Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis
Creators: name: Brady, Marian C
name: Ali, Myzoon
name: VandenBerg, Kathryn
name: Williams, Linda J
name: Williams, Louise R
name: Abo, Masahiro
name: Becker, Frank
name: Bowen, Audrey
name: Branden-burg, Caitlin
name: Breitenstein, Caterina
name: Bruehl, Stefanie
name: Copland, David A
name: Cranfill, Tamara B
name: Di Pietro-Bachmann, Marie
name: Enderby, Pamela
name: Fillingham, Joanne
name: Galli, Federica Lucia
name: Gandolfi, Marialuisa
name: Glize, Bertrand
name: Godecke, Erin
name: Hawkins, Neil
name: Hilari, Katerina
name: Hinckley, Jacqueline
name: Horton, Simon
name: Howard, David
name: Jaecks, Petra
name: Jefferies, Elizabeth
name: Jesus, Luis MT
name: Kambanaros, Maria
name: Kang, Eun Kyoung
name: Khedr, Eman M
name: Kong, Anthony Pak-Hin
name: Kukkonen, Tarja
name: Laganaro, Marina
name: Ralph, Matthew A Lambon
name: Laska, Ann Charlotte
name: Leemann, Beatrice
name: Leff, Alexander P
name: Lima, Roxele R
name: Lorenz, Antje
name: MacWhinney, Brian
name: Marshall, Rebecca Shisler
name: Mattioli, Flavia
name: MaviS, ilknur
name: Meinzer, Marcus
name: Nilipour, Reza
name: Noe, Enrique
name: Paik, Nam-Jong
name: Palmer, Rebecca
name: Papathanasiou, Ilias
name: Patricio, Brigida
name: Martins, Isabel Pavao
name: Price, Cathy
name: Jakovac, Tatjana Prizl
name: Rochon, Elizabeth
name: Rose, Miranda
name: Rosso, Charlotte
name: Rubi-Fessen, Ilona
name: Ruiter, Marina B
name: Snell, Claerwen
name: Stahl, Benjamin
name: Szaf-larski, Jerzy P
name: Thomas, Shirley A
name: Van de Sandt-Koenderman, Mieke
name: van der Meulen, Ineke
name: Visch-Brink, Evy
name: Worrall, Linda
name: Wright, Heather Harris
Publisher: name: La Trobe
Year: 2022
Subjects: classificationCode: 420699
subject: Public health not elsewhere classified

description: 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 Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected.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 &gt;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, &lt;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 &lt;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: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018110947.