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Predictors of Poststroke Aphasia Recovery: A Systematic Review-Informed Individual Participant Data Meta-Analysis

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posted on 12.07.2021, 02:20 by Myzoon Ali, Kathryn VandenBerg, Linda J Williams, Louise R Williams, Masahiro Abo, Frank Becker, Audrey Bowen, Caitlin Brandenburg, Caterina Breitenstein, Stefanie Bruehl, David A Copland, Tamara B Cranfill, Marie Di Pietro-Bachmann, Pamela Enderby, Joanne Fillingham, Federica Lucia Galli, Marialuisa Gandolfi, Bertrand Glize, Erin Godecke, Neil Hawkins, Katerina Hilari, Jacqueline Hinckley, Simon Horton, David Howard, Petra Jaecks, Elizabeth Jefferies, Luis MT Jesus, Maria Kambanaros, Eun Kyoung Kang, Eman M Khedr, Anthony Pak-Hin Kong, Tarja Kukkonen, Marina Laganaro, Matthew A Lambon Ralph, Ann Charlotte Laska, Beatrice Leemann, Alexander P Leff, Roxele R Lima, Antje Lorenz, Brian Mac Whinney, Rebecca Shisler Marshall, Marcus Meinzer, Reza Nilipour, Enrique Noe, Nam-Jong Paik, Rebecca Palmer, Ilias Papathanasiou, Brigida F Patricio, Isabel Pavao Martins, Cathy Price, Tatjana Prizl Jakovac, Elizabeth Rochon, Miranda RoseMiranda Rose, Charlotte Rosso, Ilona Rubi-Fessen, Marina B Ruiter, Claerwen Snell, Benjamin Stahl, Jerzy P Szaflarski, Shirley A Thomas, Mieke Van De Sandt-Koenderman, Ineke van der Meulen, Evy Visch-Brink, Linda Worrall, Heather Harris Wright, Marian C Brady
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.

Funding

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.

History

Publication Date

01/05/2021

Journal

Stroke

Volume

52

Issue

5

Pagination

10p. (p. 1778-1787)

Publisher

Lippincott Williams & Wilkins

ISSN

0039-2499

Rights Statement

The Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.

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