Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis.

BACKGROUND: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

Psychosomatic and Physical Well-Being Factors After Mind-Body Interventions in a Hospital Setting.

CONTEXT: Mind-body interventions encompass a variety of treatments that directly affect health. Researchers have found that yoga can decrease symptoms of depression and anxiety as well as improve dietary patterns, enhance physical function and capacity, and enrich sleep. Research has shown that mindfulness can have psychological and physiological benefits and treat symptoms of anxiety and depression. OBJECTIVE: This study intended to compare the benefits of 2 mind-body interventions-yoga and mindfulness-in a hospital setting. DESIGN: The research team performed a retrospective analysis of outcome data obtained from a hospital's programs. SETTING: The study took place at a mind-body center at a hospital in Athens, GA (USA). PARTICIPANTS: Participants were 46 individuals enrolled either in a yoga (n = 24) or a mindfulness (n = 22) intervention program at the hospital. INTERVENTION: Participants self-selected a mind-body-intervention program offered at the hospital: yoga or mindfulness. They received guided training in their chosen intervention at weekly 2-h sessions for 6 to 9 wk. OUTCOME MEASURES: Participants completed measures of anxiety, depression, mindfulness, and quality of life at 2 points during the mind-body programs, at baseline and postintervention. The programs used the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Freiburg-Mindfulness Inventory (FMI), Automatic Thought Questionnaire (ATQ), and RAND 36-Item Short Form Health Survey (SF-36). RESULTS: The results showed significant decreases between baseline and postintervention in depression (on BDI-II) and anxiety (on BAI) levels for participants in both groups; however, only participants in the mindfulness group showed significant increases in mindfulness (on FMI) and quality of life and decreases in the frequency of negative thoughts (on ATQ) and significant improvements in some health-related measures (on SF-36; all P < .05). However, a significant difference between the groups existed at postintervention only for limitations due to physical health on the SF-36. CONCLUSIONS: The overall findings suggest that both the programs are effective. Although significant differences existed between the groups only for limitations due to physical health, the significant increases in categories other than anxiety and depression for the mindfulness group suggest that mindfulness can offer a more encompassing intervention for improving psychosomatic well-being, although further research is needed.