PDF(Pubmed)
Abstract：
Stroke rehabilitation interventions are routinely personalized to address individuals\' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias.
We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database.
MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes\' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness.
959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants\' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants\' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males\' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week.
We observed a treatment response in most subgroups\' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database.
MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes\' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness.
959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants\' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants\' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males\' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week.
We observed a treatment response in most subgroups\' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
摘要：
中风康复干预通常是个性化的，以满足个人的需求，目标,和基于来自汇总随机对照试验(RCT)数据和荟萃综合的证据的挑战。个体参与者数据(IPD)荟萃分析可以更好地指导精确康复方法的发展，量化治疗反应，同时调整混杂因素并减少生态偏差。
我们探索了言语和语言治疗（SLT）干预频率（天/周）之间的关联，强度（h/周），以及不同年龄的剂量（总SLT小时）和语言结果，性别,失语症严重程度,通过对RELEASE数据库进行预先指定的亚组网络荟萃分析和慢性亚组。
MEDLINE,EMBASE,并对试验注册进行了系统搜索（2015年9月开始），包括10个与中风相关的失语症的IPD。我们提取了人口统计，中风,失语症,SLT,和偏差数据的风险。整体语言能力,听觉理解，功能沟通结果标准化。一个阶段，随机效应,网络元分析方法将IPD过滤为单个最优模型，从基线到第一次干预后随访检查SLT方案和语言恢复，对先验识别的协变量进行调整。数据按年龄二分类(/>65岁)，失语症严重程度（基于语言结果的轻度-中度/中度-重度中值），慢性（/>3个月），和性别亚组。我们报告了均值和95%置信区间的估计值。在相对方差较高(>50%)的情况下，报告了结果的完整性。
分析了959个IPD(25个RCT)。对于工作年龄的参与者，与基线相比,语言增益最大的发生在中等至高强度SLT(功能性交流3~4小时/周;总体语言和理解>9小时/周);年龄较大的参与者除听觉理解(>9小时/周)外,最大的增益发生在低强度SLT(2小时/周).对于这两个年龄组，与最佳语言增益相关的SLT频率和剂量相似。参与者在发病后3个月表现出在低强度/中等剂量下SLT的最大整体语言增益（2SLT-h/周;20至50h）;对于那些>3个月，卒中后最大获益与中等强度/高剂量SLT(3-4SLT-h/周;50小时)相关.对于中重度参与者，4SLT-天/周赋予了跨结果的最大语言收益，只有4个SLT天/周观察到听觉理解增益;轻度-中度参与者最大的功能沟通增益与相似的频率（4个SLT天/周）和最大的整体语言增益相关，具有更高频率的SLT（6天/周）。与女性相比，男性的最大收获与中等强度（功能交流；每周3至4小时/周）或高强度（整体语言和听觉理解；（每周>9小时/周）的SLT相关，而女性的最大收获与低强度SLT相关（<2SLT-h/周）。亚组之间的一致性也很明显；总体语言增益最大与20到50SLT-h相关；当SLT>9h超过4天/周时，通常观察到听觉理解增益。
我们观察到大多数亚组的治疗反应，听觉理解，和功能性交流语言收益。对一些人来说,最大治疗反应随不同的SLT频率而变化，强度,和剂量。在观察到差异的地方，工作年龄,慢性，轻度-中度,和男性亚组经历了他们最大的语言增益与高频/强度SLT。相比之下,年长的,中度-严重受损，失语症发病后3个月内的女性亚组对低强度SLT的获益最大。可接受性，临床,以及基于年龄的精准失语症康复方法的成本效益，性别,失语症严重程度,和慢性性应该在未来的临床随机对照试验中进行评估。
我们探索了言语和语言治疗（SLT）干预频率（天/周）之间的关联，强度（h/周），以及不同年龄的剂量（总SLT小时）和语言结果，性别,失语症严重程度,通过对RELEASE数据库进行预先指定的亚组网络荟萃分析和慢性亚组。
MEDLINE,EMBASE,并对试验注册进行了系统搜索（2015年9月开始），包括10个与中风相关的失语症的IPD。我们提取了人口统计，中风,失语症,SLT,和偏差数据的风险。整体语言能力,听觉理解，功能沟通结果标准化。一个阶段，随机效应,网络元分析方法将IPD过滤为单个最优模型，从基线到第一次干预后随访检查SLT方案和语言恢复，对先验识别的协变量进行调整。数据按年龄二分类(
分析了959个IPD(25个RCT)。对于工作年龄的参与者，与基线相比,语言增益最大的发生在中等至高强度SLT(功能性交流3~4小时/周;总体语言和理解>9小时/周);年龄较大的参与者除听觉理解(>9小时/周)外,最大的增益发生在低强度SLT(
我们观察到大多数亚组的治疗反应，听觉理解，和功能性交流语言收益。对一些人来说,最大治疗反应随不同的SLT频率而变化，强度,和剂量。在观察到差异的地方，工作年龄,慢性，轻度-中度,和男性亚组经历了他们最大的语言增益与高频/强度SLT。相比之下,年长的,中度-严重受损，失语症发病后3个月内的女性亚组对低强度SLT的获益最大。可接受性，临床,以及基于年龄的精准失语症康复方法的成本效益，性别,失语症严重程度,和慢性性应该在未来的临床随机对照试验中进行评估。
