More than one way to improve a CAT: Outcomes and reflections on two iterations of the Queen Square Intensive Comprehensive Aphasia Programme.
Alexander Leff, Catherine Doogan, John Bentley and 5 others
PMID 38652694WHAT IT FOUND
People with chronic aphasia in intensive Queen Square programmes had better language, communication confidence and quality of life at follow-up.
The study had no control group, so these changes cannot be proven to be caused by the programme.
Key findings
01In both year groups, people with aphasia made significant improvements across all four Comprehensive Aphasia Test language domains, and speech production had the largest gains.
02At the three-month follow-up, Comprehensive Aphasia Test scores did not significantly change from immediately after the programme, while goal attainment, quality of life, mood and communication confidence outcomes had improved.
03The second iteration used four treatment days a week for four weeks, kept Monday for planning and administration, and a random sample of six timetables showed an average of 95 hours of therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was a service audit with pre-post outcomes and no control group, so it cannot show that the programme caused the improvements. Many components were delivered together, including speech and language therapy, apps, psychologist-led groups, education and family or carer sessions, so the contribution of any single component cannot be separated. Year two participants had longer time since onset and worse baseline language scores than year one participants, so differences between iterations may reflect baseline differences as well as service changes. Carer outcomes were collected only at baseline because too few forms were returned after year two, so effects on carers were not evaluated. Therapy dose for year two was estimated from a random sample of six timetables, not from all participants. The service audit had no formal ethical approval and consent for data analysis and publication was waived.
Declared interests
University College London Hospitals NHS Foundation Trust provided clinical space and line management. Staff and service costs were provided by The National Brain Appeal, with a significant financial contribution from The Tavistock Trust for Aphasia. APL was funded by an NIHR-RP award and JC was funded by a Welcome Senior Clinical Fellowship.
The easy way to misread this
Do not conclude that the intensive programme caused the improvements. This was a pre-post service audit with no control group, no randomisation and many treatments delivered together, so natural recovery, assessment effects, selection or other supports cannot be separated.