Abstract
Objectives
To conduct a systematic review to elucidate the frequency, recovery, and associated
outcomes for poststroke aphasia over the long-term.
Data Sources
Using the Cochrane Stroke Strategy, we searched 10 databases, 13 journals, 3 conferences,
and the gray literature.
Study Selection
Our a priori protocol criteria included unselected samples of adult stroke patients
from randomized controlled trials or consecutive cohorts. Two independent reviewers
rated abstracts and articles for exclusion or inclusion, resolving discrepancies by
consensus.
Data Extraction
We documented aphasia frequencies by stroke type and setting, and computed odds ratios
(ORs) with their 95% confidence intervals (CIs) for outcomes.
Data Synthesis
We retrieved 2168 citations, reviewed 248 articles, and accepted 50. Median frequencies
for mixed stroke (ischemic and hemorrhagic) were 30% and 34% for acute and rehabilitation
settings, respectively. Frequencies by stroke type were lowest for acute subarachnoid
hemorrhage (9%) and highest for acute ischemic stroke (62%) when arrival to the hospital
was ≤3 hours from stroke onset. Articles monitoring aphasia for 1 year demonstrated
aphasia frequencies 2% to 12% lower than baseline. Negative outcomes associated with
aphasia included greater odds of in-hospital death (OR=2.7; 95% CI, 2.4–3.1) and longer
mean length of stay in days (mean=1.6; 95% CI, 1.0–2.3) in acute settings. Patients
with aphasia had greater disability from 28 days (OR=1.5; 95% CI, 1.3–1.7) to 2 years
(OR=1.7; 95% CI, 1.6–2.0) than those without aphasia. By 2 years, they used more rehabilitation
services (OR=1.5; 95% CI, 1.3–1.6) and returned home less frequently (OR=1.4; 95%
CI, 1.2–1.7).
Conclusions
Reported frequencies of poststroke aphasia range widely, depending on stroke type
and setting. Because aphasia is associated with mortality, disability, and use of
health services, we recommend long-term interdisciplinary vigilance in the management
of aphasia.
Keywords
List of abbreviations:
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Article Info
Publication History
Published online: April 07, 2016
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
