中风后慢性失语症患者的约束诱导或多模式失语症疗法与常规护理对比的COMPARE试验结果。
Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia.
作者信息
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
机构信息
Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia.
出版信息
J Neurol Neurosurg Psychiatry. 2022 Jun;93(6):573-581. doi: 10.1136/jnnp-2021-328422. Epub 2022 Apr 8.
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.
背景
虽然荟萃分析证实中风后慢性失语症的治疗是有效的，但缺乏不同干预措施的比较证据限制了处方的准确性。我们调查了与常规社区护理相比，强制性诱导失语症治疗加强版（CIAT-plus）和/或多模式失语症治疗（M-MAT）是否能带来更大的治疗益处，以及根据基线失语严重程度其疗效是否存在差异。
方法
我们进行了一项三臂、多中心、平行组、开放标签、盲终点、III期随机对照试验。我们根据西部失语症成套测验修订版失语商数（WAB-R-AQ）的基线失语情况对符合条件的参与者进行分层。将三名参与者分为一组，随机分配（1:1:1）接受30小时的CIAT-Plus或M-MAT或常规护理（UC）。主要结局是在意向性治疗人群中分析从基线到治疗完成时失语严重程度（WAB-R-AQ）的变化。次要结局包括单词检索、连贯言语、功能性沟通、多模式沟通、生活质量和成本。
结果
我们分析了201名参与者（CIAT-Plus组70名，M-MAT组70名，UC组61名）。干预后各组之间失语严重程度无显著差异：UC组与CIAT-Plus组相比为1.05分（95%CI -0.78至2.88；p=0.36）；UC组与M-MAT组相比为1.06分（95%CI -0.78至2.89；p=0.36）；CIAT-Plus组与M-MAT组相比为0.004分（95%CI -1.76至1.77；p=1.00）。CIAT-Plus和M-MAT后单词检索、功能性沟通和与沟通相关的生活质量有显著改善。单词检索益处维持到12周随访。
结论
CIAT-Plus和M-MAT对单词检索、功能性沟通和生活质量有效，而UC无效。未来研究应探索反应者的预测特征和维持剂量的影响。
试验注册号
ACTRN 2615000618550。
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