TY - JOUR
T1 - Predictors of poststroke aphasia recovery
T2 - A systematic review - informed individual participant data meta-analysis
AU - The Rehabilitation and Recovery of People with Aphasia after Stroke (RELEASE) Collaborators
AU - Ali, Myzoon
AU - VandenBerg, Kathryn
AU - Williams, Linda J.
AU - Williams, Louise R.
AU - Abo, Masahiro
AU - Becker, Frank
AU - Bowen, Audrey
AU - Brandenburg, Caitlin
AU - Breitenstein, Caterina
AU - Bruehl, Stefanie
AU - Copland, David A.
AU - Cranfill, Tamara B.
AU - di Pietro-Bachmann, Marie
AU - Enderby, Pamela
AU - Fillingham, Joanne
AU - Galli, Federica Lucia
AU - Gandolfi, Marialuisa
AU - Glize, Bertrand
AU - Godecke, Erin
AU - Hawkins, Neil
AU - Hilari, Katerina
AU - Hinckley, Jacqueline
AU - Horton, Simon
AU - Howard, David
AU - Jaecks, Petra
AU - Jefferies, Elizabeth
AU - Jesus, Luis M.T.
AU - Kambanaros, Maria
AU - Kang, Eun Kyoung
AU - Khedr, Eman M.
AU - Kong, Anthony Pak Hin
AU - Kukkonen, Tarja
AU - Laganaro, Marina
AU - Ralph, Matthew A.Lambon
AU - Laska, Ann Charlotte
AU - Leemann, Béatrice
AU - Leff, Alexander P.
AU - Lima, Roxele R.
AU - Lorenz, Antje
AU - Whinney, Brian Mac
AU - Marshall, Rebecca Shisler
AU - Mattioli, Flavia
AU - Maviş, Ilknur
AU - Meinzer, Marcus
AU - Nilipour, Reza
AU - Noé, Enrique
AU - Paik, Nam Jong
AU - Palmer, Rebecca
AU - Papathanasiou, Ilias
N1 - Funding Information:
This project was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR project number 14/04/22) and the Tavistock Trust for Aphasia and will be published in full in the Health Services and Delivery Research Journal. Further information is available at www.journalslibrary.nihr.ac.u/programmes/hsdr/140422#/. The scientific content was reviewed and informed by discussion with the NIHR Complex Reviews Support Unit, also funded by the NIHR (project number 14/178/29). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The study also received infrastructural support from the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP Research Unit); NMAHP RU and MCB are funded by the Chief Scientist Office (CSO), Scottish Government Health and Social Care Directorates.
Publisher Copyright:
© 2021 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc.
PY - 2021
Y1 - 2021
N2 - BACKGROUND AND PURPOSE: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. METHODS: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. RESULTS: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. CONCLUSIONS: Earlier intervention for poststroke aphasia was crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke.
AB - BACKGROUND AND PURPOSE: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. METHODS: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. RESULTS: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. CONCLUSIONS: Earlier intervention for poststroke aphasia was crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke.
KW - Aphasia
KW - Comprehension
KW - Demography
KW - Language
KW - Survivor
U2 - 10.1161/STROKEAHA.120.031162
DO - 10.1161/STROKEAHA.120.031162
M3 - Review Article
C2 - 33719515
AN - SCOPUS:85104977819
VL - 52
SP - 1778
EP - 1787
IS - 5
ER -