European Stroke Organisation (ESO) guideline on aphasia rehabilitation.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-05-22 DOI:10.1177/23969873241311025

Marian C Brady, Claire Mills, Hege Prag Øra, Natalia Novaes, Frank Becker, Fofi Constantinidou, Agnes Flöel, Katharina S Sunnerhagen, Jytte Isaksen, Caroline Jagoe, Luis Mt Jesus, Paola Marangolo, Marcus Meinzer, Ineke van der Meulen, Pauline Campbell, Leonard Ho, Salman Hussain, Katerina Hilari

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Abstract

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.

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欧洲中风组织（ESO）失语康复指南。

有效的失语症康复的证据正在出现，但干预和交付差异很大。该欧洲卒中组织指南遵循指南制定标准程序和分级推荐、评估、发展和评价（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失语康复。工作组确定了10个临床相关的失语康复问题，并评估了结果的相关性和重要性。在系统检索之后，独立审稿人筛选了语言疗法（SLT）治疗中风相关失语症的随机对照试验的标题摘要和全文。使用PRISMA对结果进行分析。使用Cochrane Risk-of-bias 1工具评估偏倚风险。我们优先考虑最终值数据。在可能的情况下，我们使用随机效应和平均、标准化平均差异（功能性沟通、生活质量、失语严重程度、听觉理解和口语结果）或优势比（不良事件）进行了meta分析（RevMan）。使用GRADE，我们判断证据的质量（高到极低）和ESO推荐强度（非常强到非常弱）。如果证据不足以支持建议，则说明专家意见。基于低质量的证据，我们建议提供更高的总SLT剂量（大于或等于20小时），并建议更高的SLT强度和频率来改善失语康复的结果。同样，我们建议提供量身定制的SLT以及数字和团体治疗交付模式。经颅直流电刺激（tDCS）联合SLT的证据非常低，专家一致认为这种干预措施只能在高质量试验的背景下提供。以证据为基础的临床研究优先事项，为SLT失语康复干预的选择和交付提供信息。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.