Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis
Stroke
REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE) Collaborators, Brady, M. C., et al. (2022).
Stroke, 53(3), 956-967.
This systematic review and meta-analysis investigates the association of speech-language pathology treatment intensity, dosage, frequency, duration, delivery, and content on language outcomes for people with aphasia.
National Institute for Health Research Health Services and Delivery Research (United Kingdom); Tavistock Trust for Aphasia (United Kingdom)
From database inception to September 2015
Published and non-published datasets from randomized controlled trials
959 Individual Patient Data from 25 studies
Finding demonstrated the following results for effects of dosage of Speech Language Pathology (SLP) treatment on linguistic outcomes in individuals with aphasia: <br /><br />The greatest gains in overall language (as measured by the Western Aphasia Battery–Aphasia Quotient) were associated with:<br />
<ul>
<li><span style="color: #333333;">20+ to 50 overall hours of SLP treatment (SMD=18.37 [10.58–26.16]),</span></li>
<li><span style="color: #333333;">less than or equal to 2 hours (SMD=15.85 [8.06–23.64]), 3 to 4 hours (SMD= 15.80 [8.85–22.74]), or greater than 9 hours (SMD= 15.64 [9.14–22.13]) of SLP treatment a week, and</span></li>
<li><span style="color: #333333;">5 days a week (SMD=14.95 [8.67–21.23]).</span></li>
</ul>
The greatest gains in overall comprehension (as measured by the Aachen Aphasia Test–Token Test) were associated with:<br />
<ul>
<li><span style="color: #333333;">20+ to 50 overall hours of SLP treatment (SMD=5.23 [1.51–8.95]),</span></li>
<li><span style="color: #333333;">less than or equal to 2 hours (SMD=6.5 [1.72–11.27]), 3 to 4 hours (SMD=6.01 [1.04–10.98]) , or greater than 9 hours (SMD=7.3 [4.09–10.52]) of SLP treatment a week, and </span></li>
<li><span style="color: #333333;">4 days a week.</span></li>
</ul>
<span style="color: #333333;">The greatest gains in overall functional communication (as measured by the Aachen Aphasia Test-Spontanteous Speech Communication score) were associated with:<br /></span>
<ul>
<li><span style="color: #333333;">14 to 20 overall hours of SLP treatment (SMD=0.94 [0.34–1.55]),</span></li>
<li><span style="color: #333333;">less than or equal to 2 hours (SMD=0.77 [0.36– 1.19]), 2 to 3 hours (SMD= 0.76 [0.34–1.18], or 3 to 4 hours a week (SMD= 0.76 [0.34-1.18], and</span></li>
<li><span style="color: #333333;">5 days a week (SMD=0.78 [0.48–1.09]).</span></li>
</ul>
<span style="color: #333333;">Evidence of comprehension gains was absent for SLP treatment:<br /></span>
<ul>
<li><span style="color: #333333;">less than 20 overall hours,</span></li>
<li><span style="color: #333333;">less than 3 hours a week or between 3 and 9 hours a week, and</span></li>
<li><span style="color: #333333;">less than or equal to 3 days a week.</span></li>
</ul>
<span style="color: #333333;">Evidence of functional communication gains was absent for SLP treatment:</span><br />
<ul>
<li><span style="color: #333333;">less than or equal to 5 overall hours, and</span></li>
<li><span style="color: #333333;">greater than 5 days a week</span></li>
</ul>
The following findings were noted regarding SLP rehabilitation targets and/or theoretical approaches:<br />
<ul>
<li><span style="color: #333333;">Mixed receptive-expressive therapy was associated with the greatest combined overall language (SMD=15.62 [8.82–22.43]) and functional communication gains (SMD=15.62 [8.82–22.43]).</span></li>
<li><span style="color: #333333;"> Auditory (SMD=4.46 [0.31–8.62]) and naming (SMD=4.46 [0.31–8.62]) gains were greatest for word-finding approaches. </span></li>
<li><span style="color: #333333;">Semantic-phonological therapy was associated with greater overall gains in language ability (SMD=20.39 [1.90–38.88]) and auditory comprehension (SMD=11.93 [1.44–22.43]).</span></li>
<li><span style="color: #333333;">Functional pragmatic approaches were associated with the greatest functional communication gains (SMD=1.82 [0.36–3.28]).</span></li>
<li><span style="color: #333333;">When programs were functionally tailored to the individual, they were associated with greater gains in overall language ability (SMD=16.47 [10.95-21.99]) and naming (SMD=8.79 [1.95-15.63]), with marginal gains in functional communication (SMD=0.74 [0.38-1.10]). Auditory comprehension gains were only seen for individually tailored programs (SMD= 5.26 [2.05-8.47]) as compared to untailored programs.<br /></span></li>
<li><span style="color: #333333;">Therapy tailored by difficulty was associated with greater gains in auditory comprehension (SMD=4.57 [1.55–7.60]) and greater overall language gains (SMD=14.4 [8.82–20.09]) as compared to untailored approaches.</span></li>
</ul>
<span style="color: #333333;">Of note, these results were based off of limited numbers of trials and patients, and further research is indicated in determining the effects of these treatments on language outcomes in this population.</span>
Findings demonstrated that prescribed home programs were associated with greater overall language (SMD=16.69 [10.01–23.37]) and auditory comprehension gains (SMD= 5.28 [2.19– 8.37]) for individuals with aphasia. No significant effect was found for home programs regarding functional communication outcomes. Of note, these findings were based on a limited number of studies and patient data, and further research is indicated to determine the effect of home program use on linguistic outcomes in this population.
Findings demonstrated that were no differences in language outcomes across speech-language pathology treatment service deliveries to individuals with aphasia, with equivalent results across inpatient and outpatient settings, between professionals and trained nonprofessional providers, and in face-to-face, computer-supported, or self-manages therapy approaches. Of note, these findings were based off of a small sample size with heterogeneous methodology. Further research is warranted to determine the true impact of service delivery of SLP services in this population.
