ABSTRACT

Purpose

The purpose of this review was to examine the effects of aphasia therapy on language and/or communication outcome measures when treatment was initiated within four months post-onset. The review evaluated the methodological quality of relevant studies and summarised the findings of the high-quality studies according to three clinical questions about the provision of aphasia treatment in the early period of recovery: (1) Is treatment better than no treatment? (2) Is one type of treatment more effective than another? (3) Do different treatment intensities result in different outcomes?

Methods

A literature search was performed for articles in which aphasia treatments were initiated fewer than four months post-aphasia onset and evaluated with a control or comparison group. Two authors rated the studies on defined methodological quality criteria and extracted data for addressing the clinical questions.

Results

A total of 23 studies met the inclusion criteria. Sixteen of the studies received high-quality ratings. Nine studies provided data addressing clinical question 1; however, only four of them were considered as high-quality studies. Results from the high-quality studies were mixed: two studies demonstrated treatment efficacy for early aphasia therapy, and two studies found no differences in outcome measures between participants who received treatment and a no-treatment control. Eleven studies provided data addressing clinical question 2; six of them were considered as high-quality. None of the eleven treatment-comparison studies found that one type of treatment resulted in greater gains compared to another type of treatment on primary outcome measures. Finally, six studies contributed data for addressing clinical question 3; all of them were considered as high-quality studies. Five studies found no significant difference in outcomes between participants assigned to lower- and higher-intensive weekly treatment schedules, and one study reported superior findings in outcomes when participants received less intensive treatment.

Conclusion

This review found mixed results across studies that examined whether early aphasia treatment improved language/communication outcomes more than no treatment. The review also found that when different types of aphasia treatments were compared, no treatment was more efficacious than another treatment and that increasing the weekly intensity of treatment beyond 2–5 hours did not improve outcomes on language/communication measures. The review highlights the need for additional research on the effects of early aphasia therapy. We suggest that future research considers participant characteristics that might influence how a person will respond to a specific therapeutic approach and intensity.

中文翻译：

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脑卒中后康复早期失语症治疗的系统评价

摘要

目的

本综述的目的是检查在发病后四个月内开始治疗时失语症治疗对语言和/或交流结果测量的影响。该综述评估了相关研究的方法学质量，并根据关于在恢复早期提供失语症治疗的三个临床问题总结了高质量研究的结果：（1）治疗比不治疗好吗？(2) 一种治疗比另一种更有效吗？(3) 不同的治疗强度会导致不同的结果吗？

方法

对失语症发作后不到四个月开始失语症治疗的文章进行了文献检索，并用对照组或对照组进行了评估。两位作者根据定义的方法学质量标准对研究进行评级，并提取数据以解决临床问题。

结果

共有 23 项研究符合纳入标准。其中 16 项研究获得了高质量的评级。九项研究提供了解决临床问题 1 的数据；然而，其中只有四项被认为是高质量的研究。高质量研究的结果喜忧参半：两项研究证明了早期失语症治疗的疗效，两项研究发现接受治疗的参与者和未接受治疗的对照组之间的结果指标没有差异。11 项研究提供了解决临床问题 2 的数据；其中六个被认为是高质量的。11 项治疗比较研究均未发现一种类型的治疗与另一种类型的治疗相比在主要结果指标上有更大的收益。最后，六项研究为解决临床问题 3 提供了数据；所有这些都被认为是高质量的研究。五项研究发现，分配给低强度和高强度每周治疗方案的参与者之间的结果没有显着差异，一项研究报告称，当参与者接受强度较低的治疗时，结果有更好的发现。

结论

这篇综述发现，在检查早期失语症治疗是否比不治疗更能改善语言/交流结果的研究中，结果喜忧参半。审查还发现，当比较不同类型的失语症治疗时，没有一种治疗比另一种治疗更有效，并且每周增加超过 2-5 小时的治疗强度并没有改善语言/沟通措施的结果。该评论强调需要对早期失语症治疗的效果进行更多研究。我们建议未来的研究考虑参与者的特征，这些特征可能会影响一个人对特定治疗方法和强度的反应。