A Systematic Review of Intensive Comprehensive Aphasia Programmes – Who Takes Part, What Is Measured, What Are the Outcomes?
Disability and Rehabilitation
Monnelly, K., Marshall, J., et al. (2023).
Disability and Rehabilitation, Advance online publication. https://doi.org/10.1080/09638288.2023.2274877.
This systematic review investigates the effects of Intensive Comprehensive Aphasia Programmes (ICAPs) on communication and quality of life outcomes for adults with aphasia.
Stroke Association (United Kingdom); University of London (United Kingdom)
Search results from the following article were considered for inclusion in this review:<br />
<ul>
<li>Monnelly, K., Marshall, J., & Cruice, M. (2022). Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions. <em>Disability and Rehabilitation 44</em>(21), 6471–6496. https://doi.org/10.1080/09638288.2021.1964626</li>
</ul>
From database inception to August 2022
Quantitative methodologies
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<div>Generally, ICAPs improved word finding, communication, activity/participation, and communication-related quality of life outcomes for adults with aphasia, with good maintenance of these gains. However, with the exception of word finding, evidence came from single or limited studies. Specific results included: </div>
<ul>
<li><span style="color: #333333;">Five of six studies reported improvements in at least one language modality, with four studies demonstrating maintenance of these gains over time. However, one study reported that the rates of improvements made during the ICAP were equal to those seen in pre-treatment periods. </span></li>
<li><span style="color: #333333;">Two studies reported improved scores on comprehensive language tests (e.g., the Comprehensive Aphasia Test, the Western Aphasia Battery). These improvements were noted immediately post-treatment and at follow-up. However, these improvements could not be reliably attributed to the ICAPs due to a lack of stable baseline. </span></li>
<li><span style="color: #333333;">One study demonstrated improved psychological functioning, and another demonstrated improved cognitive functioning. Both demonstrated maintenance of these gains at follow-up. </span></li>
<li><span style="color: #333333;">Two of three studies reported improved communicative participation, with maintained gains at follow-up. </span></li>
<li><span style="color: #333333;">One study reported improved activity and participation, with maintenance at follow-up. </span></li>
<li><span style="color: #333333;">Two studies investigated the impact of treatment distribution (i.e., 48 hours of treatment delivered over 3 weeks or 8 weeks). One study demonstrated that distributed therapy resulted in improved naming when compared to the ICAP, however, no other differences were reported between groups. One study reported equal outcomes across all measures of language, psychological functioning, and communication activity. </span></li>
<li><span style="color: #333333;">Two studies reported greater language outcomes for individuals with milder aphasia. </span></li>
<li><span style="color: #333333;">One study reported that time post-onset did not impact outcomes. </span></li>
<li><span style="color: #333333;">Adverse events such as fatigue and exhaustion were noted to occur during the administration of ICAPs, but they may not have been related to the intervention. </span></li>
</ul>
<div><span style="color: #333333;">The authors of this review could not complete a meta-analysis due to heterogeneity between studies and an overall lack of high-quality studies. Additional limitations to this review includes the lack of investigation of factors potentially influencing treatment outcomes (e.g., drop-out rates, missed sessions), the lack of an independent second reviewer to screen abstracts, and the potential risk of bias due to the exclusion of non-English papers.</span></div>
