Better long-term speech outcomes in stroke survivors who received early clinical speech and language therapy: What's driving recovery?
Sophie Roberts, Rachel M Bruce, Louise Lim and 10 others
PMID 34210238WHAT IT FOUND
Stroke survivors with severe or moderate aphasia who received clinical speech therapy in the first month showed better naming ability and patient-reported improvement at one year compared to those who did not.
However, the study cannot prove the therapy caused this, as patients with better recovery potential may have been prioritized for treatment.
Key findings
01Patients who received early clinical therapy had better patient-reported improvement at one month and better objective Naming scores compared to those who did not.
02The number of hours of early therapy was positively related to patient-reported improvement at one year post-stroke.
03Lesion size and site did not differ between therapy groups, so poorer outcomes in the no-therapy group were not explained by larger brain damage.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study is retrospective and observational, so it cannot prove that therapy caused the improvements. Patients who received therapy may have had better baseline health, motivation, or social support. Patient-reported outcomes rely on memory and insight, which can be biased. Patients who received more therapy might report better outcomes due to optimism or recall bias. Therapy content and intensity were not standardized or controlled. Clinical therapy varies widely, and the study could not distinguish between different types of therapeutic activities. The sample excluded patients with mild aphasia and those medically unstable in the first week, limiting generalizability to those groups. Objective assessments (CAT) were performed at varying times post-stroke (months to years), not at fixed one-year intervals, introducing potential confounding.
Declared interests
Funding was provided by Wellcome, the Medical Research Council, and the Stroke Association. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that early speech therapy definitively causes long-term recovery in aphasia. The study shows associations, but patients who received therapy may have been those more likely to recover regardless of treatment. The lack of significant objective outcomes at one year and the retrospective design mean this is not proof of efficacy.