Brady Marian C, Mills Claire, Prag Øra Hege, Novaes Natalia, Becker Frank, Constantinidou Fofi, Flöel Agnes, Sunnerhagen Katharina S, Isaksen Jytte, Jagoe Caroline, Jesus Luis Mt, Marangolo Paola, Meinzer Marcus, van der Meulen Ineke, Campbell Pauline, Ho Leonard, Hussain Salman, Hilari Katerina
Glasgow Caledonian University, Glasgow, UK.
Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Eur Stroke J. 2025 May 22:23969873241311025. doi: 10.1177/23969873241311025.
Evidence of effective aphasia rehabilitation is emerging, yet intervention and delivery varies widely. This European Stroke Organisation guideline adhered to the guideline development standard procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The resulting multi-disciplinary, evidence-based recommendations support the delivery of high-quality stroke-related aphasia rehabilitation. The working group identified 10 clinically relevant aphasia rehabilitation questions and rated outcomes' relevance and importance. Following systematic searching, independent reviewers screened title-abstracts and full-texts for randomised controlled trials of speech-language therapy (SLT) for stroke-related aphasia. Results were profiled using PRISMA. Risk-of-bias was evaluated using the Cochrane Risk-of-Bias 1 tool. We prioritised final-value data. Where possible we conducted meta-analyses (RevMan) using random effects and mean, standardised mean differences (functional communication, quality of life, aphasia severity, auditory comprehension and spoken language outcomes) or odds ratios (adverse events). Using GRADE, we judged quality of the evidence (high-to-very low) and ESO recommendation strength (very strong-to-very weak). Where evidence was insufficient to support recommendations, expert opinions were described. Based on low-quality evidence we recommend the provision of higher total SLT dose (⩾20 h) and suggest higher SLT intensity and frequency to improve outcomes in aphasia rehabilitation. Similarly, we suggest the provision of individually-tailored SLT and digital and group therapy delivery models. Very low-level evidence for transcranial direct current stimulation (tDCS) with SLT informed the expert consensus that such interventions should only be provided in the context of high-quality trials. Evidence-based clinical-research priorities to inform SLT aphasia rehabilitation intervention choice and delivery are highlighted.
有效的失语症康复证据正在不断涌现，但干预措施和实施方式差异很大。本欧洲卒中组织指南遵循了指南制定的标准程序以及推荐分级、评估、制定与评价（GRADE）方法。由此产生的多学科、基于证据的建议支持提供高质量的卒中相关性失语症康复服务。工作组确定了10个与临床相关的失语症康复问题，并对结果的相关性和重要性进行了评级。在系统检索之后，独立评审人员筛选了标题摘要和全文，以查找针对卒中相关性失语症的言语语言治疗（SLT）随机对照试验。结果使用PRISMA进行了描述。使用Cochrane偏倚风险1工具评估偏倚风险。我们优先考虑最终价值数据。在可能的情况下，我们使用随机效应以及均值、标准化均值差（功能性沟通、生活质量、失语症严重程度、听觉理解和口语结果）或比值比（不良事件）进行了荟萃分析（RevMan）。使用GRADE，我们判断了证据质量（高至极低）和欧洲卒中组织的推荐强度（极强至极弱）。在证据不足以支持推荐的情况下，描述了专家意见。基于低质量证据，我们建议提供更高的SLT总剂量（⩾20小时），并建议提高SLT强度和频率以改善失语症康复结果。同样，我们建议提供个性化的SLT以及数字和团体治疗实施模式。经颅直流电刺激（tDCS）联合SLT的极低水平证据使专家达成共识，即此类干预措施应仅在高质量试验的背景下提供。强调了为指导SLT失语症康复干预选择和实施而开展基于证据的临床研究重点。
