Communicating simply, but not too simply: Reporting of participants and speech and language interventions for aphasia after stroke

Figures & data

Figure 1. Complexity of speech and language interventions for aphasia after stroke.

Table I. Overview of therapy recommendations* for aphasia (a) and arm function (b) from two exemplar national stroke clinical guidelines (Intercollegiate Stroke Working (ISW) Party, 2016; Stroke Foundation, 2017).

Intervention	Regimen	Population	Guideline
(a) Aphasia Recommendations
Low or high-tech aids	—	—	UK and AUS
Train person + family	—	—	UK and AUS
Goal setting for therapy	—	—	AUS
Tailored	—	—	AUS
Language and communication practice	As tolerated	Within first 4 months after stroke	UK
Assistant, family member, volunteer guided by SLP	—	—	UK
Computer practice	—	>Four months after stroke	UK
Impairment based or functional treatment	—	>Four months after stroke	UK
—	As early as tolerated	—	AUS
Direct language therapy	Intensive (at least 45 min) 5 days per week	First month after stroke	AUS
(b) Arm function recommendations
Constraint-induced movement therapy	Intensive for a minimum of 2 h per day for 2 weeks plus restraint for at least 6 h a day (AUS)	Active wrist and finger extension	UK & AUS
Mental practice with motor training	Adjunct to therapy (UK)	Mild-moderate weakness of arm; (if cognitively able (UK)	UK & AUS
Practice functional activities, repetitive movements that are task specific	Every opportunity; high intensity	Bilateral or unilateral	UK
Repetitive, task specific training	—	Some voluntary movement of hand and arm	AUS
Mechanically assisted (e.g. robotics)	Only as adjunct to conventional therapy in a trial (UK)	(Mild-severe weakness) (AUS)	UK & AUS
Virtual reality	Minimum 15 h dosage	Mild-moderate arm impairment; Best within 6 months of stroke	AUS
Interactive games	Minimum 15 h dosage	Mild-moderate arm impairment; Best within 6 months of stroke	AUS
Electrical stimulation with motor training	—	Mild-severe; hand or arm weakness	AUS
Electrical stimulation	Only as adjunct to conventional therapy in a trial	—	UK
Mirror therapy	As adjunct to usual therapy	Mild-moderate weakness; complex regional pain syndrome or neglect	AUS

* Recommendations relating to screening for aphasia, the importance of delivering therapy to people with aphasia, assessment or reassessment, and information provision activities were excluded from this table which focuses specifically on therapy interventions.

Table II. Participant and speech and language pathology intervention data extraction items.

Participants
Demographics	Age, sex, handedness, ethnicity, cognition, educational background, previous occupation; participant inclusion and exclusion criteria, languages spoken
Stroke	Time since stroke^a, stroke severity (at baseline), stroke type (ischemic or haemorrhagic), hemisphere of stroke, prior stroke, mental health (depression, anxiety), cognition prior to stroke, cognition following stroke, dementia, pre-existing neurological diagnosis, visual impairment, hearing impairment, co-existing health concerns (e.g. hypertension), apraxia, dysarthria
Environmental details	Living context prior to stroke, living context following stroke, social support (marital status), socio-economic status
Speech and language pathology (based on the TIDieR checklist)
Why	Rationale, theory, therapy goal
What was delivered	Materials, procedures, supporting activities
Who provided	Expertise, training, research specific training, SLP or not
How was therapy provided	Face-to-face, telephone, computer-based; telerehabilitation; 1-to-1, group therapy
Where	Therapy context
How much	Regimen, frequency (number of days each week); duration (total length of therapy intervention); intensity (hours of therapy per week); dosage (total number of therapy hours)
Tailoring	By difficulty; by functional relevance
Modifications	To primary study protocol
Adherence	To clinical based intervention
	To home practice tasks (if prescribed)

^aInclusion criteria.

Table III. Participant descriptors in datasets.

