{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:49:16Z","timestamp":1793332156916,"version":"4.5.0"},"reference-count":30,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Tavistock Trust for Aphasia, UK"},{"DOI":"10.13039\/501100002001","name":"Health Services and Delivery Research Programme","doi-asserted-by":"publisher","award":["14\/04\/22"],"award-info":[{"award-number":["14\/04\/22"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Stroke rehabilitation interventions are routinely personalized to address individuals\u2019 needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>We explored associations between speech and language therapy (SLT) interventions frequency (days\/week), intensity (h\/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including\u2009\u2a7e\u200910 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (\u2a7d\/&gt;\u200965\u2009years), aphasia severity (mild\u2013moderate\/ moderate\u2013severe based on language outcomes\u2019 median value), chronicity (\u2a7d\/&gt;\u20093\u2009months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (&gt;\u200950%), results were reported for completeness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h\/week; overall-language and comprehension\u2009&gt;\u20099 h\/week); older participants\u2019 greatest gains occurred alongside low-intensity SLT (\u2a7d\u20092 h\/week) except for auditory comprehension (&gt;\u20099 h\/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants\u2009\u2a7d\u20093\u2009months post-onset demonstrated greatest overall-language gains for SLT at low intensity\/moderate dosage (\u2a7d\u20092 SLT-h\/week; 20-to-50 h); for those\u2009&gt;\u20093\u2009months, post-stroke greatest gains were associated with moderate-intensity\/high-dosage SLT (3\u20134 SLT-h\/week;\u2009\u2a7e\u200950 hours). For moderate\u2013severe participants, 4 SLT-days\/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for\u2009\u2a7e\u20094 SLT-days\/week; mild\u2013moderate participants\u2019 greatest functional communication gains were associated with similar frequency (\u2a7e\u20094 SLT-days\/week) and greatest overall-language gains with higher frequency SLT (\u2a7e\u20096\u2009days\/weekly). Males\u2019 greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h\/weekly) or high intensity (overall-language and auditory comprehension; (&gt;\u20099 h\/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (&lt;\u20092 SLT-h\/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT\u2009&gt;\u20099 h over\u2009\u2a7e\u20094\u2009days\/week.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We observed a treatment response in most subgroups\u2019 overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild\u2013moderate, and male subgroups experienced their greatest language gains alongside high-frequency\/intensity SLT. In contrast, older, moderate\u2013severely impaired, and female subgroups within 3\u2009months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930221097477","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T02:08:52Z","timestamp":1649988532000},"page":"1067-1077","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":56,"title":["Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis"],"prefix":"10.1177","volume":"17","author":[{"name":"The RELEASE Collaborators","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4589-7021","authenticated-orcid":false,"given":"Marian C","family":"Brady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5899-2485","authenticated-orcid":false,"given":"Myzoon","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5035-9650","authenticated-orcid":false,"given":"Kathryn","family":"VandenBerg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-1718","authenticated-orcid":false,"given":"Linda 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