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Precision rehabilit...
Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis
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Brady, MC (författare)
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Ali, M (författare)
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VandenBerg, K (författare)
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visa fler...
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Williams, LJ (författare)
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Williams, LR (författare)
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Abo, M (författare)
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Becker, F (författare)
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Bowen, A (författare)
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Brandenburg, C (författare)
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Breitenstein, C (författare)
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Bruehl, S (författare)
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Copland, DA (författare)
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Cranfill, TB (författare)
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Di Pietro-Bachmann, M (författare)
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Enderby, P (författare)
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Fillingham, J (författare)
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Galli, FL (författare)
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Gandolfi, M (författare)
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Glize, B (författare)
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Godecke, E (författare)
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Hawkins, N (författare)
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Hilari, K (författare)
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Hinckley, J (författare)
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Horton, S (författare)
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Howard, D (författare)
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Jaecks, P (författare)
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Jefferies, E (författare)
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Jesus, LMT (författare)
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Kambanaros, M (författare)
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Kang, EK (författare)
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Khedr, EM (författare)
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Kong, APH (författare)
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Kukkonen, T (författare)
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Laganaro, M (författare)
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Ralph, MAL (författare)
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- Laska, AC (författare)
- Karolinska Institutet
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Leemann, B (författare)
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Leff, AP (författare)
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Lima, RR (författare)
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Lorenz, A (författare)
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MacWhinney, B (författare)
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Marshall, RS (författare)
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Mattioli, F (författare)
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Mavis, I (författare)
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Meinzer, M (författare)
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Nilipour, R (författare)
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Noe, E (författare)
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Paik, NJ (författare)
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Palmer, R (författare)
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Papathanasiou, I (författare)
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Patricio, B (författare)
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Martins, IP (författare)
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Price, C (författare)
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Jakovac, TP (författare)
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Rochon, E (författare)
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Rose, ML (författare)
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Rosso, C (författare)
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Rubi-Fessen, I (författare)
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Ruiter, MB (författare)
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Snell, C (författare)
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Stahl, B (författare)
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Szaflarski, JP (författare)
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Thomas, SA (författare)
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Van de Sandt-Koenderman, M (författare)
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Van der Meulen, I (författare)
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Visch-Brink, E (författare)
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Worrall, L (författare)
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Wright, HH (författare)
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visa färre...
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(creator_code:org_t)
- 2022-05-18
- 2022
- Engelska.
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Ingår i: International journal of stroke : official journal of the International Stroke Society. - : SAGE Publications. - 1747-4949. ; 17:10, s. 1067-1077
- Relaterad länk:
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http://kipublication...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Stroke rehabilitation interventions are routinely personalized to address individuals’ needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. Aim: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. Methods: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild–moderate/ moderate–severe based on language outcomes’ median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. Results: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants’ greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3–4 SLT-h/week; ⩾ 50 hours). For moderate–severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild–moderate participants’ greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males’ greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. Conclusions: We observed a treatment response in most subgroups’ overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild–moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate–severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
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Till lärosätets databas
- Av författaren/redakt...
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Brady, MC
-
Ali, M
-
VandenBerg, K
-
Williams, LJ
-
Williams, LR
-
Abo, M
-
visa fler...
-
Becker, F
-
Bowen, A
-
Brandenburg, C
-
Breitenstein, C
-
Bruehl, S
-
Copland, DA
-
Cranfill, TB
-
Di Pietro-Bachma ...
-
Enderby, P
-
Fillingham, J
-
Galli, FL
-
Gandolfi, M
-
Glize, B
-
Godecke, E
-
Hawkins, N
-
Hilari, K
-
Hinckley, J
-
Horton, S
-
Howard, D
-
Jaecks, P
-
Jefferies, E
-
Jesus, LMT
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Kambanaros, M
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Kang, EK
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Khedr, EM
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Kong, APH
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Kukkonen, T
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Laganaro, M
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Ralph, MAL
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Laska, AC
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Leemann, B
-
Leff, AP
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Lima, RR
-
Lorenz, A
-
MacWhinney, B
-
Marshall, RS
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Mattioli, F
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Mavis, I
-
Meinzer, M
-
Nilipour, R
-
Noe, E
-
Paik, NJ
-
Palmer, R
-
Papathanasiou, I
-
Patricio, B
-
Martins, IP
-
Price, C
-
Jakovac, TP
-
Rochon, E
-
Rose, ML
-
Rosso, C
-
Rubi-Fessen, I
-
Ruiter, MB
-
Snell, C
-
Stahl, B
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Szaflarski, JP
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Thomas, SA
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Van de Sandt-Koe ...
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Van der Meulen, ...
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Visch-Brink, E
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Worrall, L
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Wright, HH
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visa färre...
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- Av lärosätet
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Karolinska Institutet