{"doi":"10.1161/strokeaha.121.035216","title":"Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review–Based, Individual Participant Data Network Meta-Analysis","abstract":"BACKGROUND AND PURPOSE: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. METHODS: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori-defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). RESULTS: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58-26.16] Western Aphasia Battery-Aphasia Quotient; 5.23 [1.51-8.95] Aachen Aphasia Test-Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3-5+ days/week), and comprehension (4-5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases. CONCLUSIONS: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018110947.","journal":"Stroke","year":2021,"id":149268,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":110,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9599,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":634770,"name":"Marian C. Brady","orcid":"0000-0002-4589-7021","position":1,"is_corresponding":false},{"id":634771,"name":"Myzoon Ali","orcid":"0000-0001-5899-2485","position":2,"is_corresponding":false},{"id":634772,"name":"Kathryn VandenBerg","orcid":"0000-0001-5035-9650","position":3,"is_corresponding":false},{"id":634773,"name":"Linda J. Williams","orcid":"0000-0002-6317-1718","position":4,"is_corresponding":false},{"id":349920,"name":"Louise R. Williams","orcid":"0000-0003-2430-1142","position":5,"is_corresponding":false},{"id":634774,"name":"Masahiro Abo","orcid":"0000-0001-6701-4974","position":6,"is_corresponding":false},{"id":634775,"name":"Frank Becker","orcid":"0000-0002-0857-0628","position":7,"is_corresponding":false},{"id":333724,"name":"Audrey Bowen","orcid":"0000-0003-4075-1215","position":8,"is_corresponding":false},{"id":634776,"name":"Caitlin Brandenburg","orcid":"0000-0002-6992-7790","position":9,"is_corresponding":false},{"id":634777,"name":"Caterina Breitenstein","orcid":"0000-0002-6408-873X","position":10,"is_corresponding":false},{"id":634778,"name":"Stefanie Bruehl","orcid":"0000-0003-4826-1990","position":11,"is_corresponding":false},{"id":634779,"name":"David A. Copland","orcid":"0000-0002-2257-4270","position":12,"is_corresponding":false},{"id":634780,"name":"Tamara B. Cranfill","orcid":"0000-0001-7608-6443","position":13,"is_corresponding":false},{"id":634781,"name":"Marie di Pietro-Bachmann","orcid":"0000-0001-8027-2337","position":14,"is_corresponding":false},{"id":634782,"name":"Pamela Enderby","orcid":"0000-0002-4371-9053","position":15,"is_corresponding":false},{"id":634783,"name":"Joanne Fillingham","orcid":"0000-0002-0363-8021","position":16,"is_corresponding":false},{"id":634784,"name":"Federica Lucia Galli","orcid":"0000-0001-9244-9179","position":17,"is_corresponding":false},{"id":634785,"name":"Marialuisa Gandolfi","orcid":"0000-0002-0877-4807","position":18,"is_corresponding":false},{"id":634786,"name":"Bertrand Glize","orcid":"0000-0001-9618-2088","position":19,"is_corresponding":false},{"id":634787,"name":"Erin Godecke","orcid":"0000-0002-7210-1295","position":20,"is_corresponding":false},{"id":634788,"name":"Neil Hawkins","orcid":"0000-0003-3199-221X","position":21,"is_corresponding":false},{"id":634789,"name":"Katerina Hilari","orcid":"0000-0003-2091-4849","position":22,"is_corresponding":false},{"id":634790,"name":"Jacqueline Hinckley","orcid":"0000-0002-4052-1420","position":23,"is_corresponding":false},{"id":634791,"name":"Simon Horton","orcid":"0000-0002-2133-1410","position":24,"is_corresponding":false},{"id":634792,"name":"David Howard","orcid":"0000-0001-9141-5751","position":25,"is_corresponding":false},{"id":634793,"name":"Petra Jaecks","orcid":"0000-0002-5878-1327","position":26,"is_corresponding":false},{"id":634794,"name":"Elizabeth Jefferies","orcid":"0000-0002-3826-4330","position":27,"is_corresponding":false},{"id":634795,"name":"Luis M.T. Jesus","orcid":"0000-0002-8534-3218","position":28,"is_corresponding":false},{"id":634796,"name":"Maria Kambanaros","orcid":"0000-0002-5857-9460","position":29,"is_corresponding":false},{"id":634797,"name":"Eun Kyoung Kang","orcid":"0000-0001-5315-1361","position":30,"is_corresponding":false},{"id":634798,"name":"Eman M. Khedr","orcid":"0000-0001-5679-9833","position":31,"is_corresponding":false},{"id":502506,"name":"Anthony