Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. TIDieR item reporting.

TIDieR item	Number of ICAPs reporting this item (n = 17)
1. Brief name	17
2. Why	17
3. What materials	12
4. What procedures	17
5. Who provided	15
6. How	17
7. Where	Country = 17 Setting = 16
8. When and how much	17
9. Tailoring	12
10. Modification	2
11. How well planned	3
12. How well actual	8

Table 2. Name, rationale, and materials used in the 17 ICAPs.

#	ICAP	Article	1. Brief name	2. Why	3. What materials
1	Aphasia House	Helm-Estabrooks and Whiteside 2012 [98]	The Aphasia House (Florida, US). Using life interests and values cards to select goals for an ICAP	Not ICAP-specific. Personalised goal setting can improve motivation, response to rehab, satisfaction with outcomes, increases autonomy but you must make this accessible for people with aphasia. Theory on intensive treatment. You must explore non-impairment issues (e.g., life interests and values via these accessible cards).	Life interests and values cards for goal setting depicting activities for adults, feelings/emotions, adaptations (e.g., adaptive equipment) etc. Assistive technology, articles of interest
		Whiteside and Pak Hin Kong 2013 [99]	Aphasia House ICAP	Not ICAP-specific but theory on intensive treatment, need for supportive environment, and evidence-based therapies for impairment approaches.	Life interests and values cards, assistive technology integrated also
2	Belfast	Code et al. 2010 [109]	Intensive therapy for 7 with chronic aphasia	Not ICAP-specific. To examine the effectiveness of a 1-month intensive block of therapy in improving the communication abilities of the aphasic participants. Also rationale on group treatment.	NR
3	Big Sky Montana	Off et al. 2019 [111]	Big Sky Aphasia Program ICAP (Montana, US). Caregiver intervention on an ICAP provided by SLPs and counselling staff.	ICAP theory – to improve communication impairments and psychosocial wellbeing for people with aphasia and their family caregivers. Treat all aspects of World Health Organisation International Classification of Functioning, Disability and Health (ICF) in condensed time period. Theory on intensity (e.g., neuroplasticity). Meaningful relationships between people with aphasia and significant others. Caregiver intervention affecting the caregiver-patient dyad to improve outcomes for people with aphasia and caregiver. Interprofessional collaboration important. Cohort brings share learning, share psychosocial experiences, quick bonding, shared focus, collectivism.	Caregiver materials: Your Guide to Aphasia: Recovery, Treatment & Resources Handbook available: https://comdde.usu.edu/services/research/language-and-aphasia/2_aphasia_online_handbook.pdf; Powerpoint notes; handout that differentiates aphasia symptoms from apraxia of speech symptoms; Caregiver Bill of Rights; video. For PWA: access to an adapted gym; mobility supports (e.g., wheelchair); access to adaptive recreational equipment (e.g., adaptive bikes), home program
4	Boston	Hoover et al. 2017 [100]	An Intensive Comprehensive Aphasia Program at Boston University	ICAP rationale combining evidence on intensive treatment; acknowledging the difficulty identifying key elements of change in an ICAP due to variety of participant profiles and individualised interventions; speculation that key factors include intensity, individualised treatment linked to person’s goals, using evidence-based treatment, combining group, dyadic, individual treatment, focus at multi linguistic levels from word to discourse, including communication partners, and interdisciplinary treatment.	iPad2
		Hoover and Carney 2014 [101]	An Intensive Comprehensive Aphasia Program at Boston University	No overview but indicated that treatment philosophy is the Life Participation Approach to Aphasia, so it’s focused on individual goals and meaningful activities chosen by clients. Also key is training across linguistic contexts – 1:1 – group.	Apps and iPad. Clinician resources available at www.bu.edu/aphasicenter [first author couldn’t locate but found some at http://www.bu.edu/aphasiacenter/current-programs/resources-for-arc-groups/].
		Escher et al. 2018 [102]	An Intensive Comprehensive Aphasia Program at Boston University	Not ICAP-specific. Effectiveness of OT intervention within an ICAP to address improving IADLs etc.	Adapted recipes (photos and large print), otherwise implied within goals e.g., using video calling technology
