A systematic review of maintenance following intensive therapy programs in chronic post-stroke aphasia: importance of individual response analysis

Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia

“…Although maintenance of word retrieval effects were seen at 12 weeks follow-up these were not seen at the group level for functional communication, multimodal communication or quality of life outcomes. This latter finding is consistent with the Cochrane Review of SLT5 and a recent systematic review of maintenance of outcomes following intensive aphasia interventions,29 which showed on average a 50% loss of gains at follow-up. Such loss highlights the need for research into the impacts of maintenance doses of intervention on preserving therapeutic gains after intensive aphasia interventions as well as careful examination of participant factors associated with treatment response and maintenance of response.…”

Operationalising treatment success in aphasia rehabilitation

“…The response rate is the percentage of participants who were treated 'per protocol' (the ontreatment group) and showed beneficial effects from pre to post intervention that were equal to or larger than the critical change score ('treatment responders'). To date, large scale aphasia randomised controlled trials (RCTs) lack reports of such therapy response rates (Menahemi-Falkov et al, 2021). However, the treatment response rate in a given population should be reported in any aphasia intervention study.…”

“…There is an additional argument for choosing a more liberal type I error level of 10% (two-sided) in clinical populations like PWA: with a liberal type-I error level, the type-II error level, i.e., the error of 'overlooking' a 'true' difference, is reduced. In Table 3 we provide the cut-off scores for an individual treatment success for common aphasia OMIs based on a systematic review of intervention effects in post-stroke aphasia rehabilitation (Menahemi-Falkov et al, 2021). BNT = Boston Naming Test; WAB = Western Aphasia Battery Aphasia; ANELT = Amsterdam Nijmegen Everyday Language Test; AAT = Aachen Aphasia Test; CETI = Communicative Effectiveness Index.…”

“…The SDC90 for the WAB-R AQ in chronic post-stroke aphasia has been estimated at 8.26 points (see Table 3; the benchmark has been reported in Menahemi-Falkov et al, 2021) 9 . If an individual scored 50 on the WAB-R AQ at the baseline assessment, the posttreatment score would have to be at least (50 + 8.26 =) 58.26 points to be considered a statistically significant improvement in 'true' performance level with 90% confidence.…”

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

“…The breadth of treatment protocols and targets precludes discussion here, but general trends involve establishing higher levels of evidence for some of the most established protocols (e.g., semantic feature analysis [SFA, see NCT04215952], constraint-induced aphasia therapy (CIAT, [114]), or verb network strengthening treatment [VNeST, NCT05152979]) or to examine optimal dose/frequency/intensity, either generally [115] or for specific protocols (e.g., [116]). The latter question has also prompted investigations of intensive treatment programs where a significant amount of treatment (e.g., 30 h) is provided over a relatively brief period of time (e.g., 2 weeks; NCT04957225, [117,118]). Such programs report favorable outcomes, including the psychological well-being of participants [119,120], but the optimal timing of such intensive practice is not known (i.e., acute vs. subacute vs. chronic), especially considering feasibility and tolerance concerns during earlier stages of recovery [121,122].…”