Post stroke aphasia is associated with functional recovery, mobility, continence, emotional well-being, place of discharge and return to work. The effective management and rehabilitation of this language impairment is vitally important. Although SLT clinical practice and current guidelines accept the benefit of SLT for people with aphasia following stroke, evidence of the effectiveness of therapy has been of varying quality, based on different intervention models and often poorly reported. Previous systematic reviews on this topic area focused on English language publications, included non-randomised and quasi-randomised controlled trials or lacked meta-analyses.
To evaluate through a rigorous Cochrane systematic literature review the effectiveness of SLT for people with aphasia following a stroke compared with no SLT, social support or an alternative SLT approach.
Medline, Cinahl the Cochrane Controlled Trials Register (from inception-July 2011) and the grey literature. Additional records were identified by contacting trialists, clinical experts and searching relevant reference lists.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES:
Randomised controlled trials that evaluated standard SLT interventions compatible with clinical practice (and targeting improvements in communicative abilities) were compared with no intervention, social support or other therapy intervention.
Primary outcome - functional communication. Secondary outcomes - measures of language ability, acceptability and costs.
Data were double extracted. Where possible, odds ratios, mean differences and standardised mean differences with 95% confidence intervals were calculated. Risk of bias was also assessed.
19 randomised comparisons (1414 people), comparing the effects of SLT with no SLT, were included. Meta-analysis of effect demonstrated an overall benefit at the end of SLT for participantsí functional communication [P = 0.008, SMD 0.30, 95% CI 0.08-0.52], expressive language (general [P=0.02; SMD 0.77, 95% CI 0.14 to 1.39]; writing [P=0.002; SMD 0.45, 95% CI 0.16-0.74]), receptive language (mixed skills [P = 0.02, MD 8.04, 95% CI 1.55-14.52] and reading [P =0.05, SMD 0.29, 95% CI 0.00-0.58]). Limited data were available on psychosocial impact and costs.
Seven randomised comparisons (432 people) compared SLT with social support but found no evidence of a difference in functional communication.
We included 25 randomised comparisons (910 people) comparing the effects of different SLT approaches. When compared to conventional SLT, high intensity SLT (7 to 20 hours per week) reduced the severity of aphasia [SMD 0.35, CI 95% 0.04 to 0.66); p=0.03]. This finding was confounded by a significantly higher participant drop out from the high intensity groups [OR 2.01, CI 95% 1.07 to 3.79); p=0.03]. We observed little evidence of differences between other therapy approaches (e.g. group, volunteer-facilitated, computer-facilitated SLT).
SLT for people with aphasia following stroke improves performance on measures of functional communication, expressive language and receptive language. High intensity SLT therapy may be beneficial for some. Improved quality of design and reporting (randomisation processes, interventions, outcome data including costs) and conduct (intention to treat analyses, loss to follow-up) of SLT trials for people with aphasia would further improve our understanding of the most effective approach to SLT for aphasia following stroke.