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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
Computer-based treatment should be considered to improve receptive and expressive language (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
Computer-based language treatment is efficacious (Grade A 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
Computer-based treatment is effective for individuals with aphasia (Grade A 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
The use of computer-based treatment is recommended for individuals with aphasia (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
The use of computer-based treatment is recommended for individuals with aphasia (Level C Evidence)
 
 
 
 
 
Evidence-Based Systematic Reviews
Therapeutic Interventions for Aphasia Initiated More Than Six Months Post Stroke: A Review of the Evidence
Allen, L., Mehta, S., et al. (2012).
Topics in Stroke Rehabilitation, 19(6), 523-535.

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

Description
This is a review of randomized controlled trials examining the efficacy of aphasia treatments provided to individuals with 6 months post onset of stroke-induced aphasia.

Conclusions

  • Evidence was found in support of a number of treatments for individuals with chronic aphasia. These included:

    • computer-based aphasia treatments

    • constraint-induced language aphasia therapy

    • delivery of intensive aphasia therapy

    • conversation partner training

  • Given the heterogeneity of patients included and wide range of interventions included, further research is warranted.

» 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
  • Strong evidence (Level 1a) from two studies (one of fair and one of good quality) suggests that computer-based aphasia treatment can improve language skills at the impairment level

  • Limited evidence (Level 2) suggests that improvements from computer-based treatment generalize to functional communication.
 
  
  

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
Computer-Assisted Treatment of Word Retrieval Deficits in Aphasia
Fink, R., Brecher, A., et al. (2005).
Aphasiology, 19(10/11), 943-954
.
Added: May 2012
 
Description
This article provides an overview of computer-assisted treatments for word retrieval deficits as well as presents findings from a study examining the use of a computer-assisted treatment program, MossTalk Words®. Patient satisfaction ratings were reported
 
Conclusions
Participants reported high satisfaction for use of computer-based naming treatment (MossTalk Words®). High ratings were given for ease of use, enjoyment, and perceived effectiveness in improving word finding skills
 
  

 
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