The National Center for Evidence-Based Practice
in Communication Disorders
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Aphasia
Service Delivery

Format

(e.g., individual, group)

 


 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.12 Aphasia
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd
.
Added: May 2012
 
Description

This guideline provides recommendations for the assessment and treatment of individuals with aphasia. These guidelines are specific to speech-language pathologists. Levels of evidence recommendations are graded A, B or C based on the following criteria: 

  • Level A: Recommendations obtained from randomized controlled trials (RCT). 
  • Level B: Recommendations obtained from well-conducted clinical studies.
  • Level C: Recommendations obtained from expert opinion.  
Recommendations
In addition to individual speech and language treatment, individuals with aphasia should have opportunity to participate in group treatment (Level A Evidence)
 
 
 
  
 
Catalan Agency for Health Technology Assessment and Research
 
Stroke: Clinical Practice Guideline (2nd edition)
Catalan Agency for Health Technology Assessment and Research. (2007).
Barcelona (Spain): Catalan Agency for Health Technology Assessment and Research, 112 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment, management, and rehabilitation of acute stroke in adults. The target audiences for this guideline include professionals, managers, and planners involved in the care of adults with acute stroke. Of particular interest to speech-language pathologists is the section on assessment and intervention for aphasia, dysarthria, cognitive disorders and dysphagia. Recommendations are graded A, B, C, D, or "Point of Good Practice" based on the strength of supporting evidence below:  

  • Grade A: Recommendations based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population.
  • Grade B: Recommendations based on high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence.
  • Grade C: Recommendations based on well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence.
  • Grade D: Recommendations based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence.
  • Points of Good Practice: Recommendations based on the clinical experience of the guideline development group.  
Recommendations
The incorporation of group treatment is supported (Grade B Evidence)
 
 
 
 
Department of Veterans Affairs; Department of Defense; American Heart Association / American Stroke Association
 
VA/DOD Clinical Practice Guideline for the Management of Stroke Rehabilitation
Management of Stroke Rehabilitation Working Group. (2010).
Veterans Health Administration, Department of Defense, 150 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment and management of adult patients (18 years or older) with post-stroke functional disability receiving services in the Veteran's Health Administration (VHA) or Department of Defense (DoD) healthcare system. The target audience of this guideline is VHA and DoD health care professionals providing treatment in primary care, specialty care, long-term care or community settings. Of particular interest to speech-language pathologists is a section on the management of communication impairments (aphasia, dysarthria, apraxia), cognitive impairments and swallowing. Recommendations are graded A, B, C, D or I based on the following criteria:  

  • Grade A: A strong recommendation that clinicians provide the intervention to eligible patients based on good evidence that the intervention improves important health outcomes and benefits substantially outweigh harms.
  • Grade B: A recommendation that clinicians provide the intervention to eligible patients based on at least fair evidence that the intervention improves health outcomes and benefits outweigh harms.
  • Grade C: No recommendation for or against the provision of the intervention. At least fair evidence was found that the intervention can improve health outcomes, but concludes that the balance of benefits and harms is too close to justify a general recommendation.
  • Grade D: Recommendation against providing the intervention based on at least fair evidence that the intervention is ineffective or that harms outweigh benefits.
  • Grade I: Information insufficient to recommend for or against providing the intervention. Evidence that intervention is effective is either lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined
Recommendations
Aphasia treatment incorporating the use of trained volunteers is supported (Grade B Evidence)
 
 
 
 
Australian Government Department of Health and Ageing
 
Clinical Guidelines for Acute Stroke Management 2010
National Stroke Foundation (2010).
Melbourne (Australia): National Stroke Foundation, 167 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment and management of stroke and transient ischemic attack (TIA) in adults. These guidelines are primarily intended to assist health care workers in improving quality and effectiveness of service. Of particular interest to speech-language pathologists is chapter six which focuses on rehabilitation management for aphasia, dysphagia, dysarthria, apraxia and cognitive-communication deficits. Recommendations are graded A, B, C, D or "Good Practice Point" based on the following criteria:  

  • Grade A: Evidence can be trusted to guide practice.
  • Grade B: Evidence can be used to guide practice in most situations.
  • Grade C: Evidence provides some support, but care should be taken in application.
  • Grade D: Evidence is weak and should be applied cautiously.
  • Good Practice Point: Evidence based on clinical experience and expert opinion
Recommendations
  • Group treatment and conversation groups are recommended for individuals with aphasia (Grade C Evidence).
  • For individuals with chronic aphasia, group treatment should be recommended for longer durations (Grade C Evidence)
 
 
 
New Zealand Ministry of Health
 
New Zealand Clinical Guidelines for Stroke Management 2010
Stroke Foundation of New Zealand and New Zealand Guidelines Group (2010).
Wellington (New Zealand): Stroke Foundation of New Zealand, 347 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the management of individuals recovering from stroke and transient ischemic attacks. The target audience of the guideline is all healthcare professionals providing services to persons with stroke and their family in the New Zealand context. Of particular interest to speech-language pathologists are the sections discussing communication (aphasia, apraxia, dysarthria), cognition and swallowing disorders. Levels of evidence recommendations are graded as A, B, C, D or "Good Practice Points" and defined as follows:

  • Level A: Body of evidence can be trusted to guide practice.
  • Level B: Body of evidence can be trusted to guide practice in most situations.
  • Level C: Body of evidence provides some support for recommendation(s) but care should be taken in its application.
  • Level D: Body of evidence is weak and recommendation must be applied with caution.
  • Good Practice Point: Recommended best practice based on clinical experience and expert opinion
Recommendations
  • Group treatment and conversation groups are recommended for individuals with aphasia (Level C Evidence).
  • For individuals with chronic aphasia, group treatment should be recommended for longer durations (Level C Evidence).  
 
