Do social determinants influence post-stroke aphasia outcomes? A scoping review

Figures & data

Figure 1. Commission of Social Determinants of Health conceptual framework for social determinants of health [8]. Reprinted with permission.

This figure depicts the socioeconomic and political factors that influence a person’s socioeconomic position, material circumstances, which in turn influence health outcomes.

Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart of study selection process.

This figure depicts the articles that were screened as part of this scoping review including 4880 articles were identified, 2050 were screened at the level of title and abstract, 47 were reviewed at full text, and 25 were included in the final yield.

Table 1. Studies examining SDOHs and aphasia outcomes.

Author (year)	Country	Study design^a	Total participants (PWA)	Measure used to diagnose aphasia	TPO at assessment	Type of outcome^b	Outcome measure/s	SDOHs	SDOH categories	Significant effect
Connor et al. (2001)[30]	USA	Retrospective cohort (Level III-3)	39 (39)	BDAE	4 months; 103 months	Language and related impairments	BDAE	Education SES (employment)	High; low High; low	Yes Yes
de Riesthal and Wertz (2004)[42]	USA	Prospective cohort (Level III-1)	34 (34)	PICA	4 weeks; 48 weeks	Language and related impairments	PICA; RFP	Education	Number of years of education	No
Ellis and Peach (2017[44])	USA	Cohort of persons at different stages (Level IV)	381 (381)	WAB-R	5.4 years ± 4.9	Language and related impairments	WAB-R	Ethnicity	Non-Hispanic black; white.	Yes
Grohn et al. (2012)[28]	Australia	n.a. Qualitative study	15 (15)	WAB-R	3 months	Quality of life	SLARS	Social support	Support of family/friends; support of others	n.a.
El Hachioui et al. (2013)[31]	The Netherlands	Prospective cohort (Level III-1)	130 (130)	ASRS	1 week; 2 weeks; 6 weeks; 52 weeks	Language and related impairments	ASRS	Gender Education	Male; female High (high school/university); low (unfinished elementary school)	No No
Hilari et al. (2003)[43]	UK	Cohort of persons at different stages (Level IV)	83 (83)	FAST	41 months [13 months–250 months]	Quality of life	SAQOL-39;	Gender Ethnicity SES (employment type) SES (employment status) Social support	Male; female Asian; black; white Professional; associate professional; other admin/ clerical; own account non-professional; supervisor/ technician; intermediate; other; never worked Retired; inactive because of stroke; part-time/voluntary work; student Social Support Survey	No No No No No
Hilari and Northcott (2006)[47]	UK	Retrospective cohort (Level III-3)	83 (83)	SLT report	1year 1 month − 20 years 10 months	Quality of Life	SAQOL-39	Social support	Overall Perceived Social Support Subscales: Tangible support Emotional support Informational support Social companionship Affectionate support Social network: Size of network Frequency of contact Children Relatives Friends	No No No Yes Yes No No Yes Yes No
Johnson et al. (2022) [67]	USA	Retrospective cohort (Level III-3)	224 (224)	WAB	Mean 38.5 months; range 6–212	Language and related impairments	WAB	Gender Education SES (income)	Male; female Years Median income for postcode according to US census data	No No No
Keenan and Brassell (1974)[45]	USA	Case series (Level IV)	39 (39)	Descriptive scale	10–14 days; variable discharge date	Language and related impairments	Scale: Good; fair; poor	SES (employment status)	Full-time, part-time, unemployed	No
Kim et al. (2019)[35]	Korea	Prospective cohort (Level III-1)	235 (235)	KFAST	7 days; 3 months; 6 months; 12 months	Language and related impairments	KFAST	Education	No formal education; primary education; secondary education; higher education	Yes
Lahiri et al. (2021)[41]	India	Prospective cohort (Level III-1)	163 (163)	BWAB	3–7 days; 3 months	Language and related impairments	BWAB	Gender education	Male; female Number of years of education	No No
Lahiri et al. (2021)[39]	India	Prospective cohort (Level III-1)	208 (208)	BWAB	3–7 days	Language and related impairments	BWAB	Gender education	Male; female Number of years of education	No No
Lazar et al. (2008)[36]	USA	Prospective cohort (Level III-1)	91 (22)	Descriptive scale	24–72 h; 90 days	Language and related impairments	BDAE; WAB-R	Education	<High school degree; High school degree; Some post-secondary education; College/ university degree; Some post-graduate education; Graduate degree	No
Lee et al. (2015)[46]	Korea	Prospective cohort with case control (Level III-1)	72 (30)	Medical record	29.1mths [6–81mths]	Quality of life	SAQOL-39	SES (income)	Low; average; high	Yes
Lee et al. (2020)[38]	Korea	Retrospective cohort (Level III-3)	68 (68)	KWAB	< 1 week; 2 weeks; 3 months	Language and related impairments	KWAB	Gender education	Male; female Number of years of education	No No
Lendrem and Lincoln (1985)[48]	UK	Prospective cohort (Level III-1)	52 (52)	WAST	4 weeks	Language and related impairments	PICA; FCP; BDAE	Gender	Male; female	No
Lwi et al. (2021) [37]	USA	Retrospective cohort (Level III-3)	168 (168)	WAB-R	Mean time between assessments 42.2 months (SD = 58.4; range 2–284)	Language and related impairments	WAB-R	Gender education	Male; female Number of years of education	No Yes
Mazaux et al. (2013)[34]	France	Prospective cohort (Level III-1)	100 (100)	ASRS	1 month; 12 months	Participation	ECVB	Gender education SES (employment type)	Male; female No diploma; junior college; senior college; University Managers; shopkeepers; blue/ white collars; farmers/ rural dwellers; others	No No Yes
Oliveira and Damasceno (2009)[40]	Brazil	Prospective cohort (Level III-1)	33 (33)	Description of aphasia type	72 h; 12 months	Language and related impairments	Neurological exam^c	Gender Education	Male; female Number of years of education	No No
Pedersen et al. (1995)[51]	Denmark	Prospective cohort (Level III-1)	881 (330)	SSS	12 h	Language and related impairments	ScSS	Gender	Male; female	No
Pizzamiglio et al. (1985)[49]	Italy	Prospective cohort (Level III-1)	89 (89)	Language battery	3 months	Language and related impairments	Naming, repetition, phonemic/ semantic discrimination, syntactic comprehension	Gender	Male; female	Yes
Ribeiro Lima et al. (2021)[32]	Brazil	Pre/post cohort without control (Level IV)	26 (26)	BDAE-SF	Median 8 months (range 6–28); 12 weeks post	Quality of life	SAQOL-39	Gender Education SES (income) Social support	Male; female Years Median split <2 or >2 people residing in household; presence or absence of a carer	Yes No No Yes
Sarno et al. (1970)[29]	USA	Cohort of persons at different stages (Level IV)	31 (31)	FCP	3 months	Language and related impairments	Pre– Post- testing: pre-reading; writing; understanding; speaking.	Gender education SES (employment type)	Gender Primary; secondary Labour; businessmen, professionals, housewives	No No No
Sarno et al. (1985)[50]	USA	Prospective cohort non-randomised (Level III-2)	60 (60)	Description of aphasia type	4–6 months; 1–2.5 years	Language and related impairments	FCP; BDAE: Word fluency, token test subtests	Gender	Male; female	No
Worrall et al. (2017)[33]	Australia	Prospective cohort (Level III-1)	58 (58)	WAB-R	3 months; 6 months; 9 months; 12 months	Language and related impairments; Participation; Personal factors; Environment; Quality of life	ALA	Gender Education SES (income) Social support (marital status) Social Support (social network size)	Male; female High school; graduate/post-graduate Low; below median; above median Single: married/de facto; divorced/separated; widower/ widowed ≤10; 11–20; 21–30; ≥31	Yes for participation Yes for participation Yes for language impairment & participation No Yes for participation

