ABSTRACT

Background: Improved discourse production is a priority for all key stakeholders in aphasia rehabilitation. A Cochrane review of randomised controlled trials (RCTs) for aphasia found speech and language therapy treatment to be effective for improving the ability to communicate in everyday interaction. However, this large-scale review did not focus exclusively on treatment for discourse production and did not include other treatment research designs. Thus, the extent of the evidence base addressing discourse interventions is currently unclear.

Objective: The present study undertakes the first systematic review of research on treatment for discourse production in aphasia, appraises the quality of the evidence base; characterises the methods for measuring outcomes; and describes discourse treatment in terms of both content and efficacy.

Design: Scopus, Medline, and EmBase databases were searched, providing 334 records. Twenty-five studies (reporting on 127 participants) met inclusion criteria and were reviewed with the following research questions: What is the quality of the study designs used? How complete is the intervention reporting? What is the range, type, and content of outcome measures used? What is the range, type, and content of discourse treatments reported to date? Are discourse treatments efficacious?

Results: Seven of the 25 studies met the criteria for quality review, with 3 RCTs scoring moderately well and 3 (of 4) case studies scoring moderate-low. Most studies had adequate levels of completeness of treatment reporting, with 3 scoring highly. There were 514 different outcome measures reported across the 25 studies, with measures of words-in-discourse the most common. Studies were grouped into six treatment categories: “word production in discourse”, “sentence production in discourse”, “discourse macrostructure”, “discourse scripts”, “multi-level”, and “no consensus”. Twenty-two studies reported post-treatment gains, most commonly noted in increased word production. Changes in sentence production and discourse macrostructure were present but infrequently assessed.

Conclusions: Discourse treatment is an emerging field of research. Despite limitations in the evidence base, there are clear positive signs that discourse treatment is efficacious. There is emerging evidence for beneficial effects on word and sentence production in discourse, for improved discourse macrostructure, and for treatments working at multiple levels of language. To strengthen the evidence in this field and improve outcomes for people with aphasia, we need more discourse treatment research using an explicit theoretical rationale, high-quality study designs, more complete reporting, and agreed treatment and assessment methods.

摘要

背景：改进话语生成是失语症康复所有主要利益相关者的优先事项。一项针对失语症的随机对照试验 (RCT) 的 Cochrane 综述发现，言语和语言治疗可有效提高日常互动中的交流能力。然而，这项大规模审查并没有完全关注话语产生的治疗，也没有包括其他治疗研究设计。因此，目前尚不清楚处理话语干预的证据基础的范围。

目的：本研究首次对失语症话语产生治疗研究进行系统评价，评价证据基础的质量；描述测量结果的方法；并从内容和效力两方面描述了话语处理。

设计：搜索了 Scopus、Medline 和 EmBase 数据库，提供了 334 条记录。25 项研究（报告 127 名参与者）符合纳入标准，并通过以下研究问题进行审查：所使用的研究设计的质量如何？干预报告的完整程度如何？使用的结果测量的范围、类型和内容是什么？迄今为止报道的话语处理的范围、类型和内容是什么？话语治疗有效吗？

结果： 25 项研究中有 7 项符合质量审查标准，其中 3 项 RCT 得分中等，3（4 项）案例研究得分中等。大多数研究具有足够的治疗报告完整性水平，其中 3 项得分很高。在 25 项研究中报告了 514 种不同的结果测量，其中话语测量最常见。研究分为六个处理类别：“话语中的单词生成”、“话语中的句子生成”、“话语宏观结构”、“话语脚本”、“多层次”和“无共识”。22 项研究报告了治疗后的收益，最常见的是增加单词量。句子产生和话语宏观结构的变化是存在的，但很少被评估。

结论：话语处理是一个新兴的研究领域。尽管证据基础有限，但有明显的积极迹象表明话语治疗是有效的。有新的证据表明对话语中的单词和句子产生、改善话语宏观结构以及在多个语言水平上起作用的治疗产生有益影响。为了加强该领域的证据并改善失语症患者的结果，我们需要使用明确的理论原理、高质量的研究设计、更完整的报告以及商定的治疗和评估方法进行更多的话语治疗研究。