Tidier descriptions of speech and language therapy interventions for people with aphasia; consensus from the RELEASE Collaboration


Miranda L. Rose, La Trobe University
Myzoon Ali, Glasgow Caledonian University
Andrew Elders, Glasgow Caledonian University
Jon Godwin, Glasgow Caledonian University
Anastasia Karachalia Sandri, Glasgow Caledonian University
Linda J. Williams, University of Edinburgh
Louise R. Williams, Glasgow Caledonian University
Kathryn VandenBerg, Glasgow Caledonian University
Stefanie Abel, University of Manchester
Masahiro Abo, The Jikei University School of Medicine
Frank Becker, University of Oslo
Audrey Bowen, University of Manchester
Caitlin Brandenburg, The University of Queensland, Australia
Caterina Breitenstein, University of Muenster
David Copland, The University of Queensland, Australia
Tamara B. Cranfill, Eastern Kentucky University
Marie di Pietro-Bachmann, University Hospitals and University of Geneva
Pamela Enderby, University of Sheffield
Joanne Fillingham, NHS Improvement, London
Federica Lucia Galli, Polytechnic University of Marche
Marialuisa Gandolfi, University of Verona
Bertrand Glize, University of Bordeaux
Erin Godecke, Edith Cowan University
Katerina Hilari, University of London
Jacqueline Hinckley, University of South FloridaFollow
Simon Horton, University of East Anglia
David Howard, University of Newcastle-upon-Tyne
Petra Jaecks, Universitat Bielefeld
Elizabeth Jefferies, University of York
Luis M. T. Jesus, University of Aveiro
Maria Kambanaros, University of Technology, Limassol, Cyprus
Eman M. Khedr, Assiut University
Anthony PH Kong, Kangwon National University
Tarja Kukkonen, Tampere University Hospital
Eun Kyoung Kang, Kangwon National University
Matthew A. Lambon Ralph, University of Manchester
Marina Laganaro, University of Geneva
Ann Charlotte Laska, Karolinska Institute
Beatrice Leemann, University of Geneva
Alexander P. Leff, University College London
Antje Lorenz, Humboldt-University Berlin
Brian MacWhinney, Carnegie Mellon University
Flavia Mattioli, ASST Spedali Civili of Brescia
Ilknur Mavis, Anadolu University
Marcus Meinzer, The University of Queensland, Australia
Enrique Noé Sebastián, Hospitales Vithas-Nisa
Reza Nilipour, University of Social Welfare and Rehabilitation Sciences
Robyn O'Halloran, La Trobe University
Nam-Jong Paik, Seoul National University
Rebecca Palmer, University of Sheffield
Ilias Papathanasiou, Technological Educational Institute of Western Greece
Brigida F. Patricio, Polytechnic Institute of Porto
Isabel Pavão Martins, Universidade de Lisboa
John Pierce, La Trobe University
Cathy Price, University College London
Tatjana Prizl Jakovac, University of Zagreb
Elizabeth Rochon, University of Toronto
Charlotte Rosso, Universite Paris-Sorbonne (Paris IV)
Roxele Lima Ribeiro, Educational Association Bom Jesus - IELUSC
Ilona Rubi-Fessen, University of Cologne
Marina B. Ruiter, Radboud University Nijmegen
Rebecca Shisler Marshall, University of Georgia
Steve Small, University of California, Irvine
Claerwen Snell, Warrington Hospital
Benjamin Stahl, Charité Universitätsmedizin Berlin
Jerzy P. Szaflarski, University Of Alabama At Birmingham
Shirley Thomas, University of Nottingham
Leanne Togher, The University of Sydney
Ineke van der Meulen, Rijndam Rehabilitation, Rotterdam
Mieke van de Sandt-Koenderman, Rijndam Rehabilitation, Rotterdam
Evy Visch-Brink, Erasmus University of Rotterdam
Linda Worrall, The University of Queensland, Australia
Heather Harris Wright, East Carolina University
Marian C. Brady, Glasgow Caledonian University

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Aphasia rehabilitation, Speech and language interventions, Categorizing interventions






