Therapy - three months post onset

5.3 People with aphasia more than three months post onset of stroke should be offered intensive/high dose speech and language therapy if they can tolerate it.

Reference: Brady et al., 2016: Cochrane review; The RELEASE collaborators, 2022b: Meta-analysis 25 RCTs (959 IPD)

NHMRC level of Evidence: I

Rationale:  The results of a Cochrane review (Brady et al., 2016) suggested a benefit of intensive/high dose over non-intensive/low dose speech and language therapy on measures of functional communication. However, there was a significantly higher dropout rate from high dose/high intensity intervention, particularly in studies recruiting participants within 3 months of aphasia onset. 

In The RELEASE group meta-synthesis of individual participant data (n= 959 IPD; 25 RCTs; The RELEASE collaborators, 2022b) subgroup analyses revealed that study participants who were less than or equal to 3 months after stroke onset showed their best language gains from therapy provided less than or equal to 2 hours per week (n=62 IPD; 2 RCTs), 3-5 days per week (n=3 IPD; 1 RCT), and from 20 to 50 hours total (n=27 IPD; 3 RCTs). For participants more than 3 months after stroke onset greatest gains followed 3-4 hours per week (n=25 IPD; 2 RCTs), 5 days per week (n= 44 IPD; 1 RCT), for equal to or more than 50 hours of therapy) n=15 IPD; 1 RCT). However, caution is required in interpreting this finding given the low numbers of IPD/RCTs in these specific subgroup analyses.

 References:

1. Brady et al., 2016: Cochrane review
2. ● The RELEASE collaborators, 2022b: Meta-analysis 25 RCTs (959 IPD)
3. Brady, M. C., Kelly, H., Godwin, J., & Enderby, P. (2012). Speech and language therapy for aphasia following stroke. The Cochrane database of systematic reviews, 5, CD000425. doi: 10.1002/14651858.CD000425.pub3