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Stroke: A Journal of Cerebral Circulation


Aphasia, Humans, Language Therapy, Network Meta-Analysis, Stroke, Stroke Rehabilitation







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BACKGROUND AND PURPOSE: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia.

METHODS: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori-defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI).

RESULTS: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58-26.16] Western Aphasia Battery-Aphasia Quotient; 5.23 [1.51-8.95] Aachen Aphasia Test-Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3-5+ days/week), and comprehension (4-5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours,/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was

CONCLUSIONS: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services. Registration: URL:; Unique identifier: CRD42018110947.



We thank the Collaboration of Aphasia Trialists (IS1208) EU Cooperation in Science and Technology and Patient and Public Involvement group members of the University of East Anglia Aphasia Research Collaboration.

Sources of Funding

This study was supported by the National Institute for Health Research Health Services and Delivery Research (14/04/22); The Tavistock Trust for Aphasia, United Kingdom. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the National Institute for Health Research, National Health Service, UK or the Department of Health, UK. All members of the REhabilitation and recovery of peopLE with Aphasia after StrokE collaboration had the opportunity to review and critically appraise the final draft of the manuscript.

Supplemental Material is available with this article at





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