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  Dosage, intensity and frequency of language therapy for aphasia: An individual participant data network meta-analysis

RELEASE Collaboration, & Stahl, B. (2022). Dosage, intensity and frequency of language therapy for aphasia: An individual participant data network meta-analysis. Stroke, 53(3), 956-967. doi:10.1161/strokeaha.121.035216.

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RELEASE Collaboration, Author              
Stahl, Benjamin1, Author              
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1Department of Neurology, Charité University Medicine Berlin, Germany, ou_persistent22              

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Free keywords: Aphasia; Big data; Comprehension; Language therapy; Meta-analysis; Stroke
 Abstract: 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 Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected.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.

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Language(s): eng - English
 Dates: 2021-04-282021-07-302021-12-012022-03
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: DOI: 10.1161/strokeaha.121.035216
Other: epub 2021
PMID: 34847708
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Title: Stroke
Source Genre: Journal
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Publ. Info: Philadelphia, PA : Lippincott Williams & Wilkins
Pages: - Volume / Issue: 53 (3) Sequence Number: - Start / End Page: 956 - 967 Identifier: ISSN: 0039-2499
CoNE: https://pure.mpg.de/cone/journals/resource/954925447729