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.
Keywords
List of abbreviations:
ASHA (American Speech-Language-Hearing Association), BNT (Boston Naming Test), CI (confidence interval), CETI (Communicative Effectiveness Index), COS (core outcome set), ES (effect size), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), QOL (quality of life), SEM (standard error of measurement), WAB-AQ (Western Aphasia Battery-Aphasia Quotient)To read this article in full you will need to make a payment
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References
- Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.Arch Phys Med Rehabil. 2010; 91: 196-202
- A meta-analysis of clinical outcomes in the treatment of aphasia.J Speech Lang Hear Res. 1998; 41: 172-187
- Speech and language therapy for aphasia following stroke.Cochrane Database Syst Rev. 2016; : CD000425
- The efficacy of treatment for aphasic persons: a meta-analysis.Brain Lang. 1994; 47: 582-608
- Review: single-subject clinical-outcome research: designs, data, effect sizes, and analyses.Aphasiology. 1999; 13: 445-473
- Western Aphasia Battery-Revised.The Psychological Corporation, San Antonio2006
- Borenstein M. Introduction to meta-analysis. John Wiley & Sons, Inc., Chichester, United Kingdom2009
- Standard error of measurement.Educ Meas Issues Pract. 1991; 10: 33-41
- Measuring outcomes in aphasia research: a review of current practice and an agenda for standardisation.Aphasiology. 2014; 28: 1364-1384
- Outcome measures for aphasia therapy: it’s not what you do, it’s the way that you measure it.Eur J Disord Commun. 1997; 32: 189-202
- A survey of outcome measures used by Australian speech pathologists.Asia Pac J Speech Lang Hear. 2001; 6: 149-162
- Outcome assessment in aphasia: a survey.J Commun Disord. 2005; 38: 1-27
- More outcomes than trials: a call for consistent data collection across stroke rehabilitation trials: Review.Int J Stroke. 2013; 8: 18-24
- Which outcomes are most important to people with aphasia and their families? An international nominal group technique study framed within the ICF.Disabil Rehabil. 2017; 39: 1364-1379
- Which treatment outcomes are most important to aphasia clinicians and managers? An international e-Delphi consensus study.Aphasiology. 2017; 31: 643-673
- Core outcomes in aphasia treatment research: an e-Delphi consensus study of international aphasia researchers.Am J Speech Lang Pathol. 2016; 25: S729-S742
Wallace S, Worrall L, Rose T, Le Dorze G. Improving research outcome measurement in aphasia: development of a core outcome set. Paper presented at: International Aphasia Rehabilitation Conference. December 14, 2016; London.
- Preferred Reporting Items for Systematic Review and Meta-Analysis protocols (PRISMA-P).Syst Rev. 2015; 349: g7647
- Zotero quick start guide.(Available at:) (Accessed May 30, 2018)
- Use of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems.BMC Public Health. 2011; 11: S3
- Counting what counts: a framework for capturing real-life outcomes of aphasia intervention.Aphasiology. 2008; 22: 258-280
- The Communicative Effectiveness Index: development and psychometric evaluation of a functional communication measure for adult aphasia.J Speech Hear Disord. 1989; 54: 113-124
- Boston Naming Test.Lea & Febiger, Philadelphia1983
- Statistical power in meta-analysis.(Available at:) (Accessed May 30, 2018)
- Psychometric properties of the Stroke and Aphasia Quality of Life Scale (SAQOL-39) in a generic stroke population.Clin Rehabil. 2009; 23: 544-557
- Sensitivity to change and responsiveness of the Stroke and Aphasia Quality-of-Life Scale (SAQOL) in a Singapore stroke population.Aphasiology. 2017; 31: 427-446
- Differential treatment intensity research: a missing link to creating optimally effective communication interventions.Ment Retard Dev Disabil Res Rev. 2007; 13: 70-77
- Effect of treatment for bilingual individuals with aphasia: a systematic review of the evidence.NEL J Neurolinguistics. 2010; 23: 319-341
- The state of the evidence: ASHA develops levels of evidence for communication sciences and disorders.ASHA Lead. 2007; 12: 8-25
- Steps in the process of evidence-based practice: assessing the evidence.(Available at:) (Accessed October 4, 2017)
- SIGN 50: a guideline developer’s handbook.(Available at:) (Accessed October 4, 2017)
- Cochrane handbook for systematic reviews of interventions. Vol 4. John Wiley & Sons, Inc., Chichester2011
- Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2016; 14: 937-947