 
 
 
Evidence-Based Systematic Reviews
The Efficacy of Outpatient and Community-Based Aphasia Group Interventions: A Systematic Review
Lanyon, L. E., Rose, M. L., et al. (2013).
International Journal of Speech Language Pathology, Epub ahead of print retrieved April 18, 2013 from http://dx.doi.org/10.3109/17549507.2012.752865.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: May 2013

Description
This is a review of experimental and non-experimental design studies investigating the effectiveness of community and outpatient-based aphasia groups to improve the communication, quality of life and psychological well being in individuals with chronic aphasia.

Conclusions
There is evidence to suggest that group-based aphasia treatment improves specific linguistic processes (e.g., picture naming, total speech utterances and performance on aphasia test batteries). However limited evidence exists to determine the effects of group-based aphasia treatment on communication activity/participation.

» See full summary and quality ratings



Speech and Language Therapy for Aphasia Following Stroke
Brady, M. C., Kelly, H., et al. (2012).
Cochrane Database of Systematic Reviews, 5, CD000425.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is an update of an original systematic review by Greener et al. (1999) and subsequent review by Kelly et al. (2010) investigating the effects of speech language therapy intervention in adults with stroke-induced aphasia.

Conclusions

  • At the time of the review, insufficient evidence exists regarding the effects of group versus one-on-one treatment. No differences were found in measures of expressive and receptive language skills in three studies comparing group and individual speech and language treatment. 

  • Additionally, little evidence of any difference was found between computer-facilitated speech and language treatment versus one-on-one speech and language treatment.  

» See full summary and quality ratings



Evidence-Based Review of Stroke Rehabilitation
Teasell, R. W., Foley, N. C., et al. (2011).
Retrieved from http://www.ebrsr.com
.
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012 
 
Description

This is an update of the Teasell et al. (2009) evidence-based review investigating the effectiveness of pharmacological and non-pharmacological interventions for stroke rehabilitation. Of particular interest to speech-language pathologists are the modules specific to aphasia, dysphagia, perceptual disorders and cognitive disorders. The levels of evidence used to summarize the review findings are based on the United States Agency for Health Care Policy and Research (AHCPR) criteria:  

  • Level 1a: Strong evidence supported by a meta-analysis or two or more randomized controlled trials (RCTs) with at least “fair” quality.
  • Level 1b: Moderate evidence supported by at least one RCT of “fair” quality.
  • Level 2: Limited evidence supported by at least one controlled trial with a minimum of 10 participants in each arm of the study.
  • Level 3: Findings supported by expert consensus opinion in the absence of evidence.
  • Level 4: Conflicting evidence based on disagreement between the findings of at least two RCTs. Where there are more than four RCTs, conclusions are based on the results of the majority of studies, unless conflicting results are reported in a higher quality study.
Conclusions
  • Based on one fair quality study, moderate evidence (Level 1b) suggests that group aphasia treatment can improve performance on communication and linguistic measures for individuals with chronic aphasia.
  • Limited evidence (Level 2) suggests that participation in group treatment improves communication.
  • Moderate evidence (Level 1b) suggests that writing treatment in group setting is less beneficial compared to individual treatment.  
 
 
 
Rehabilitation of Aphasia: More Is Better
Bhogal, S. K., Teasell, R. W., et al. (2003).
Topics in Stroke Rehabilitation, 10(2), 66-76
.
Added: May 2012 
 
Description
This is a review of studies investigating the effects of aphasia speech and language therapy on individuals post-stroke
 
Conclusions
Moderate evidences suggests that group aphasia treatment for writing is less beneficial compared to individual treatment
 
 
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
Reconciling the Perspective of Practitioner and Service User: Findings From The Aphasia in Scotland Study
Law, J., Huby, G., et al. (2010).
International Journal of Language & Communication Disorders, 45(5), 551-60
.
Added: May 2012
 
Description
This is a qualitative study of 21 speech-language pathologists and 14 individuals with aphasia. This study examines the views and perspectives of service providers and patients in the treatment of aphasia
 
Conclusions
  • Respondents who experienced group and individual therapy "indicated that, while they had enjoyed both, they felt that they benefited more from the latter" (p. 555).
  • Respondents indicated a preference for "aphasia specific groups rather than more generic stroke support groups" (p. 555)
 
 
 
An Evaluation of Short-Term Group Therapy for People with Aphasia
Brumfitt, S. M., & Sheeran, P. (1997).
Disability and Rehabilitation, 19(6), 221-30
Added: May 2012
 
Description
This is a qualitative study of six individuals with aphasia. This study examines the impact of a short term group treatment to improve functional communication skills. In addition to pre-post measures of functional communication, satisfaction and psychosocial measures were obtained
 
Conclusions
  • The authors reported significant differences in communication competence and attitudes about communication abilities post-group treatment.
  • Satisfaction with group treatment was rated high on a 7-item scale. Participants rated their agreement/disagreement with seven statements (e.g., 'I feel the group has given me increased confidence', 'It was useful to see myself on video practicing different sorts of conversations', and 'I do not avoid as many situations as I used to')
 
 
 
Is Anyone Speaking My Language?
Horton, S., Mudd, D., et al. (1998).
International Journal of Language & Communication Disorders, 33(Suppl), 126-31
Added: May 2012
 
Description
This is a retrospective study of 18 individuals with aphasia and their carers (n = 12). This study examines how individuals with aphasia and their family members perceive speech and language treatment and what aspects of treatment they feel need improvements
 
Conclusions
Respondents indicated that group therapy was an important aspect of treatment, but indicated that "moves between different types and levels of therapy should be smoother" (p. 130)
 
 

 
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