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Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia

BACKGROUND: While meta-analyses confirm treatment for chronic post-stroke aphasia is effective, a lack of comparative evidence for different interventions limits prescription accuracy. We investigated whether Constraint-Induced Aphasia Therapy Plus (CIAT-plus) and/or Multimodality Aphasia Therapy (M...

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Autores principales: Rose, Miranda L, Nickels, Lyndsey, Copland, David, Togher, Leanne, Godecke, Erin, Meinzer, Marcus, Rai, Tapan, Cadilhac, Dominique A, Kim, Joosup, Hurley, Melanie, Foster, Abby, Carragher, Marcella, Wilcox, Cassie, Pierce, John E, Steel, Gillian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148985/
https://www.ncbi.nlm.nih.gov/pubmed/35396340
http://dx.doi.org/10.1136/jnnp-2021-328422
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author Rose, Miranda L
Nickels, Lyndsey
Copland, David
Togher, Leanne
Godecke, Erin
Meinzer, Marcus
Rai, Tapan
Cadilhac, Dominique A
Kim, Joosup
Hurley, Melanie
Foster, Abby
Carragher, Marcella
Wilcox, Cassie
Pierce, John E
Steel, Gillian
author_facet Rose, Miranda L
Nickels, Lyndsey
Copland, David
Togher, Leanne
Godecke, Erin
Meinzer, Marcus
Rai, Tapan
Cadilhac, Dominique A
Kim, Joosup
Hurley, Melanie
Foster, Abby
Carragher, Marcella
Wilcox, Cassie
Pierce, John E
Steel, Gillian
author_sort Rose, Miranda L
collection PubMed
description BACKGROUND: While meta-analyses confirm treatment for chronic post-stroke aphasia is effective, a lack of comparative evidence for different interventions limits prescription accuracy. We investigated whether Constraint-Induced Aphasia Therapy Plus (CIAT-plus) and/or Multimodality Aphasia Therapy (M-MAT) provided greater therapeutic benefit compared with usual community care and were differentially effective according to baseline aphasia severity. METHODS: We conducted a three-arm, multicentre, parallel group, open-label, blinded endpoint, phase III, randomised-controlled trial. We stratified eligible participants by baseline aphasia on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ). Groups of three participants were randomly assigned (1:1:1) to 30 hours of CIAT-Plus or M-MAT or to usual care (UC). Primary outcome was change in aphasia severity (WAB-R-AQ) from baseline to therapy completion analysed in the intention-to-treat population. Secondary outcomes included word retrieval, connected speech, functional communication, multimodal communication, quality of life and costs. RESULTS: We analysed 201 participants (70 in CIAT-Plus, 70 in M-MAT and 61 in UC). Aphasia severity was not significantly different between groups at postintervention: 1.05 points (95% CI −0.78 to 2.88; p=0.36) UC group vs CIAT-Plus; 1.06 points (95% CI −0.78 to 2.89; p=0.36) UC group vs M-MAT; 0.004 points (95% CI −1.76 to 1.77; p=1.00) CIAT-Plus vs M-MAT. Word retrieval, functional communication and communication-related quality of life were significantly improved following CIAT-Plus and M-MAT. Word retrieval benefits were maintained at 12-week follow-up. CONCLUSIONS: CIAT-Plus and M-MAT were effective for word retrieval, functional communication, and quality of life, while UC was not. Future studies should explore predictive characteristics of responders and impacts of maintenance doses. TRIAL REGISTRATION NUMBER: ACTRN 2615000618550.
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spelling pubmed-91489852022-06-16 Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia Rose, Miranda L Nickels, Lyndsey Copland, David Togher, Leanne Godecke, Erin Meinzer, Marcus Rai, Tapan Cadilhac, Dominique A Kim, Joosup Hurley, Melanie Foster, Abby Carragher, Marcella Wilcox, Cassie Pierce, John E Steel, Gillian J Neurol Neurosurg Psychiatry Cognitive Neurology BACKGROUND: While meta-analyses confirm treatment for chronic post-stroke aphasia is effective, a lack of comparative evidence for different interventions limits prescription accuracy. We investigated whether Constraint-Induced Aphasia Therapy Plus (CIAT-plus) and/or Multimodality Aphasia Therapy (M-MAT) provided greater therapeutic benefit compared with usual community care and were differentially effective according to baseline aphasia severity. METHODS: We conducted a three-arm, multicentre, parallel group, open-label, blinded endpoint, phase III, randomised-controlled trial. We stratified eligible participants by baseline aphasia on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ). Groups of three participants were randomly assigned (1:1:1) to 30 hours of CIAT-Plus or M-MAT or to usual care (UC). Primary outcome was change in aphasia severity (WAB-R-AQ) from baseline to therapy completion analysed in the intention-to-treat population. Secondary outcomes included word retrieval, connected speech, functional communication, multimodal communication, quality of life and costs. RESULTS: We analysed 201 participants (70 in CIAT-Plus, 70 in M-MAT and 61 in UC). Aphasia severity was not significantly different between groups at postintervention: 1.05 points (95% CI −0.78 to 2.88; p=0.36) UC group vs CIAT-Plus; 1.06 points (95% CI −0.78 to 2.89; p=0.36) UC group vs M-MAT; 0.004 points (95% CI −1.76 to 1.77; p=1.00) CIAT-Plus vs M-MAT. Word retrieval, functional communication and communication-related quality of life were significantly improved following CIAT-Plus and M-MAT. Word retrieval benefits were maintained at 12-week follow-up. CONCLUSIONS: CIAT-Plus and M-MAT were effective for word retrieval, functional communication, and quality of life, while UC was not. Future studies should explore predictive characteristics of responders and impacts of maintenance doses. TRIAL REGISTRATION NUMBER: ACTRN 2615000618550. BMJ Publishing Group 2022-06 2022-04-08 /pmc/articles/PMC9148985/ /pubmed/35396340 http://dx.doi.org/10.1136/jnnp-2021-328422 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Cognitive Neurology
Rose, Miranda L
Nickels, Lyndsey
Copland, David
Togher, Leanne
Godecke, Erin
Meinzer, Marcus
Rai, Tapan
Cadilhac, Dominique A
Kim, Joosup
Hurley, Melanie
Foster, Abby
Carragher, Marcella
Wilcox, Cassie
Pierce, John E
Steel, Gillian
Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia
title Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia
title_full Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia
title_fullStr Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia
title_full_unstemmed Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia
title_short Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia
title_sort results of the compare trial of constraint-induced or multimodality aphasia therapy compared with usual care in chronic post-stroke aphasia
topic Cognitive Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148985/
https://www.ncbi.nlm.nih.gov/pubmed/35396340
http://dx.doi.org/10.1136/jnnp-2021-328422
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