Pak‐Hin Kong","orcid":"0000-0002-6211-0358","position":32,"is_corresponding":false},{"id":634799,"name":"Tarja Kukkonen","orcid":"0000-0002-8189-0337","position":33,"is_corresponding":false},{"id":634800,"name":"Marina Laganaro","orcid":"0000-0002-4054-0939","position":34,"is_corresponding":false},{"id":462876,"name":"Matthew A. Lambon Ralph","orcid":"0000-0001-5907-2488","position":35,"is_corresponding":false},{"id":634801,"name":"Ann Charlotte Laska","orcid":"0000-0002-7330-940X","position":36,"is_corresponding":false},{"id":634802,"name":"Béatrice Leemann","orcid":"0000-0003-2226-6777","position":37,"is_corresponding":false},{"id":634803,"name":"Alexander P. Leff","orcid":"0000-0002-0831-3541","position":38,"is_corresponding":false},{"id":634804,"name":"Roxele R. Lima","orcid":"0000-0002-9914-4789","position":39,"is_corresponding":false},{"id":634805,"name":"Antje Lorenz","orcid":"0000-0002-0200-1977","position":40,"is_corresponding":false},{"id":634806,"name":"Brian MacWhinney","orcid":"0000-0002-4988-1342","position":41,"is_corresponding":false},{"id":634807,"name":"Rebecca Shisler Marshall","orcid":"0000-0001-9313-5454","position":42,"is_corresponding":false},{"id":634808,"name":"Flavia Mattioli","orcid":"0000-0002-4912-5520","position":43,"is_corresponding":false},{"id":634809,"name":"İlknur Maviş","orcid":"0000-0003-3924-1138","position":44,"is_corresponding":false},{"id":563587,"name":"Marcus Meinzer","orcid":"0000-0003-1370-3947","position":45,"is_corresponding":false},{"id":634810,"name":"Reza Nilipour","orcid":"0000-0003-4180-7989","position":46,"is_corresponding":false},{"id":278362,"name":"Enrique Noé","orcid":"0000-0002-2547-8727","position":47,"is_corresponding":false},{"id":634811,"name":"Nam-Jong Paik","orcid":"0000-0002-5193-8678","position":48,"is_corresponding":false},{"id":634812,"name":"Rebecca Palmer","orcid":"0000-0002-2335-7104","position":49,"is_corresponding":false},{"id":634813,"name":"Ilias Papathanasiou","orcid":"0000-0003-0999-696X","position":50,"is_corresponding":false},{"id":634814,"name":"Brigida Patricio","orcid":"0000-0002-2619-470X","position":51,"is_corresponding":false},{"id":634815,"name":"Isabel Pavão Martins","orcid":"0000-0002-9611-7400","position":52,"is_corresponding":false},{"id":634816,"name":"Cathy Price","orcid":"0000-0003-0111-9364","position":53,"is_corresponding":false},{"id":634817,"name":"Tatjana Prizl Jakovac","orcid":"0000-0002-5018-9556","position":54,"is_corresponding":false},{"id":634818,"name":"Elizabeth Rochon","orcid":"0000-0001-5521-0513","position":55,"is_corresponding":false},{"id":634819,"name":"Miranda L. Rose","orcid":"0000-0002-8892-0965","position":56,"is_corresponding":false},{"id":634820,"name":"Charlotte Rosso","orcid":"0000-0001-7236-1508","position":57,"is_corresponding":false},{"id":634821,"name":"Ilona Rubi-Fessen","orcid":"0000-0002-9775-3812","position":58,"is_corresponding":false},{"id":634822,"name":"Marina B. Ruiter","orcid":"0000-0001-6147-5235","position":59,"is_corresponding":false},{"id":634823,"name":"Claerwen Snell","orcid":"0000-0001-8606-7801","position":60,"is_corresponding":false},{"id":634824,"name":"Benjamin Stahl","orcid":"0000-0003-3957-1495","position":61,"is_corresponding":false},{"id":311438,"name":"Jerzy P. Szaflarski","orcid":"0000-0002-5936-6627","position":62,"is_corresponding":false},{"id":634825,"name":"Shirley A. Thomas","orcid":"0000-0003-0704-9387","position":63,"is_corresponding":false},{"id":634826,"name":"Mieke van de Sandt-Koenderman","orcid":"0000-0002-8104-6937","position":64,"is_corresponding":false},{"id":634827,"name":"Ineke van der Meulen","orcid":"0000-0002-6156-3873","position":65,"is_corresponding":false},{"id":634828,"name":"Evy Visch-Brink","orcid":"0000-0001-7833-0112","position":66,"is_corresponding":false},{"id":634829,"name":"Linda Worrall","orcid":"0000-0002-3283-7038","position":67,"is_corresponding":false},{"id":634830,"name":"Heather Harris Wright","orcid":"0000-0001-6922-6364","position":68,"is_corresponding":false},{"id":635691,"name":"The REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE) Collaborators","orcid":null,"position":0,"is_corresponding":true}],"reference_count":48,"raw_metadata":null,"created_at":"2026-07-18T23:42:51.282401Z","pmid":"34847708","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}