5	Chicago	Babbitt et al. 2015 [114]	0	Focuses on intensity – neuroplasticity principles and providing more therapy than in typical US outpatient facilities	Computers, iPads
6	Copenhagen	Jensen and Lonnberg 2009 [136]	Intensive rehabilitation programme for returning to work post aphasia	Not ICAP-specific. Statement that return to work may be a goal of rehabilitation.	NR
7	Glasgow	Mackenzie 1991 [115]	An intensive aphasia group efficacy study of 5 people with aphasia	Not ICAP-specific. Whether improvement in communication followed a brief course of intensive intervention. Literature on evidence for intensive treatment.	Pictures, written cue cards, TV, newspapers, clocks
8	InteRACT	Persad et al. 2013 [107] NB this article also reports on UMAP	InteRACT – Intensive Residential Aphasia Communication Therapy program (Halifax, Canada)	The overarching goal of the ICAP is to maximize communication potential and enhance life participation [p.390]. Paper is clear on ICAP model but not specific on rationale.	NR
9	iTAWC	Ferdinandi and Duke 2012 [108]	A pilot intensive comprehensive aphasia treatment for 7 PWA in British Colombia	ICAPs have received attention in the literature but they haven’t been available in British Colombia	NR
10a and b	LIFT 1 and 2 Rodriguez	Rodriguez et al. 2013 [104]	LIFT – Aphasia Language Impairment and Functional Therapy (Brisbane, Australia)	Research-based ICAP developed for the purpose of evaluating treatment outcomes across the ICF domains. [p.1339]. Rationale on neuroplasticity, patient-centred goal setting, inclusion of communication partner, but acknowledge difficulty identifying which aspects of an ICAP effect change.	Accessible written information, communication book, rest linked to treatment approaches (e.g., use of pictures)
10c	LIFT 3 Dignam	Dignam et al. 2015 [103]	LIFT – Aphasia Language Impairment and Functional Therapy (Brisbane, Australia)	Rationale focused on evidence from neuroscience of intensive training versus evidence for long-term learning from distributed practice.	NR
		Dignam et al. 2016 [105]	LIFT – Aphasia Language Impairment and Functional Therapy (Brisbane, Australia)	Not ICAP-specific. This study focused on novel word learning in aphasia to inform recovery mechanisms and help predict potential for improvement.	Computer software programmes, for example, StepbyStep
11	Louisiana	Fitzgerald-DeJean et al. 2012 [113]	Use of experience sampling method with one gentleman who took part in an intensive aphasia program	Not ICAP-specific. Mostly focused on testing whether the experience sampling method works. Program was designed to promote functional communication in a relatively natural setting.	Computers, humorous videos, a device [palmOne Zire 31 PDA] to collect ESM data.
12	Milton Keynes	Brindley et al. 1989 [116]	Intensive therapy for Broca’s aphasia (5 people per cohort for 2 cohorts)	Not ICAP-specific. Allocating more time to traditional treatment. Theory given for individual approaches, for example, syntax programme, effective communication programme, group sessions, word retrieval programme, verbal memory programme.	Photographs borrowed from home to use in treatment
13	Oklahoma	Prigatano et al. 1985 [135]	Neuropsychological rehabilitation after closed head injury in young adults	Not ICAP-specific. Rehab emphasizes cognitive retraining but doesn’t include the emotional and motivational problems experienced. Including psychotherapeutic interventions might maximise recovery.	Non-SLP: Cognitive retraining materials and tasks
14	PIRATE	Winans-Mitrik et al. 2014 [112]	PIRATE – the Program for Intensive Residential Aphasia Treatment and Education (Pittsburg, US). Outcomes of a total of 73 first-time participants in an ICAP.	No ICAP-specific rationale. Detail on approaches, for example, groups generalise gains/enhance social participation & on psycholinguistic treatment theory, for example, PALPA	Customised resources for each participant, for example, support groups in their area. Home treatment program.
15	UMAP	Hinckley & Craig 1998 [106]	UMAP – University of Michigan Aphasia Program	Not ICAP-specific. Rationale for intensive treatment.	Computers
		Persad et al. 2013 [107] NB this article also reports on InteRACT	UMAP – University of Michigan Aphasia Program	The overarching goal of the ICAP is to maximize communication potential and enhance life participation. [p.390] Paper is clear on ICAP model but not specific on rationale.	NR

NR: not reported, that is, no information provided for TIDieR analysis.

