Title: SemaFoRe: Semantic Feature and Repetition therapy in aphasia: A pilot RCT
Funder: Department of Health (England)

Abstract: Background Aphasia is an acquired communication problem, with word retrieval difficulties being a prevalent difficulty experienced. One treatment reported in the literature and widely used is ‘Semantic Feature Analysis’ (SFA) (1). This treatment aims to improve word retrieval by asking the patient to retrieve semantic features of the word (e.g. what the word is used for). Studies have shown improvement in word retrieval, but the existing evidence base is lacking statistical rigour, being based on only 15 single subjects across 8 published papers, with few items It is also not known whether this treatment is more beneficial than more straightforward therapies that aim to combine word sound and meaning, nor to what extent treatment effects generalises to words that are not part of the training. Aims This is a pilot RCT which aims to answer questions of feasibility in evaluating SFA. It will address issues of sample size calculation, recruitment & retention, acceptability and what constitutes a clinically meaningful difference, to inform a future trial. The study will compare SFA with therapy where the word’s sound and meaning is activated simultaneously (repetition in the presence of a picture, hereafter called RIPP) (2). It will examine whether treatment effects generalise to words not targeted in therapy. It is known that no generalisation is seen in RIPP but there is some (weak) evidence of generalisation with SFA. The study aims to provide rigorous and valid foundations to inform a definitive trial which will provide therapists with a robust evidence base to inform therapy. Plan of Investigation This study uses a crossover RCT with 30 patients. In a cross-over trial, patients receive both treatments, with order of treatment randomised to take into account possible order effects (whether RIPP then SFA is different to SFA then RIPP). Two repeated measures pre-therapy will identify any changes during this period. Patients will then either receive SFA or RIPP treatment. Performance on picture naming, a comprehension task, a connected speech measure and a measure of client satisfaction will be reassessed and a period of no therapy will follow. Patients then receive the other treatment, followed by reassessment. Treatment items will be randomly split into 3 sets, 50 items for SFA, 50 for RIPP treatment and a control set, never seen in treatment (to see if generalisation takes place). Potential Impact The study is of significance to therapists working in the NHS who are treating people with aphasia. SFA as a treatment is frequently used clinically (3), yet its efficacy has not been robustly tested. The reports of its efficacy have methodological weaknesses and in particular fail to address whether this treatment is more efficacious than a simpler alternative (e.g. RIPP) and whether treatment effects generalise to untreated items The therapy regimen (number and length of sessions, assessments used etc.) is designed to be directly applicable to therapists working in the NHS. The results of this pilot study will inform the design and conduct of a future definitive trial in this area which will aim to address these questions.


Research activity codes: 6.7 PHYSICAL
Health categories: STROKE;INJURIES AND ACCIDENTS