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Abstract

Objective:

Attention control comparisons in trials of stroke rehabilitation require care to minimize the risk of comparison choice bias. We compared the similarities and differences in SLT and social support control interventions for people with aphasia.

Data sources:

Trial data from the 2016 Cochrane systematic review of SLT for aphasia after stroke

Methods:

Direct and indirect comparisons between SLT, social support and no therapy controls. We double-data extracted intervention details using the template for intervention description and replication. Standardized mean differences and risk ratios (95% confidence intervals (CIs)) were calculated.

Results:

Seven trials compared SLT with social support (n = 447). Interventions were matched in format, frequency, intensity, duration and dose. Procedures and materials were often shared across interventions. Social support providers received specialist training and support. Targeted language rehabilitation was only described in therapy interventions. Higher drop-out (P = 0.005, odds ratio (OR) 0.51, 95% CI 0.32–0.81) and non-adherence to social support interventions (P < 0.00001, OR 0.18, 95% CI 0.09–0.37) indicated an imbalance in completion rates increasing the risk of control comparison bias.

Conclusion:

Distinctions between social support and therapy interventions were eroded. Theoretically based language rehabilitation was the remaining difference in therapy interventions. Social support is an important adjunct to formal language rehabilitation. Therapists should continue to enable those close to the person with aphasia to provide tailored communication support, functional language stimulation and opportunities to apply rehabilitation gains. Systematic group differences in completion rates is a design-related risk of bias in outcomes observed.

Keywords

Aphasia meta-analysis social support rehabilitation stroke

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References

Brady

Kelly

Godwin

et al . SLT for aphasia following stroke. Cochrane Database Syst Rev 2016; 5: CD000425.

Braunholtz

Edwards

Lilford

RJ.

Are randomized clinical trials good for us (in the short term)? Evidence for a ‘trial effect’. J Clin Epidemiol 2001; 54: 217–224.

Purvis

Hill

Kilkenny

et al . Improved in-hospital outcomes and care for patients in stroke research: an observational study. Neurology 2016; 87: 206–213.

Royal College of Physicians (RCP). National clinical guidelines for stroke. 5th ed. London: RCP, 2016.

Hilari

Northcott

‘Struggling to stay connected’: comparing the social relationships of healthy older people and people with stroke and aphasia. Aphasiology 2016; 316: 674–687.

Parr

Living with severe aphasia: tracking social exclusion. Aphasiology 2011; 21(1): 98–123.

Herbert

Gaudiano

BA.

Moving from empirically supported treatment lists to practice guidelines in psychotherapy: the role of the placebo concept. J Clin Psychol 2005; 61: 893–908.

Herbert

Gaudiano

BA.

Introduction to the special issue on the placebo concept in psychotherapy. J Clin Psychol 2005; 61: 787–790.

Pollock

Baer

Campbell

et al . Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev 2014; 4: CD001920.

10.

Higgins

JPT

Green

Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, March 2011, http://training.cochrane.org/handbook

11.

Liberati

Altman

Tetzlaff

et al . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.

12.

Hoffmann

Glasziou

Boutron

et al . Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014; 348: g1687.

13.

DerSimonian

Laird

Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–188.

14.

Bucher

Guyatt

Griffith

et al . The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol 1997; 50: 683–691.

15.

Hedges

Olkin

Statistical methods for meta-analysis. New York: Academic Press, 1985.

16.

Woolf

Caute

Haigh

et al . A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: a quasi-randomised controlled feasibility study. Clin Rehabil 2016; 30: 359–373.

17.

David

Enderby

Bainton

Treatment of acquired aphasia: speech therapists and volunteers compared. J Neurol Neurosurg Psychiatry 1982; 45: 957–961.

18.

Lincoln

Pickersgill

Hankey

et al . An evaluation of operant training and speech therapy in the language rehabilitation of moderate aphasics. Behav Psychother 1982; 10: 162–178.

19.

Elman

Bernstein-Ellis

The efficacy of group communication treatment in adults with chronic aphasia. J Speech Lang Hear Res 1999; 42: 411–419.

20.

Rochon

Laird

Bose

et al . Mapping therapy for sentence production impairments in nonfluent aphasia. Neuropsychol Rehabil 2005; 15: 1–36.

21.

Bowen

Hesketh

Patchick

et al . Clinical effectiveness, cost effectiveness and service users’ perceptions of early, intensively-resourced communication therapy following a stroke, a randomised controlled trial (The ACT NoW study). London: Health Technology Assessment, 2011.

22.

Shewan

Kertesz

Effects of speech and language treatment on recovery from aphasia. Brain Lang 1984; 23: 272–299.

23.

Skehon

Cartwright

Francis

JJ.

Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res 2017; 17: 88.

24.

Bell

Kenward

Fairclough

et al . Differential dropout and bias in randomised controlled trials: when it matters and when it may not. BMJ 2013; 346: e8668.

25.

Schulz

Altman

Moher

et al . CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010; 8: 18.

26.

Bhogal

Teasell

Speechley

Intensity of aphasia therapy, impact on recovery. Stroke 2003; 34: 987–993.

27.

Robey

The efficacy of treatment for aphasic persons: a meta-analysis. Brain Lang 1994; 47: 582–608.

28.

Robey

A meta-analysis of clinical outcomes in the treatment of aphasia. J Speech Lang Hear Res 1998; 41: 172–187.

29.

Cherney

Patterson

Raymer

et al . Evidence-based systematic review: effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia. J Speech Lang Hear Res 2008; 51: 1282–1299.

30.

Wade

Investigating the effectiveness of rehabilitation professions – a misguided enterprise?

Clin Rehabil 2005; 19: 1–3.

31.

Meinzer

Streiftau

Rockstroh

Intensive language training in the rehabilitation of chronic aphasia – effective training by laypersons. J Int Neuropsychol Soc 2007; 13: 846–853.

32.

Doesborgh

SJC

Van de Sandt-Koenderman

MWE

Dippel

DWJ

et al . Effects of semantic treatment on verbal communication and linguistic processing in aphasia after stroke: a randomized controlled trial. Stroke 2004; 35: 141–146.

33.

Martins

Leal

Fonseca

et al . A randomized, rater-blinded, parallel trial of intensive speech therapy in sub-acute post-stroke aphasia: the SP-I-R-IT study. Int J Lang Commun Disord 2013; 48: 421–431.

34.

Godecke

Hird

Lalor

et al . Very early poststroke aphasia therapy: a pilot randomized controlled efficacy trial. Int J Stroke 2012; 7: 635–644.

35.

Katz

Wertz

RT.

The efficacy of computer-provided reading treatment of chronic aphasic adults. J Speech Lang Hear Res 1997; 40: 493–507.

36.

Palmer

Cooper

Enderby

et al . Clinical and cost effectiveness of computer treatment for aphasia post stroke (Big CACTUS): study protocol for a randomised controlled trial. Trials 2015; 16: 18.

37.

Shewan

Bandur

DL.

Treatment of aphasia: a language-oriented approach. San Diego, CA: College-Hill Press, 1986.

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Attention control comparisons with SLT for people with aphasia following stroke: methodological concerns raised following a systematic review