Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia.
La Trobe University, and School of Allied Health, Human Services and Sport (A.M.F., J.E.P., M.L.R., M.C., C.W.), Melbourne, VIC, Australia.
Stroke. 2024 Jul;55(7):1877-1885. doi: 10.1161/STROKEAHA.123.046031. Epub 2024 Jun 5.
High-intensity therapy is recommended in current treatment guidelines for chronic poststroke aphasia. Yet, little is known about fatigue levels induced by treatment, which could interfere with rehabilitation outcomes. We analyzed fatigue experienced by people with chronic aphasia (>6 months) during high-dose interventions at 2 intensities.
A retrospective observational analysis was conducted on self-rated fatigue levels of people with chronic aphasia (N=173) collected during a previously published large randomized controlled trial of 2 treatments: constraint-induced aphasia therapy plus and multi-modality aphasia therapy. Interventions were administered at a higher intensity (30 hours over 2 weeks) or lower intensity (30 hours over 5 weeks). Participants rated their fatigue on an 11-point scale before and after each day of therapy. Data were analyzed using Bayesian ordinal multilevel models. Specifically, we considered changes in self-rated participant fatigue across a therapy day and over the intervention period.
Data from 144 participants was analyzed. Participants were English speakers from Australia or New Zealand (mean age, 62 [range, 18-88] years) with 102 men and 42 women. Most had mild (n=115) or moderate (n=52) poststroke aphasia. Median ratings of the level of fatigue by people with aphasia were low (1 on a 0-10-point scale) at the beginning of the day. Ratings increased slightly (+1.0) each day after intervention, with marginally lower increases in the lower intensity schedule. There was no evidence of accumulating fatigue over the 2- or 5-week interventions.
Findings suggest that intensive intervention was not associated with large increases in fatigue for people with chronic aphasia enrolled in the COMPARE trial (Constraint-Induced or Multimodality Personalised Aphasia Rehabilitation). Fatigue did not change across the course of the intervention. This study provides evidence that intensive treatment was minimally fatiguing for stroke survivors with chronic aphasia, suggesting that fatigue is not a barrier to high-intensity treatment.
目前的治疗指南建议对慢性卒中后失语症患者进行高强度治疗。然而，对于治疗引起的疲劳程度知之甚少，而这可能会影响康复效果。我们分析了在两种强度下接受高剂量干预的慢性失语症患者（>6 个月）所经历的疲劳程度。
对先前发表的一项关于两种治疗方法的大型随机对照试验（强制性语言治疗+多模态语言治疗）中收集的 173 名慢性失语症患者的自我报告疲劳水平进行了回顾性观察分析。干预措施以较高强度（2 周内 30 小时）或较低强度（5 周内 30 小时）进行。参与者在每天治疗前后使用 11 点量表对疲劳程度进行评分。使用贝叶斯有序多水平模型对数据进行分析。具体来说，我们考虑了治疗日和干预期间参与者自我报告的疲劳变化。
分析了 144 名参与者的数据。参与者为来自澳大利亚或新西兰的英语使用者（平均年龄 62 岁[范围 18-88 岁]，102 名男性，42 名女性），其中 115 名患有轻度和 52 名患有中度卒中后失语症。大多数人在治疗开始时的疲劳水平评分较低（0-10 分制的 1 分）。干预后每天略有增加（增加 1.0），低强度方案的增加幅度略低。在 2 或 5 周的干预过程中，没有证据表明疲劳程度逐渐增加。
研究结果表明，对于参加 COMPARE 试验（强制性或多模态个性化失语症康复）的慢性失语症患者，高强度干预与疲劳程度的大幅增加无关。在干预过程中，疲劳程度没有变化。这项研究为高强度治疗对慢性失语症卒中幸存者的疲劳程度影响较小提供了证据，表明疲劳不是高强度治疗的障碍。