- Oral reading for language in aphasia: Impact of aphasia severity on cross-modal outcomes in chronic nonfluent aphasia.Semin Speech Lang. 2010; 31: 42-51
- The role of intensity in constraint-induced language therapy for people with chronic aphasia.Aphasiology. 2016; 30: 339-363
- Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs.Psychol Methods. 2002; 7: 105-125
- Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.BMJ. 2011; 343: d4002
- Foundations of clinical research: applications to practice.3rd ed. Prentice Hall, Upper Saddle River2009
- Evaluating single-subject treatment research: lessons learned from the aphasia literature.Neuropsychol Rev. 2006; 16: 161-169
- The efficacy of group communication treatment in adults with chronic aphasia.J Speech Lang Hear Res. 1999; 42: 411-419
- The efficacy of computer-provided reading treatment for chronic aphasic adults.J Speech Hear Res. 1997; 40: 493-507
- Item response theory analysis of the Western Aphasia Battery.Aphasiology. 2010; 24: 1326-1341
- Test-retest reliability of three aphasia tests: performance of non-brain-damaged older adults.J Commun Disord. 1997; 30: 33-43
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6: 6
Supplemental Appendix S2 References for all included studies
Included Within Group Studies
- Improving outcomes for persons with aphasia in advanced community-based treatment programs.Stroke; a Journal of Cerebral Circulation. 1999; 30: 1370-1379
- Promoting recovery in chronic aphasia with an interactive technology.Archives of Physical Medicine and Rehabilitation. 1997; 78: 841-846
- Implementation of computer-based language therapy in aphasia.Therapeutic Advances in Neurological Disorders. 2009; 2: 299-311
- Structure, Processes, and Retrospective Outcomes From an Intensive Comprehensive Aphasia Program.American Journal of Speech-Language Pathology / American Speech-Language-Hearing Association. 2015; 24: 854-863
- High scores on the Western Aphasia Battery correlate with good functional communication skills (as measured with the Communicative Effectiveness Index) in aphasic stroke patients.Disability and Rehabilitation: An International, Multidisciplinary Journal. 2005; 27 (∗): 287-291
- Modified ACT and CART in severe aphasia.Aphasiology. 2011; 25: 836-848
- Intensive language therapy in chronic aphasia: Which aspects contribute most?.Aphasiology. 2008; 22: 408-421
- Writing treatment for severe aphasia: Who benefits?.Journal of Speech, Language, and Hearing Research. 2003; 46 (∗): 1038-1060
- Conversation analysis as a dependent measure in communication therapy with four individuals with aphasia.Asia Pacific Journal of Speech, Language & Hearing. 1997; 2 (19p): 43-61
- Functional Imaging Before and After Constraint-Induced Language Therapy for Aphasia Using Magnetoencephalography.Neurocase. 2006; 12: 322-331
- Therapy with a prosthesis for writing in aphasia.Aphasiology. 1989; 3: 709-715
- Oral reading for language in aphasia: Impact of aphasia severity on cross-modal outcomes in chronic nonfluent aphasia.Seminars in Speech and Language. 2010; 31: 42-51
- Novel technology for treating individuals with aphasia and concomitant cognitive deficits.Topics in Stroke Rehabilitation. 2008; 15: 542-554
- Computerized script training for aphasia: Preliminary results.American Journal of Speech-Language Pathology. 2008; 17: 19-34
- Outcome of a one-month therapy intensive for chronic aphasia: Variable individual responses.Seminars in Speech and Language. 2010; 31 (∗): 21-23
- Experimental analysis of syntax training in Broca’s aphasia: A generalization and social validation study.Journal of Speech & Hearing Disorders. 1987; 52 (∗): 143-155
- Performance Variability as a Predictor of Response to Aphasia Treatment.Neurorehabilitation and Neural Repair Neurorehabilitation and Neural Repair. 2016;
- Effect of semantic naming treatment on crosslinguistic generalization in bilingual aphasia.Journal of Speech, Language, and Hearing Research. 2006; 49: 729-748
- Effect of verb network strengthening treatment (VNeST) on lexical retrieval of content words in sentences in persons with aphasia.Aphasiology. 2009; 23: 402-424
- Effect of Verb Network Strengthening Treatment (VNeST) in persons with aphasia: Extension and replication of previous findings.American Journal of Speech-Language Pathology. 2014; 23: S312-S329
- Use of semantic feature analysis in group discourse treatment for aphasia: Extension and expansion.Aphasiology. 2012; 26: 64-82
