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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 ( 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.

Additional file 1. Table S1. Intervention effects on cognitive functioning. Table S2. Intervention effects on cognitive functioning, per protocol. Table S3. Intervention effects, separately for patients with and without endocrine therapy. Table S4. Intervention effects, separately for patients of different age categories (30-44, 45-59, 60-75 years). Table S5. Intervention effects, separately for patients of with pre- and peri- menopausal status and patients with postmenopausal status. Table S6. Intervention effects on cognitive functioning, stratified for low versus high levels of fatigue measured with the EORTC QLQ C-30 fatigue scale. Table S7. Intervention effects on patient-reported outcomes.

Contains fulltext : 291410.pdf (Publisher’s version ) (Open Access) BACKGROUND: Physical exercise in cancer patients is a promising intervention to improve cognition and increase brain volume, including hippocampal volume. We investigated whether a 6-month exercise intervention primarily impacts total hippocampal volume and additionally hippocampal subfield volumes, cortical thickness and grey matter volume in previously physically inactive breast cancer patients. Furthermore, we evaluated associations with verbal memory. METHODS: Chemotherapy-exposed breast cancer patients (stage I-III, 2-4 years post diagnosis) with cognitive problems were included and randomized in an exercise intervention (n = 70, age = 52.5 ± 9.0 years) or control group (n = 72, age = 53.2 ± 8.6 years). The intervention consisted of 2x1 hours/week of supervised aerobic and strength training and 2x1 hours/week Nordic or power walking. At baseline and at 6-month follow-up, volumetric brain measures were derived from 3D T1-weighted 3T magnetic resonance imaging scans, including hippocampal (subfield) volume (FreeSurfer), cortical thickness (CAT12), and grey matter volume (voxel-based morphometry CAT12). Physical fitness was measured with a cardiopulmonary exercise test. Memory functioning was measured with the Hopkins Verbal Learning Test-Revised (HVLT-R total recall) and Wordlist Learning of an online cognitive test battery, the Amsterdam Cognition Scan (ACS Wordlist Learning). An explorative analysis was conducted in highly fatigued patients (score of ≥ 39 on the symptom scale 'fatigue' of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), as previous research in this dataset has shown that the intervention improved cognition only in these patients. RESULTS: Multiple regression analyses and voxel-based morphometry revealed no significant intervention effects on brain volume, although at baseline increased physical fitness was significantly related to larger brain volume (e.g., total hippocampal volume: R = 0.32, B = 21.7 mm(3), 95 % CI = 3.0 - 40.4). Subgroup analyses showed an intervention effect in highly fatigued patients. Unexpectedly, these patients had significant reductions in hippocampal volume, compared to the control group (e.g., total hippocampal volume: B = -52.3 mm(3), 95 % CI = -100.3 - -4.4)), which was related to improved memory functioning (HVLT-R total recall: B = -0.022, 95 % CI = -0.039 - -0.005; ACS Wordlist Learning: B = -0.039, 95 % CI = -0.062 - -0.015). CONCLUSIONS: No exercise intervention effects were found on hippocampal volume, hippocampal subfield volumes, cortical thickness or grey matter volume for the entire intervention group. Contrary to what we expected, in highly fatigued patients a reduction in hippocampal volume was found after the intervention, which was related to improved memory functioning. These results suggest that physical fitness may benefit cognition in specific groups and stress the importance of further research into the biological basis of this finding.

Background and Purpose:\ud 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.\ud \ud Methods:\ud 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.\ud \ud Results:\ud 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 (

© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Purpose: Speech and language pathology (SLP) for aphasia is a complex intervention delivered to a heterogeneous population within diverse settings. Simplistic descriptions of participants and interventions in research hinder replication, interpretation of results, guideline and research developments through secondary data analyses. This study aimed to describe the availability of participant and intervention descriptors in existing aphasia research datasets. Method: We systematically identified aphasia research datasets containing ≥10 participants with information on time since stroke and language ability. We extracted participant and SLP intervention descriptions and considered the availability of data compared to historical and current reporting standards. We developed an extension to the Template for Intervention Description and Replication checklist to support meaningful classification and synthesis of the SLP interventions to support secondary data analysis. Result: Of 11, 314 identified records we screened 1131 full texts and received 75 dataset contributions. We extracted data from 99 additional public domain datasets. Participant age (97.1%) and sex (90.8%) were commonly available. Prior stroke (25.8%), living context (12.1%) and socio-economic status (2.3%) were rarely available. Therapy impairment target, frequency and duration were most commonly available but predominately described at group level. Home practice (46.3%) and tailoring (functional relevance 46.3%) were inconsistently available. Conclusion : Gaps in the availability of participant and intervention details were significant, hampering clinical implementation of evidence into practice and development of our field of research. Improvements in the quality and consistency of participant and intervention data reported in aphasia research are required to maximise clinical implementation, replication in research and the generation of insights from secondary data analysis. Systematic review registration: PROSPERO CRD42018110947.

