The efficacy of outpatient and community-based aphasia group interventions: A systematic review

Abstract

This paper examines the evidence for community and outpatient aphasia groups using the International Classification of Functioning, Disability and Health (ICF) framework. A systematic search of the literature using eight electronic databases was completed; 29 studies met inclusion and exclusion criteria. Level of evidence and methodological quality was assessed and effect sizes calculated where possible. Evidence favouring community and outpatient groups centred on four level ii and level iii-i studies that examined the efficacy of highly structured group activities for improving specific linguistic processes with five medium-large effect sizes calculated. Medium and large effect sizes were also calculated on a level iii-i study examining number of friendships and community access. No effect sizes were available for level ii or level iii studies examining communication activity and participation. Overall, the results indicate that community and outpatient group participation can improve specific linguistic processes. There is also some evidence that group participation can benefit social networks and community access. However, there is limited evidence demonstrating improvement in functional communication as a consequence of group participation. The current evidence is not comprehensive. Further well-designed studies, particularly examining activity and participation, and contextual factors are required to advance community and outpatient aphasia group practice and participation.

Guidelines for Adult Stroke Rehabilitation and Recovery

“…507 Two systematic reviews have addressed group therapy. 499,508 Group treatments for people with aphasia occur across the continuum of care. 508 Overall, results indicate that group participation can improve specific linguistic processes with no significant difference in outcomes between individual one-on-one therapy and group therapy.…”

“…499,508 Group treatments for people with aphasia occur across the continuum of care. 508 Overall, results indicate that group participation can improve specific linguistic processes with no significant difference in outcomes between individual one-on-one therapy and group therapy. There is also some evidence that outpatient and community-based group participation can benefit social networks and community access.…”

Current Evidence for Post Stroke Aphasia Treatment

“…Several studies used constraint induced aphasia therapy, group discussion, recreational activities with therapist. There was no significant benefit in functional communication, receptive and expressive language for people treated with group-based treatment compared to conventional one-on-one speech language therapy [2,12]. However, there was no statistically significant effectiveness in oneon-one speech and language therapy group compared to group-based treatment group.…”

Setting a Research Agenda to Inform Intensive Comprehensive Aphasia Programs

“…There are similar statements regarding the other components: "Group therapy and conversation groups can be used for people with aphasia and should be available in the longer term for those with chronic and persisting aphasia" (Level C); "Interventions should be individually tailored but can include delivery of therapy programs via computer" (Level C). Although more recently published systematic reviews 48,50 have upgraded the level of evidence in some areas, there is in conversation and the impact of speech and language problems on family and social life. If an intervention targeted at improving participation in family conversation is provided, and this intervention does not have goals related to reading and writing, the inclusion of reading and writing items in the outcome assessment may dilute the treatment effect.…”

“…48 Stroke rehabilitation guidelines in many countries have driven the inclusion of these components into practice. For example, the Australian Stroke Rehabilitation Guidelines 49 recommend that "all stroke survivors and their families/ carers should be offered information tailored to meet their needs using relevant language and communication formats" (Level A evidence).…”