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Dosage, intensity, and frequency of language therapy for aphasia: a systematic review–based, individual participant data network meta-analysis
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 Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected.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. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018110947.
URL: https://eprints.whiterose.ac.uk/184302/
https://eprints.whiterose.ac.uk/184302/1/STROKEAHA.121.035216%20%281%29.pdf
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2
Utilising a systematic review-based approach to create a database of individual participant data for meta- and network meta-analyses: the RELEASE database of aphasia after stroke
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3
Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis
Leemann, B.; Nilipour, R.; Rose, M. L.. - : Lippincott, Williams & Wilkins, 2021
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4
Predictors of Poststroke Aphasia Recovery
Bowen, A.; Williams, L.; Pavao Martins, I.. - : Ovid Technologies (Wolters Kluwer Health), 2021
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5
Utilising a systematic review-based approach to create a database of individual participant data for meta- and network meta-analyses: the RELEASE database of aphasia after stroke
Williams, LR; Ali, M; VandenBerg, K. - : Informa UK Limited, 2021
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6
Predictors of poststroke aphasia recovery: a systematic review-informed individual participant data meta-analysis
Ali, M; VandenBerg, K; Williams, LJ. - : Wolters Kluwer Health, 2021
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7
Communicating simply, but not too simply: Reporting of participants and speech and language interventions for aphasia after stroke
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8
RELEASE: A protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia
Brady, M. C.; Ali, M.; VandenBerg, K.. - : Taylor & Francis (Routledge), 2019
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9
RELEASE : a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia
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10
RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia
In: Aphasiology, 2019 (2019)
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11
Tidier descriptions of speech and language therapy interventions for people with aphasia; consensus from the release collaboration
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12
Tidier descriptions of speech and language therapy interventions for people with aphasia; consensus from the RELEASE collaboration
Rose, M.L.; Ali, M.; Elders, A.. - : Taylor & Francis, 2018
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13
Stuttering. A clinical handbook on diagnosis assessment and treatment (in Farsi)
Howell, P; Nilipour, R. - : Isfahan University Press, 2009
In: Isfahan University Press: Isfahan. (2009) (2009)
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14
Emerging Issues in Speech Therapy in Iran
In: Folia phoniatrica et logopaedica. - Basel : Karger 54 (2002) 2, 65-68
OLC Linguistik
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