50-hour speech and language therapy best bet for poststroke aphasia

Speech and language therapy (SLT)—delivered over 4–5 days weekly for up to 50 hours in total—yields the greatest overall language, functional communication, and auditory comprehension gains for patients with stroke-related aphasia, according to data from the RELEASE* study.

In RELEASE, researchers conducted a systematic review and network meta-analysis. They searched multiple databases for published, unpublished, and emerging trials that examined the effect of SLT (intensity, dosage, frequency, duration, delivery, and content) on pertinent outcomes in patients with poststroke aphasia.

A total of 25 trials, which involved 959 individual participant data, met the inclusion criteria. Pooled data showed that high-dose SLT (>20 to 50 hours in total) produced the highest gains in overall language and comprehension (18.37 Western Aphasia Battery–Aphasia Quotient; 5.23 Aachen Aphasia Test–Token Test).

In terms of intensity, 2–4 and ≥9 hours/week of SLT correlated with the greatest clinical improvements in overall language, functional communication, and comprehension. Frequent SLT also yielded the greatest clinical gains for overall language, functional communication (3–5+ days/week), and comprehension (4–5 days/week).

Evidence of comprehension gains was not found when SLT was administered for ≤20 hours, <3 hours/week, and ≤3 days/week.

Finally, in terms of delivery, optimal overall gains were obtained when SLT interventions involved mixed receptive-expressive therapy, was tailored by functional relevance, and augmented by prescribed home practice tasks.

The risk of trial bias was low to moderate.

The present data may have important implications, as they suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services.

*The REhabilitation and recovery of peopLE with Aphasia after StrokE