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Background: Speech and language therapy (SLT) interventions for people with aphasia are complex – for example, interventions vary by delivery model (face-to-face, tele-rehabilitation), dynamic (group, 1-to-1) and provider. Therapists tailor the functional relevance and intervention difficulty to the individual’s needs. Therapy regimes are planned at a specific intensity (hours per week), frequency (number of weekly sessions), duration (time from start to end of therapy intervention) and dose (total number of therapy hours). Detailed and transparent description of interventions for people with aphasia facilitates replication in clinic, between-study comparisons and data-syntheses. Incomplete intervention reporting and inconsistencies in the use of terminology have been observed (RELEASE: REhabilitation and recovery of peopLE with Aphasia after StrokE Collaborators, Citation2015-2018; Brady, Kelly, Godwin, Enderby, & Campbell, Citation2016; Pierce, O’Halloran, Togher, & Rose, Citationin press). Even when similar terms are used there may be little agreement on their use (Pierce et al., in press).

Our RELEASE Collaboration includes 72 multidisciplinary, multilingual aphasia researchers from 28 countries. In preparation for planned meta-analyses (HS&DR 14/04/22) we sought to extract and synthesise information on SLT interventions for aphasia. Description of interventions in research reports have benefited from the Template for Intervention Description and Replication (TIDieR; (Hoffmann et al., Citation2014). The TIDieR checklist supports transparent reporting, data extraction and synthesis in aphasia research. It has facilitated an exploration of the contribution specific parameters (for example intensity) may make to the effectiveness of (or tolerance to) an intervention (Brady et al., Citation2016). However, while the variables described above are readily summarised, other aspects of therapeutic interventions such as the theoretical approach, the materials used and the procedures employed (the “Why” and “What” within TIDieR) are more challenging to summarise in manner supporting data synthesis and meta-analyses. The World Health Organisation’s (“International Classification of Health Interventions (ICHI),”) also seeks a framework which supports the synthesis and statistical analysis of healthcare interventions based on (a) the treatment target, (b) the intended action to the target and (c) the processes and methods required to carry out the action (ICHI, Citation2018). However a framework which complements these initiatives and which supports greater consistency in the description of SLT interventions for aphasia is required.

Aims: We sought to develop international consensus on a framework to support the description of SLT interventions for people with aphasia.

Methods and procedures: Two researchers independently extracted information about the SLT interventions in our RELEASE database (Hoffmann et al., 2014). Information on therapy approaches, materials and procedures were extracted, where possible, as direct quotes from published reports. Using the narrative descriptions, similar approaches were grouped and assigned to one or more category labels by an experienced speech and language therapist. These preliminary groupings were shared with RELEASE Collaborators for review. Each reviewed interventions included within up to four category labels and responses via email were requested. There followed an opportunity for group discussion on the proposed categorisation via videoconference.

Outcomes and results: Therapy interventions were categorised based on three perspectives (a) the role of the intervention within the study design e.g., usual care as a comparison control (b) the intervention target e.g., rehabilitation of spoken language production and (c) the theoretical approach e.g., semantic therapy. We identified 15 SLT approaches. Categories were not mutually exclusive; rather they represented different ways of categorising a complex intervention. Inadequate reporting of therapy interventions, procedures and materials hampered some classifications. The Collaboration facilitated knowledge sharing relating to emerging treatment category definitions such as multimodal treatment (Pierce et al., Citationin press) which reflected interventions aimed to utilise a range of learning mechanisms and neural networks to facilitate language recovery.

Conclusions: Our collaboration agreed on a framework which supports transparent description, data synthesis and meta-analyses of SLT interventions for people with aphasia after stroke.



This project was funded by the National Institute for Health Research (NIHR), Health Services and Delivery Research Programme [HS&DR–14/04/22]. MCB is funded by the Chief Scientist Office (CSO), Scottish Government Health and Social Care Directorates. The project originated amongst members of the Collaboration of Aphasia Trialists (IS1208) funded by the EU Cooperation in Science and Technology [COST IS1208 2013-2017] and the Tavistock Trust for Aphasia (TTA) (2017-2020).



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