Grey shaded rows represent the data extracted from grey literature to supplement that which available from the peer reviewed publication.

Table 3. Procedures, providers, how and where ICAPs were provided and detail on tailoring.

Article	4. What procedures	5. Who provided	6. How	7. Where	9. Tailoring
Helm-Estabrooks and Whiteside 2012 [98]	Set goals with LIV cards, provide intensive therapy that includes group approaches	NR	Group	The Aphasia House at the University of Central Florida	Individualised
Whiteside and and Pak Hin Kong 2013 [99]	4 PWA per cohort. 4 students per participant. Each student took on 1 area of impairment and devised an approach based on literature review of evidence and consultation with clinical educator.	4 graduate level student clinicians per participant (i.e., 16 students per programme) and clinical educator mentioned	1:1, group, dyadic	The Aphasia House at the University of Central Florida	Individualised
Code et al. 2010 [109]	Tx planned daily by 2 SLTs. Small groups formed based on having either mild or severe aphasia and one group for apraxia of speech (AOS). No specific detail on what therapy was provided other than it was individualised based on test results and participants with AOS received group sessions on articulation and speech practice. Counselling offered 1:1 for PWA and there were 4 counselling groups for families (1 a week) on topics of coping etc.	2 experienced SLTs familiar w participants; trained and experienced assistant (unspecified type); trained counsellor experienced in aphasia	1:1; group (of 7)	Belfast, by the charity Speech Matters	Individualised
Off et al. 2019 [111]	20–30 min opening and closing meetings each day for PWA and caregivers. For PWA. SLT: individualised comprehensive evidence-based therapy provided daily in individual and small conversation group (2–3 people) formats and weekly in a large group (4–8 people). Weekly community outings. MDT: Opportunity for physical therapy and consultation with AAC experts as needed. For caregivers: SLT weekly SSLT-led education group for education/ training/ psychosocial support (topics including the nature of aphasia, apraxia of speech, and stroke; the nature of recovery; neuroplasticity, communication strategies, tools and resources). MDT: Counsellor-led counselling groups provided twice a week (focus on personal wellness, caregiving strategies, emotional health, adaptation to significant life changes). Once a week group lunch. Once a week community outing. End of ICAP potluck social.	Certified and licenses SLPs, graduate student clinicians enrolled on the SLP program, a licensed professional counsellor and a counsellor-in-training. A caregiver who became a liaison between the caregivers and the interprofessional team.	1:1; small group (2–3); large group (4–8)	Big Sky Montana: The University clinic of the University of Montana in Missoula; counselling for caregivers provided in a separate building.	The caregiver engagement is optional.
Hoover et al. 2017 [100]	Dyadic treatment, for example, CILT, PACE. Group treatment, for example, LPPA, Toastmasters, newsletter group, language games, current events, book club, occupational therapy, physical treatment, nutrition treatment. Community-based outings weekly with caregivers. Caregiver training from all disciplines.	Licensed clinical faculty and second-year, MS-SLP graduate students at Boston University under 100% faculty supervision [p.85]. Average 8 students per program who had completed the aphasia course. All received extensive interprofessional orientation and training.	1:1; group; dyadic; computer	At Boston University	Individualised (based on their goals)
Hoover and Carney 2014 [101]	Speech-language therapy, occupational therapy, physical therapy, and nutrition treatment. Extensive detail on content of therapy, for example, specific apps and iPad useability features used, content and purpose of group sessions.	Speech-language pathology, occupational therapy, physical therapy, and nutrition faculty planned, coordinated, and conducted treatment along with supervised graduate student clinicians (27).	1:1; group; dyadic; computer	At Boston University	Individualised
Escher et al. 2018 [102]	Provided OT input as part of an ICAP, delivered daily in group or individual or joint sessions with other MDT. Focus “on IADLs, leisure, social participation, and work or volunteering, and they emphasized the use of problem-solving techniques” (p. 3).	An OT and 2 OT graduate students. Interprofessional team including physical therapists, speech-language pathologists and nutritionists. University faculty from the department of occupational therapy [and the other MDT areas] along with students from each of these professional programmes.	1:1; group [for OT]	NR	Individualised (based on their goals)