- A comparison of two theoretically driven treatments for verb inflection deficits in aphasia.Neuropsychologia. 2008; 46 (∗): 3088-3100
- Selective treatment of regular versus irregular verbs in agrammatic aphasia: Efficacy data.Aphasiology. 2013; 27 (∗): 678-705
- A comparison of intention and pantomime gesture treatment for noun retrieval in people with aphasia.American Journal of Speech-Language Pathology. 2012; 21: s126-s139
- Neural recruitment associated with anomia treatment in aphasia.NeuroImage. 2006; 32: 1403-1412
- Functional communication in individuals with chronic severe aphasia using augmentative communication.AAC: Augmentative and Alternative Communication. 2008; 24: 269-280
- The Influence of Phonomotor Treatment on Word Retrieval Abilities in 26 Individuals With Chronic Aphasia: An Open Trial.Journal of Speech, Language & Hearing Research. 2015; 58 (15p): 798-812
- Anomia treatment platform as behavioral engine for use in research on physiological adjuvants to neurorehabilitation.Journal of Rehabilitation Research and Development. 2014; 51: 391-400
- Phoneme-based rehabilitation of anomia in aphasia.Brain and Language. 2008; 105: 1-17
- Training phoneme to grapheme conversion for patients with written and oral production deficits: A model-based approach.Aphasiology. 2005; 19: 53-76
- Typicality of inanimate category exemplars in aphasia treatment: Further evidence for semantic complexity.Journal of Speech, Language, and Hearing Research. 2008; 51: 1550-1568
- Semantic complexity in treatment of naming deficits in aphasia: Evidence from well-defined categories.American Journal of Speech-Language Pathology. 2008; 17: 389-400
- Treatment for lexical retrieval using abstract and concrete words in persons with aphasia: Effect of complexity.Aphasiology. 2009; 23: 835-853
- Treatment of Category Generation and Retrieval in Aphasia: Effect of Typicality of Category Items.Journal of Speech Language and Hearing Research. 2011; 54: 1101
- The Role of Semantic Complexity in Treatment of Naming Deficits Training Semantic Categories in Fluent Aphasia by Controlling Exemplar Typicality.Journal of Speech, Language, and Hearing Research. 2003; 46: 773-787
- iPractice: Piloting the effectiveness of a tablet-based home practice program in aphasia treatment.Seminars in Speech and Language. 2014; 35: 51-63
- Multiple Oral Re-reading treatment for alexia: The parts may be greater than the whole.Neuropsychological Rehabilitation. 2010; 20: 601-623
- Involving relatives in aphasia therapy: An application of language enrichment therapy.International Journal of Rehabilitation Research. 1986; 9: 259-267
- Animal-assisted therapy for persons with aphasia: A pilot study.Journal of Rehabilitation Research and Development. 2006; 43: 357-366
- Ultra-rapid access to words in chronic aphasia: The effects of intensive language action therapy (ILAT).Brain Topography. 2015; 28: 279-291
- Unilateral forced nostril breathing and aphasia—Exploring unilateral forced nostril breathing as an adjunct to aphasia treatment: A case series.The Journal of Alternative and Complementary Medicine. 2015; 21: 91-99
- Production and integrated training of adjectives in three individuals with nonfluent aphasia.Aphasiology. 2014; 28: 1198-1222
- Integrated training for aphasia: An application of part-whole learning to treat lexical retrieval, sentence production, and discourse-level communications in three cases of nonfluent aphasia.American Journal of Speech-Language Pathology. 2014; 23: 105-119
- Changes of right-hemispheric activation after constraint-induced, intensive language action therapy in chronic aphasia: fMRI evidence from auditory semantic processing.Frontiers in Human Neuroscience. 2014; 8
- The role of intensity in constraint-induced language therapy for people with chronic aphasia.Aphasiology. 2016; 30: 339-363
- Therapy for naming difficulties in aphasia: Application of a cognitive neuropsychological model.NEL Journal of Neurolinguistics. 1991; 6: 139-157
- Constraint Induced Aphasia Therapy: Volunteer-led, unconstrained and less intense delivery can be effective.NeuroRehabilitation. 2016; 39: 97-109
- Intensive multimodal communication treatment for people with chronic aphasia.Aphasiology Aphasiology. 2015; : 1-23
- Computerised training for impairments of word comprehension and retrieval in aphasia.Aphasiology. 2006; 20: 257-268
- Contrasting effects of errorless naming treatment and gestural facilitation for word retrieval in aphasia.Neuropsychological Rehabilitation. 2012; 22: 235-266