Variable	IPD available (%)	IPD n = 5928 (%)	Datasets n = 174 (%)
Sex
Female	2143 (38.6)	5550 (93.6)	158 (90.8)
Male	3407 (61.4)
Handedness
Right	3719 (95.9)	3879 (65.4)	111 (63.8)
Left	133 (3.4)
Ambidextrous	27 (0.7)
Ethnicity
Asian	248 (16.8)	1475 (24.9)	24 (13.8)
Black	67 (4.5)
Hispanic/Latino	9 (0.6)
Mixed	2 (0.1)
Other	33 (2.2)
White	1116 (75.7)
Living context
Alone	146 (20.8)	701 (11.8)	21 (12.1)
Formal care environment	70 (10.0)
Living with others	473 (67.5)
Mixed	12 (1.7)
Stroke
Ischaemic	2795 (81.8)	3416 (57.6)	97 (55.7)
Intracerebral haemorrhage	547 (16.0)
Subarachnoid haemorrhage	31 (0.9)
Mixed	42 (1.2)
Aneurysm	1 (0.03)
Hemisphere
Left	3965 (96)	4130 (69.7)	130 (74.7)
Right	81 (2.0)
Bilateral	84 (2.0)
Prior stroke
Yes	110 (8.6)	1274 (21.5)	45 (25.9)
No	1164 (91.4)
Socioeconomic status
(excl. postcode, occupation, education, deprivation index)	175 (3.0)	175 (3.0)	4 (2.3)
Visual impairment
Corrected	312 (20.9)	1494 (25.2)	35 (20.1)
No impairment^a	1122 (75.1)
Impairment present (unspecified)^a	60 (4.0)
Cognitive impairment
No impairment ^a	3347 (84.8)	3945 (66.5)	100 (57.5)
Impairment present (unspecified)^a	7 (0.2)
Assessment score reported	591 (15.0)
Dysarthria
No dysarthria^a	634 (67.7)	937 (15.8)	19 (10.9)
No or mild dysarthria^a	178 (19.0)
Dysarthria present (unspecified)^a	125 (13.3)
Apraxia
No apraxia^a	606 (59.9)	1011 (17.1)	34 (19.5)
Apraxia present (unspecified)^a	375 (37.1)
Assessment score available	30 (3.0)
Depression
Present^a	352 (17.0)	2075 (35.0)	62 (35.6)
Absent^a	1723 (83.0)
	Median [IQR]	IPD n = 5928 (%)	Datasets n = 174 (%)
Age (years)	63 [53–72]	5785 (97.6)	169; 97.1
Education	12 [10, 16]	3125 (52.7)	84 (48.3)
Stroke severity
National Institute of Health Stroke Scale (NIHSS)	11 [5–17]	716 (12.1)	8 (4.6)
Modified Rankin Scale (mRS)	4 [3–4]	489 (8.2)	6 (3.4)
Barthel Index (BI)		442 (7.5)	5 (2.9)
0–20 scale	16 [9–20]
0–100 scale	60 [15–95]

IPD: individual participant data; IQR: interquartile range.

^aVia categorical description.

Table IV. Descriptions of aphasia research participants; comparison of data availability.

Participant descriptor	Brookshire 1983 (n = 52) %	Roberts et al. (2003) (n = 100) %	RELEASE 2019 (n = 174) %
Age	91	92	97
Sex	48	91	91
Handedness	23	60	64
Education	35	55	48
SES	—	—	2
Ethnicity	—	—	14
Native Language	15 (of English)	41	—
Presence of bi/multilingualism	—	19	7
Occupation	—	36	17
IQ	3	1 (Pre-morbid)	58 (Cognitive impairment)
Social integration	—	10	12 (Living context)
Personality	—	5	—
Depression	3 (Mood/alertness)	4	36
Medical status	—	Diabetes 1	Diabetes 5
		Hypertension 5	Hypertension 6
Vision	4 (Hemianopia)	17	20
	2 (Acuity)
Hearing	19	30	52
Type of stroke	—	22	56
Lesion location	53 (Hemisphere)	83	75 (Hemisphere)
	13 (Within hemisphere)
Stroke severity	—	–	5^b
Hemiplegia	10 (Hemiparesis)		—
Aetiology	49	80	100^a
Prior stroke	—	24	26
Aphasia severity	64	82	100^a
Time since onset	60	83	100^a
Type of aphasia	54	78	–
Dysarthria	—	14	11
Apraxia of speech	—	28	20
Prior treatment	—	24	—
Recruitment location	28	30	100