Babbitt et al. 2015 [114]	10 participants per program. Individual and group treatment: reading/writing treatment, constraint-induced language treatment, computer-based treatment, conversation/interactive group. Ideally each treatment hour focused on the same type of treatment to maximize repetitions.	Speech-language pathologists who are recruited from other positions for the program duration. They are trained in evidence-based aphasia tx. 6 treating clinicians per ICAP. 2 of these each had over 20 years of experience. Others came from a variety of settings (inpatient/outpatient/day rehab with between 2–15 years of experience in neurological communication impairments).	1:1, groups (3–5 PWA with 1–2 clinicians)	Offsite of an urban rehabilitation centre in Chicago, transient with no dedicated clinical space requiring set-up and break-down of equipment/ supplies/ materials.	Individualised
Jensen and Lonnberg 2009 [136]	Intensive language and communication training combined with social and vocational rehabilitation followed by a work trial or vocational placement.	NR	NR	Centre for Rehabilitation of Brain Injury in Copenhagen	NR
Mackenzie 1991 [115]	Individual treatment programmes on picture naming, verbal expression, and sequential picture description. Group treatments with 2 or 3 participants/ group.	The author (likely an SLT given affiliation to School of Speech Therapy) and an SLT employed 0.5 for the project. 2 additional SLTs each provided group sessions on 1 day a week (unclear if this equals one on one day and another on another day). SLT students participated in unspecified ways.	1:1; group (of 5); pairs	In a college of education [somewhere in Scotland, assuming Glasgow from author affiliation]	Everyone did group treatment but individual treatment options came from a set menu of up to 3 possible treatments – naming [4 people], verbal expression [3], and sequential description [for the 1 who didn’t do naming]. Target items for naming were different for each but all targets came from items on the Picture Naming Test. Same for verbal expression treatment with targets from the Verbal Expression Test and for sequential description with targets from the Sequential Description Test.
Persad et al. 2013 [107] NB this article also reports on UMAP	Individual: impairment-based language and motor speech (e.g., MIT), reading/writing, for example, anagram and copy treatment; functional/ multimodal communication skills (e.g., PACE), and computer skills. Group treatment for conversation and community integration. Group recreation treatment and group physical therapy.	NR	1:1, group, computer	InteRACT at Dalhousie University	NR
Ferdinandi and Duke 2012 [108]	Individual treatment including constraint-induced language therapy, use of technology, group treatment, and an adapted book club	9 SLPs from Colombia Speech and Language Services Inc. with 7 graduate speech students.	1:1; group	iTAWC: Assumed Vancouver from author affiliation but not detail on setting	NR
Rodriguez et al. 2013 [104]	2 ICAPs ran, LIFT 1 giving treatment to n = 4 PWA; LIFT 2 gave treatment to n = 7. Treatment included impairment-based approaches such as SFA, phonological components analysis, modified mapping treatment, mind-mapping for narrative, AOS treatment, etc. Functional approaches included context-specific tasks and compensatory or strategical approaches. Group therapy provided education about aphasia and social interaction. There were family group sessions and computer-based treatment only for LIFT2.	The goal planning interview… was facilitated by LIFT clinicians and researchers experienced in goal-setting [p. 1345] For every four participants, two full-time clinicians, and two full-time student volunteers were required [p. 1347]	1:1; Group for LIFT1. 1:1; Group; family group; computer for LIFT2	LIFT: University of Queensland [given in Dignam et al., 2015]	Individualised (to level of language breakdown and individual goals)
Dignam et al. 2015 [103]	3 intensive and 8 distributed ICAPs were run and the groups pooled. n = 16 LIFT and n = 18 D-LIFT (who don’t qualify for ICAP intensity). Impairment treatment focused on word-retrieval using SFA/phonological component analysis. Computer treatment for same. Functional treatment for individual communication goals. Group therapy for education on aphasia, communication strategies, and support.	Qualified speech pathologists who received training on the treatment approaches used. Sometimes computer tx led by speech pathology students or a trained allied health assistant supervised by a qualified speech pathologist.	Group; Computer [Individual not mentioned but Rodriguez procedures referenced so assumed it involves 1:1 too]	LIFT: University of Queensland and in rehabilitation centres in Brisbane and Sydney	Functional treatment tailored to individuals’ goals
