus Univ Technol, Nicosia, Cyprus
[28] Kangwon Natl Univ Hosp, Seoul, South Korea
[29] Assiut Univ Hosp, Assiut, Egypt
[30] Univ Cent Florida, Orlando, FL 32816 USA
[31] Tampere Univ Hosp, Tampere, Finland
[32] Univ Cambridge, Cambridge, England
[33] Karolinska Inst, Stockholm, Sweden
[34] Hop Univ Geneve, Geneva, Switzerland
[35] UCL, London, England
[36] Educ Assoc Bom Jesus IELUSC, Joinville, SC, Brazil
[37] Humboldt Univ, Berlin, Germany
[38] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA
[39] Univ Georgia, Athens, GA 30602 USA
[40] Azienda Socio Sanit Terr, Lodi, Italy
[41] Anadolu Univ, Eskisehir, Turkey
[42] Univ Med Greifswald, Greifswald, Germany
[43] Univ Social Welf & Rehabil Sci, Tehran, Iran
[44] NEURORHB Hosp Vithas, Seville, Spain
[45] Seoul Natl Univ, Coll Med, Seoul, South Korea
[46] Technol Educ Inst Western Greece, Patras, Greece
[47] Sch Polytech Inst Porto, Porto, Portugal
[48] Univ Lisbon, Lisbon, Portugal
[49] Univ Zagreb, Zagreb, Croatia
[50] Univ Toronto, Toronto, ON, Canada
关键词
aphasia; big data; comprehension; language therapy; meta-analysis; stroke; RANDOMIZED CONTROLLED-TRIAL; TRANSCRANIAL MAGNETIC STIMULATION; ACUTE STROKE PATIENTS; POSTSTROKE APHASIA; LIMB APRAXIA; USUAL CARE; REHABILITATION; SPEECH; EFFICACY; PEOPLE;
D O I
10.1161/STROKEAHA.121.035216
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:956 / 967
页数:12
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