—: did not extract this data; SES: socio-economic status.

^aInclusion criteria therefore 100% of this dataset;

^bBased on National Institute of Health Stroke Scale.

Table V. Descriptions of speech and language pathology interventions for aphasia after stroke (RELEASE dataset) using an extended TIDieR framework.

Description of intervention	IPD n = 2330 (%)	Datasets n = 67 (%)
SLP by theoretical approach^a^,b
Semantic	34 (1.5)	2 (1.5)
Phonological	124 (5.3)	9 (13.4)
Semantic and phonological	260 (11.2)	15 (22.4)
Functional and pragmatic	246 (10.6)	8 (11.9)
Constraint Induced aphasia therapy	113 (4.8)	7 (10.4)
Melodic intonation therapy	61 (2.6)	4 (6.0)
Conversational partner training	55 (2.4)	2
Verbal therapy	887 (38.1)	43
Multimodal therapy	308 (13.2)	13
SLP by language impairment target^a^,b
Spoken language; of which naming (or word-finding)   and other spoken language	734 (31.5)	41
	489 (21.0)	30
	245 (10.5)	11
Auditory comprehension	68 (2.9)	4
Auditory comprehension and spoken language	651 (27.9)	24
Reading	10 (0.4)	1
Writing	0	0
Who provided SLP^b
Professional	1871 (80.3)	62 (92.5)
Non-professional	274 (11.8)	7 (10.4)
How was SLP provided (mode of delivery)^b
Face-to-face	1957 (84.0)	60 (89.6)
Computer	315 (13.5)	15 (22.4)
Telephone	15 (0.6)	1 (1.5)
Constraint induced aphasia therapy	113 (4.8)	7 (10.4)
Self-managed	106 (4.5)	4 (6.0)
One-to-one	1613 (69.2)	47 (70.1)
Group	148 (6.4)	8 (11.9)
Mixed	207 (8.9)	9 (13.4)
Where was SLP provided^b
Clinic, hospital or rehabilitation setting	1866 (80.1)	48 (71.6)
Home	575 (24.7)	17 (23.4)
When and how much SLP^b
Frequency (days per week)	2057 (88.3)	66 (98.5)
Duration (weeks)	1960 (84.1)	64 (95.5)
Intensity (hours per week)	1882 (80.8)	60 (89.6)
Dosage (total hours)	1978 (84.9)	62 (92.5)
Home practice	1306 (56.1)	31 (46.3)
Tailoring^b
By difficulty	1393 (59.8)	42 (62.7)
By functional relevance	873 (37.5)	31 (46.3)

n: total; IPD: individual participant data.

^aExtended categories to TIDieR checklist;

^bCategories are not mutually exclusive. One intervention may appear more than once in this category.

Intercollegiate Stroke Working Party, (2016). National Clinical Guidelines for Stroke. Fifth Edition. Retrieved from https://www.strokeaudit.org/Guideline/Full-Guideline.aspx

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Stroke Foundation (2017/2019). Clinical Guidelines for Stroke Management. Melbourne Australia.

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Roberts, P., Code, C., & McNeil, M. (2003). Describing participants in aphasia research: Part 1. Audit of current practice. Aphasiology, 17, 911–932. doi:10.1080/02687030344000328

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