Dignam et al. 2016 [105]	This paper reports on 30 PWA, 29 of whom are the same as in the Dignam 2015 paper and received the same treatment as described in Dignam 2015. Participants in this paper also completed a novel word learning activity, but this was not part of the therapy (was in Assessment).	As above – qualified speech pathologist who were trained in Aphasia LIFT; computer tx facilitate by student or training AH assistant under supervision.	Group; Computer; [doesn’t explicitly say individual therapy was provided but this is assumed from individualised treatment sets for naming tx]	LIFT: [Author affiliations all Brisbane and paper references Dignam 2015]	Naming treatment targets for each participant selected from 309 picture stimuli from BOSS (bank of standardised stimuli) – 24 the participant couldn’t name and 6 they could name were included in their treatment sessions.
Fitzgerald-DeJean et al. 2012 [113]	Daily treatment including computer lab, pantomime/improvisation and music appreciation, community reintegration, wellness group. Tai chi happened 3 times a week for the first 3 weeks and was replaced by watching humorous videos. Psychological support group for carers. Weekly socials and some community-based field trips.	A certified SLP and student clinicians (SLP) for SLP activities. Graduate students in psychology for psychological support. Clinical instructor in kinesiology to administer modified Tai Chi.	1:1; small group; entire group (of 6)	University based. Assume Louisiana as all authors based there.	NR
Brindley et al. 1989 [116]	Visit all participants at home pre- treatment to gather info for treatment data, all completed a 1:1 syntax and group effective communication programme, then optional extras delivered depending on profile, for example, word retrieval, articulation, attention and STM. Unclear of time allocated to each component. All but one went home at the weekend.	SLTs. Volunteer assisted in the group sessions.	1:1; Group (of 5)	Milton Keynes hospital. Residential. Hospital accommodation.	Everyone in syntax programme 1:1 and everyone in effective communication groups. 8/10 had 1 of 3 additional programme options and 2/8 had 2 of 3 additional programme options (from word retrieval, articulation, verbal memory).
Prigatano et al. 1985 [135]	Individual and group treatment focusing on increased awareness and acceptance of brain injury, intensive cognitive retraining of deficits, developing compensatory skills. Relatives met weekly for support and help to generalise.	3 clinical neuropsychologists, 1 speech and language pathologist, 1 occupational therapist and part-time physical therapists. A research psychologist helps develop various cognitive retraining materials and tasks. A consultant psychiatrist meets with the staff monthly to discuss the management of various patients.	1:1, small groups	Presbyterian Hospital Oklahoma City	NR
Winans-Mitrik et al. 2014 [112]	Treatment planning meeting to establish goals. Individual treatment: cognitive-linguistic aphasia therapy (e.g., SFA, VNEST, TUF, phono-motor treatment, spelling treatment); weekly social and therapeutic group activities (e.g., ordering food in a restaurant). Weekly client and caregiver [when available] education in a group. Home treatment program.	Licensed SLPs experienced in aphasia	1:1; Groups (3 people per cohort)	PIRATE: VA Pittsburgh Healthcare System (VAPHS). Residential. Only for community-dwelling veterans and active duty military personnel.	Individualised
Hinckley & Craig 1998 [106]	Individual, group and computer lab treatments provided. Therapy was individualised including role-playing, community outings, naming.	Certified SLPs	1:1; Small group; Computer lab	UMAP: University of Michigan	Individualised treatment. Also, Groups 1–3 got different therapy intensities during the non-intensive periods.
Persad et al. 2013 [107] NB this article also reports on InteRACT	Tailored treatment including evidence-based interventions. Caregivers encouraged to attend. Additional weekly social and recreational activities provided. Weekly music and art therapy. [Music and art is the only bit not mentioned in Hinckley & Craig 1998]	NR	1:1; Group; Computer based	University of Michigan Aphasia Program (UMAP)	Individualised