- Effects of gesture+verbal treatment for noun and verb retrieval in aphasia.Journal of the International Neuropsychological Society. 2006; 12: 867-882
- Using semantic feature analysis to improve contextual discourse in adults with aphasia.American Journal of Speech-Language Pathology. 2008; 17: 161-172
- Effects of gesture+verbal and semantic-phonologic treatments for verb retrieval in aphasia.Aphasiology. 2006; 20: 286-297
- Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme.Aphasiology. 2013; 27: 1339-1361
- Multi-modality aphasia therapy is as efficacious as a constraint-induced aphasia therapy for chronic aphasia: A phase 1 study.Aphasiology. 2013; 27: 938-971
- Changes in functional connectivity related to direct training and generalization effects of a word finding treatment in chronic aphasia.Brain and Language. 2015; 150: 103-116
- Verb production in agrammatic aphasia: The influence of semantic class and argument structure properties on generalisation.Aphasiology. 2003; 17 (∗): 213-241
- Mapping therapy: A treatment programme for agrammatism.Aphasiology. 1994; 8: 19-54
- Masked Repetition Priming in Treatment of Anomia: A Phase 2 Study.American Journal of Speech-Language Pathology. 2015; 24 (∗) (18p): S895-S912
- Change in perception of communication abilities of aphasic patients and their families.Aphasiology. 1995; 9: 565-575
- Combining Teletherapy and On-line Language Exercises in the Treatment of Chronic Aphasia: An Outcome Study.International Journal of Telerehabilitation. 2014; 6: 3-20
- The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The complexity account of treatment efficacy (CATE).Journal of Speech, Language, and Hearing Research. 2003; 46: 591-607
- Therapy and support services for people with long-term stroke and aphasia and their relatives: A six-month follow-up study.Clinical Rehabilitation. 2005; 19: 372-380
- A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia.Neuropsychological Rehabilitation. 2013; 23: 102-132
- Personality differences among patients with chronic aphasia predict improvement in speech-language therapy.Topics in Stroke Rehabilitation. 2013; 20 (∗): 421-431
- Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia.International Journal of Language & Communication Disorders. 1998; 33: 45-70
- Modified response elaboration training: A systematic extension with replications.Aphasiology. 2012; 26 (∗): 1407-1439
- Changes in N400 topography following intensive speech language therapy for individuals with aphasia.Brain and Language. 2012; 123: 94-103
- Note: ∗=excluded from dose frequency subgroup analysis reported in Table 1 because of insufficient information to classify in the original publication, or because participants received both types of dose frequency before post-treatment assessment.
Included Between Group Studies
- Delayed stimulus-specific improvements in discourse following anomia treatment using an intentional gesture.Journal of Speech, Language, and Hearing Research. 2014; 57: 439-454
- Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform.Frontiers in Human Neuroscience. 2015; 8
- Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform.Frontiers in Human Neuroscience. 2015; 8 (Retrieved from)
- A comparison of aphasia therapy outcomes before and after a Very Early Rehabilitation programme following stroke.International Journal of Language & Communication Disorders. 2014; 49 (13p): 149-161
- Very early poststroke aphasia therapy: a pilot randomized controlled efficacy trial.International Journal of Stroke: Official Journal of the International Stroke Society. 2012; 7: 635-644
- The efficacy of computer-provided reading treatment for chronic aphasic adults.Journal of Speech & Hearing Research. 1997; 40: 493-507
- A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy.Journal of the International Neuropsychological Society. 2006; 12: 843-852
- Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial.International Journal of Neuroscience. 2016; 126: 235-242
- Constraint-induced aphasia therapy versus intensive semantic treatment in fluent aphasia.American Journal of Speech-Language Pathology. 2015; 24: 281-294
Article info
Publication history
Published online: September 18, 2018
Footnotes
Supported by National Institutes of Health/National Institute on Deafness and Other Communication Disorders (grant no. T32DC013017).
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