Notes: ALA: Assessment for Living with Aphasia: ASHA FACS: ASHA Functional Assessment of Communication Skills in Adults; ASRS: Aphasia Severity Rating Scale; BI: Barthel Index; BDAE: Boston Diagnostic Aphasia Examination; BDAE-SF: Boston Diagnostic Aphasia Examination-Short Form; BWAB: Bengali Western Aphasia Battery; ECVB: Echelle de Communication Verbale de Bordeaux; FAST: Frenchay Aphasia Screening Test; FCP: Functional Communication Profile; KFAST: Korean Frenchay Aphasia Screening Test; KWAB: Korean version of the Western Aphasia Battery; n.a.: Not applicable; NHMRC: National Health and Medical Research Council; PICA: Porch Index of Communicative Ability; PWA: people with aphasia; RFP: Rating of Functional Performance; SAQOL-39: Stroke and Aphasia Quality of Life-39; ScSS: Scandinavian Stroke Scale; SLARS: Successfully Living With Aphasia Rating Scale; SDHs: social determinants of health; SSS: Stroke Severity Scale; TPO: Time post onset of aphasia; WAB: Western Aphasia Battery; WAB-R: Western Aphasia Battery-Revised; WAST: Whurr Aphasia Screening Test.

^aIntervention studies were classified according to the NHMRC Intervention levels of evidence hierarchy. Non-intervention studies were classified according to the NHMRC Prognosis levels of evidence hierarchy [27].

^bOutcome measures classified according to the Living with Aphasia: A Framework of Outcome Measures [55].