NR: not reported, that is, no information provided for TIDieR analysis.

Grey shading signifies grey literature reports.

Table 4. Modifications and adherence and fidelity on ICAPs.

Article	10. Modifications	11. How well planned	12 How well actual
Off et al. 2019 [111]	Counselling has only been included in the Summer ICAP sessions [not Fall]. No specific reason given.	NR	Although attendance is not mandatory, the majority of caregivers have attended on a regular basis.
Hoover et al. 2017 [100]	NR	Saying students received 100% supervision and daily training to ensure treatment fidelity	NR
Hoover and Carney 2014 [101]	No change of intervention but change of outcome measure (ALA with cohort 1 and ASHA FACS with cohorts 2 and 3)	NR	NR
Escher et al. 2018 [102]	Variation in amount of OT delivered “from year to year was based on individual and cohort needs and goals” (p. 3)	NR	18 of 19 attended at least 85% of the occupational therapy sessions. 1 had considerable health problems and missed a full week of the program.
Babbitt et al. 2015 [114]	NR	Steps to ensure treatment fidelity: Clinicians required to read articles on evidenced based treatment 2-day training session including videos of experienced clinicians implementing the treatment and practice through role-play; program director observed occasional treatment sessions and gave feedback on treatment procedures. 10% of treatment sessions were videoed and reviewed by the program director.	Summary statement that the strategies ensured treatment was delivered according to the design. Of 74 most participants attended all treatment – occasional missed sessions due to outside appointments. 1 person missed 2 days with illness.
Mackenzie 1991 [115]	NR	NR	No patient was absent on any day
Rodriguez et al. 2013 [104]	Dosage increased in LIFT2 “based on performance on outcome measures and participant feedback” (p. 1343). Added the family group sessions and computer-based treatment only for LIFT2.	Number of treatment hours received by each participant was calculated.	Of 8 enrolled in LIFT2, 1 didn’t complete due to onset of prolonged cold/flu. Of total possible treatment hours 7 received 99–100%; 2 received 90–95%; 2 received 85–89%. Sessions missed due to outside obligations, illness, fatigue in the last week.
Dignam et al. 2015 [103]	NR	Aphasia LIFT manual developed to promote treatment fidelity.	All 16 completed LIFT. Mean treatment attendance rate was high LIFT = 47.7 h. D-LIFT not reported as didn’t reach ICAP intensity but attendance at D-LIFT 47.9 and 16/18 completed D-LIFT due to acute-onset medical reasons
Dignam et al. 2016 [105]	NR	NR	There were 30 included in this trial and 28 completed. 2 D-LIFT participants withdrew due to acute-onset medical reasons.
Fitzgerald-DeJean et al. 2012 [113]	NR	0 for the intervention but participant compliance in completing the Experience Sampling 4 times a day for each of 4 questions asked	0 for the intervention, but 100% compliance/completion 464 potential responses [4 variables × 4 times/day × 29 days]
Winans-Mitrik et al. 2014 [112]	NR	NR	3 did not complete the programme (1 was query acute stroke, 1 personal reasons, 1 unsafe for independent living due to multiple falls)
Hinckley & Craig 1998 [106]	NR	0. No detail on fidelity during intensive periods. But tried to ensure non-intensive therapy contained the same content as intensive – did this via a retrospective progress note review and reading reports describing treatment. Attendance at non-intensive sessions confirmed by oral/written communication with treating SLP.	0. But adherence to a similar treatment approach for the non-intensive treatment was confirmed.

NR: not reported, that is, no information provided for TIDieR analysis.

Grey shading signifies grey literature reports.

Seven ICAPs did not report any data for TIDieR items 10, 11 and 12 and were thus not included above: Aphasia House, Belfast, Copenhagen, InteRACT, iTAWC, Milton Keynes, Oklahoma, and UMAP.

Figure 2. Professionals involved in ICAPs.

Figure 3. Country of ICAP origin.

Figure 4. Setting of ICAP.

Figure 5. Duration of ICAP in weeks .

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