Background: Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. \ud \ud Aim: To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke.\ud \ud Methods and procedures: We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use metaand network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions.\ud \ud Outcomes and results: Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains.\ud \ud Conclusion: Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke.\ud \ud Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947

Background: Speech and language therapy (SLT) interventions for people with aphasia are complex – for example, interventions vary by delivery model (face-to-face, tele-rehabilitation), dynamic (group, 1-to-1) and provider. Therapists tailor the functional relevance and intervention difficulty to the individual’s needs. Therapy regimes are planned at a specific intensity (hours per week), frequency (number of weekly sessions), duration (time from start to end of therapy intervention) and dose (total number of therapy hours). Detailed and transparent description of interventions for people with aphasia facilitates replication in clinic, between-study comparisons and data-syntheses. Incomplete intervention reporting and inconsisten-cies in the use of terminology have been observed (RELEASE: REhabilitation and recovery of peopLE with Aphasia after StrokE Collaborators, 2015-2018; Brady, Kelly, Godwin, Enderby, & Campbell, 2016; Pierce, O’Halloran, Togher, & Rose, in press). Even when similar terms are used there may be little agreement on their use (Pierce et al., in press). Our RELEASE Collaboration includes 72 multidisciplinary, multilingual aphasia researchers from 28 countries. In preparation for planned meta-analyses (HS&DR 14/04/22) we sought to extract and synthesise information on SLT interventions for aphasia. Description of interventions in research reports have benefited from the Template for Intervention Description and Replication (TIDieR; (Hoffmann et al., 2014). The TIDieR checklist supports transparent reporting, data extraction and synthesis in aphasia research. It has facilitated an exploration of the contribution specific parameters (for example intensity) may make to the effectiveness of (or tolerance to) an intervention (Brady et al., 2016). However, while the variables described above are readily summarised, other aspects of therapeutic interventions such as the theoretical approach, the materials used and the procedures employed (the “Why” and “What” within TIDieR) are more challenging to summarise in manner supporting data synthesis and meta-analyses. The World Health Organisation’s (“International Classification of Health Interventions (ICHI),”) also seeks a framework which supports the synthesis and statistical analysis of healthcare interventions based on (a) the treatment target, (b) the intended action to the target and (c) the processes and methods required to carry out the action (ICHI, 2018). However a framework which complements these initiatives and which supports greater consistency in the description of SLT interventions for aphasia is required.\ud \ud Aims: We sought to develop international consensus on a framework to support the description of SLT interventions for people with aphasia. Methods and procedures: Two researchers independently extracted information about the SLT interventions in our RELEASE database (Hoffmann et al., 2014). Information on therapy approaches, materials and procedures were extracted, where possible, as direct quotes from published reports. Using the narrative descriptions, similar approaches were grouped and assigned to one or more category labels by an experienced speech and language therapist. These preliminary groupings were shared with RELEASE Collaborators for review. Each reviewed interventions included within up to four category labels and responses via email were requested. There followed an opportunity for group discussion on the proposed categorisation via videoconference.\ud \ud Outcomes and results: Therapy interventions were categorised based on three per-spectives (a) the role of the intervention within the study design e.g., usual care as a comparison control (b) the intervention target e.g., rehabilitation of spoken language production and (c) the theoretical approach e.g., semantic therapy. We identified 15 SLT approaches. Categories were not mutually exclusive; rather they represented different ways of categorising a complex intervention. Inadequate reporting of therapy interven-tions, procedures and materials hampered some classifications. The Collaboration facilitated knowledge sharing relating to emerging treatment category definitions such as multimodal treatment (Pierce et al., in press) which reflected interventions aimed to utilise a range of learning mechanisms and neural networks to facilitate language recovery.\ud \ud Conclusions: Our collaboration agreed on a framework which supports transparent description, data synthesis and meta-analyses of SLT interventions for people with aphasia after stroke.