^cNeurological exam includes subtests for attention; visual, phonemic perceptions; spontaneous speech; fluency; repetition; naming; comprehension; automatic speech; praxis.

Table 2. Aphasia recovery, SDOHs, aphasia outcomes, and time post onset.

TPO	Author (year)	Country	Gender	Education	Ethnicity	SES	Social support
Language
≤ 1 week	Pedersen et al. (1995)[51]	Denmark	□	–	–	–	–
	Lahiri et al. (2021)[39]	India	□	□	–	–	–
≤ 3 M TPO	Sarno et al. (1970)[29]	USA	□	□	–	□	–
	Lendrem and Lincoln (1985)[48]	UK	□	–	–	–	–
	Lazar et al. (2008)[36]	USA	–	□	–	–	–
	Lahiri et al. (2020) [41]	India	□	□	–	–	–
	Lee et al. (2020)[38]	Korea	□	□	–	–	–
≤ 12 M TPO	Oliveira et al. (2009)[40]	Brazil	□	□	–	–	–
	El Hachioui et al. (2013)[31]	The Netherlands	□	□	–	–	–
	Worrall et al. (2017)[33]	Australia	□	□	–	■	□ □
	Kim et al. (2019)[35]	Korea	–	■	–	–	–
> 12 M TPO	Connor et al. (2001)[30]	USA	–	■	–	■	–
	Ellis and Peach (2017)[44]	USA	–	–	■	–	–
	Lwi et al. (2021)^a[37]	USA	□	■	–	–	–
	Johnson et al. (2022)^a	USA	□	□	–	□	–
Participation
≤ 12 M TPO	Mazaux et al. (2013)[34]	France	□	□	–	■	–
	Worrall et al. (2017)[33]	Australia	■	■	–	■	■
Environment
≤ 12 M TPO	Worrall et al. (2017)[33]	Australia	□	□	–	□	□
Personal factors
≤ 12 M TPO	Worrall et al. (2017)[33]	Australia	□	□	–	□	□
Quality of life
≤ 3 M TPO	Grohn et al. (2012)[28]	Australia	–	–	–	–	■^b
≤ 12 M TPO	Worrall et al. (2017)[33]	Australia	□	□		□	□ □
> 12 M TPO	Hilari et al. (2003)[43]	UK	□	–	□	□	□
	Hilari and Northcott (2006)[47]	UK	–	–	–	–	■ □ ■
	Lee et al. (2015) [46]	Korea	–	–	–	■	–

Notes: ■: Significant finding; □: non-significant finding; □□: multiple measures of SDOH used; SES: socio-economic status; M: month; TPO: time post onset.

^aStudies recruited participants >6 months post-onset however mean TPO >12 M.

^bQualitative study.

Table 3. Response to aphasia intervention, SDOHs, aphasia outcomes, and time post onset.

TPO	Author (year)	Country	Gender	Education	Ethnicity	SES	Social support
Language outcomes
≤3 M TPO	Keenan and Brassell (1974)[45]	USA	–	–	–	□	–
≤12 M TPO	Pizzamiglio et al. (1985)[49]	Italy	■	–	–	–	–
	de Riesthal and Wertz (2004)[42]	USA	–	□	–	–	–
>12 M TPO	Sarno et al. (1985)[50]	USA	□
Participation outcomes
>12 M TPO	Sarno et al. (1985)[29]	USA	□	–	–	–	–
Quality of life outcomes
>12 M TPO	Ribeiro Lima et al. (2021)[32]	Brazil	■	□	–	□	■ ■

Notes: ■: Significant finding; □: non-significant finding; □□: multiple measures of SDOH used; SES: socio-economic status; M: month; TPO: time post onset.

Table 4. Classification of aphasia outcome measures in included studies (n = 25).

Language impairments
Assessment for Living With Aphasia^a
Boston Diagnostic Aphasia Examination
Frenchay Aphasia Screening Test (multiple versions)
Neurosensory Centre Comprehensive Examination for Aphasia
Porch Index of Communicative Ability
Western Aphasia Battery (multiple versions)
Scandinavian Stroke Scale
Researcher-developed batteries
Activity and participation
Assessment for Living with Aphasia^a
Echelle de Communication Verbale de Bordeaux
Functional Communication Profile
Rating of Functional Performance
Personal identity, attitudes and feelings
Assessment for Living with Aphasia^a
Environmental factors
Assessment for Living with Aphasia^a
Quality of life
Assessment for Living with Aphasia^a
Stroke and Aphasia Quality of Life Scale-39
Successfully Living with Aphasia Rating Scale

Note: Some studies examined multiple outcomes.

^aThe Assessment for Living with Aphasia was used by Worrall et al. [33] to assess outcomes across all A-FROM domains [26].

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