Dataset Information

Benchmarks of Significant Change After Aphasia Rehabilitation.

ABSTRACT: OBJECTIVE:To establish benchmarks of significant change for aphasia rehabilitation outcome measures (ie, Western Aphasia Battery-Aphasia Quotient [WAB-AQ], Communicative Effectiveness Index [CETI], Boston Naming Test [BNT]) and assess if those benchmarks significantly differ across subgroups (ie, time post onset, dose frequency, treatment type). DATA SOURCES:A comprehensive literature search of 12 databases, reference lists of previous reviews, and evidence-based practice materials was conducted. STUDY SELECTION:Randomized controlled trials, quasi-experimental studies, single-subject design, and case studies that used a standardized outcome measure to assess change were included. Titles and full-text articles were screened using a dual review process. Seventy-eight studies met criteria for inclusion. DATA EXTRACTION:Data were extracted independently, and 25% of extractions were checked for reliability. All included studies were assigned quality indicator ratings and an evidence level. DATA SYNTHESIS:Random-effects meta-analyses were conducted separately for each study design group (ie, within-/between-group comparisons). For within-group designs, the summary effect size after aphasia rehabilitation was 5.03 points (95% confidence interval, 3.95-6.10, P<.001) on the WAB-AQ, 10.37 points (6.08-14.66, P<.001) on the CETI, and 3.30 points (2.43-4.18, P<.001) on the BNT. For between-group designs, the summary effect size was 5.05 points (1.64-8.46, P=.004) on the WAB-AQ and 0.55 points (-1.33 to 2.43, P=.564) on the BNT, the latter of which was not significant. Subgroup analyses for the within-group designs showed no significant differences in the summary effect size as a function of dose frequency or treatment type. CONCLUSIONS:This study established benchmarks of significant change on 3 standardized outcome measures used in aphasia rehabilitation.

SUBMITTER: Gilmore N

PROVIDER: S-EPMC6422764 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Benchmarks of Significant Change After Aphasia Rehabilitation.

Gilmore Natalie N Dwyer Michaela M Kiran Swathi S

Archives of physical medicine and rehabilitation 20180918 6

<h4>Objective</h4>To establish benchmarks of significant change for aphasia rehabilitation outcome measures (ie, Western Aphasia Battery-Aphasia Quotient [WAB-AQ], Communicative Effectiveness Index [CETI], Boston Naming Test [BNT]) and assess if those benchmarks significantly differ across subgroups (ie, time post onset, dose frequency, treatment type).<h4>Data sources</h4>A comprehensive literature search of 12 databases, reference lists of previous reviews, and evidence-based practice material ...[more]

PMID: 30240594

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Project description:Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research-practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5-20 sessions). Sessions occurred 1-2 times a week over 4-14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75-15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12-30 hr) over the course of 15 sessions (interquartile range: 10-24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research-practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568.

Project description:IntroductionAphasia is an impairment of language that occurs in 30%-40% of stroke survivors. This often chronic condition results in poor outcomes for the individual with aphasia and their family. Long-term aphasia management is limited, with few people receiving sufficient services by 6-12 months postonset. We present a protocol for the development of coproduced aphasia service elements. We will use experience-based codesign (EBCD), an approach that enables service users and providers to collaboratively develop services and care pathways. Drawing on the experiences of people with aphasia, their families and clinicians we will establish priorities for the development of new services and later work together to codesign them.Methods and analysisThis research will be coproduced with people with aphasia (n=30-60), their families (n=30-60) and speech pathologists (n=30-60) in Queensland, Australia, using EBCD. A consumer advisory committee will provide oversight and advice throughout the research. In phase 1, we will use semistructured interviews and the nominal group technique to explore experiences and unmet needs in aphasia rehabilitation. Data will be analysed using thematic analysis and the resulting themes will be prioritised in multistakeholder focus groups. Outcomes of phase 1 will inform future research (phase 2) to codesign services. Financial costs and participant experiences of EBCD will be measured.Ethics and disseminationHuman Research Ethics Committee approval for phase 1 has been obtained (HREC/2020/QRBW/61368). Results will be reported in peer-reviewed journal articles, presented at relevant conferences and, following EBCD suggested best practice, fed back to participants and community members at a celebratory event at completion of the project. The inclusion of service users in all stages of research will facilitate an integrated approach to knowledge translation. A summary of research findings will be made available to participating sites.

Project description:An advantage of rehabilitation administered on computers or tablets is that the tasks can be self-administered and the cueing required to complete the tasks can be monitored. Though there are many types of cueing, few studies have examined how participants' response to rehabilitation is influenced by self-administered cueing, which is cueing that is always available but the individual decides when and which cue to administer. In this study, participants received a tablet-based rehabilitation where the tasks were selfpaced and remotely monitored by a clinician. The results of the effectiveness of this study were published previously (Des Roches et al., 2015). The current study looks at the effect of cues on accuracy and rehabilitation outcomes. Fifty-one individuals with aphasia completed a 10-week program using Constant Therapy on an iPad targeted at improving language and cognitive deficits. Three questions were examined. The first examined the effect of cues on accuracy collapsed across time. Results showed a trend where the greater the cue use, the lower the accuracy, although some participants showed the opposite effect. This analysis divided participants into profiles based on cue use and accuracy. The second question examined how each profile differed in percent cue use and on standardized measures at baseline. Results showed that the four profiles were significantly different in frequency of cues and scores on WAB-R, CLQT, BNT, and ASHA-FACS, indicating that participants with lower scores on the standardized tests used a higher percentage of cues, which were not beneficial, while participants with higher scores on the standardized tests used a lower frequency of cues, which were beneficial. The third question examined how the relationship between cues and accuracy was affected by the course of treatment. Results showed that both more and less severe participants showed a decrease in cue use and an increase in accuracy over time, though more severe participants continued to used a greater number of cues. It is possible that self-administered cues help some individuals to access information that is otherwise inaccessible, even if there is not an immediate effect. Ultimately, the results demonstrate the need for individually modifying the levels of assistance during rehabilitation. time, though more severe participants continued to used a greater number of cues. It is possible that self-administered cues help some individuals to access information that is otherwise inaccessible, even if there is not an immediate effect. Ultimately, the results demonstrate the need for individually modifying the levels of assistance during rehabilitation.

Dataset Information

Benchmarks of Significant Change After Aphasia Rehabilitation.

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Benchmarks of Significant Change After Aphasia Rehabilitation.

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