Hoover Elizabeth, Szabo Gretchen, Kohen Francine, Vitale Sarah, McCloskey Nicholas, Maas Edwin, Kulkarni Varsha, DeDe Gayle
Department of Speech, Language & Hearing Sciences, Boston University, MA.
Adler Aphasia Center, Maywood, NJ.
Am J Speech Lang Pathol. 2025 May 6;34(3):1203-1218. doi: 10.1044/2025_AJSLP-24-00279. Epub 2025 Apr 10.
Aphasia is a communication disorder that affects up to 30% of stroke survivors. Insufficient access to communication services creates personal, social, and financial costs to people with aphasia (PwA), care partners, and the community. Group conversation treatment has the potential to improve communication and reduce social isolation in a cost-effective manner, but little is known about its critical ingredients. This multicenter randomized controlled trial examined the effects of conversation treatment and whether the pattern of changes on outcome measures differed when treatment was delivered in large groups compared to dyads.
One hundred four PwA were randomly assigned to a dyad, large group, or delayed control condition. Conversation group treatment was 1 hr, twice weekly, over 10 weeks. Individual communication goals were addressed within thematically oriented conversation treatment. To evaluate treatment effects, primary (Aphasia Communication Outcome Measure [ACOM]) and secondary outcome measures were examined at pretreatment, posttreatment, and 6 weeks posttreatment.
The ACOM did not show significant changes in the planned omnibus analyses. Post hoc analyses suggested that the large group, but not dyad, treatment condition showed a treatment effect on the ACOM from pre- to posttreatment. Both treatment conditions showed changes on a measure of naming, and the dyads also showed improvement on a measure of repetition.
The study failed to show the effects of conversation treatment in the omnibus analysis, but there was evidence that conversation group treatment, delivered in a large group, is effective for people with chronic aphasia. This study also illustrated how manipulating the size of the group may alter the outcomes for individuals. The results of this study offer support for a treatment option for PwA across the continuum of care.
失语症是一种交流障碍，影响多达30%的中风幸存者。交流服务获取不足给失语症患者、护理伙伴和社区带来了个人、社会和经济成本。小组对话治疗有可能以具有成本效益的方式改善交流并减少社会隔离，但对其关键要素知之甚少。这项多中心随机对照试验研究了对话治疗的效果，以及与双人组治疗相比，在大组中进行治疗时，结果测量指标的变化模式是否有所不同。
104名失语症患者被随机分配到双人组、大组或延迟对照组。对话组治疗为期10周，每周两次，每次1小时。在以主题为导向的对话治疗中确定个人交流目标。为评估治疗效果，在治疗前、治疗后和治疗后6周检查主要（失语症交流结果测量[ACOM]）和次要结果测量指标。
在计划的综合分析中，ACOM未显示出显著变化。事后分析表明，大组而非双人组治疗条件在治疗前到治疗后对ACOM显示出治疗效果。两种治疗条件在命名测量指标上均有变化，双人组在重复测量指标上也有改善。
该研究在综合分析中未能显示对话治疗的效果，但有证据表明，大组进行的对话组治疗对慢性失语症患者有效。这项研究还说明了如何通过改变小组规模来改变个体的治疗结果。本研究结果为失语症患者在整个护理过程中的一种治疗选择提供了支持。
