Examining Dose Frameworks to Improve Aphasia Rehabilitation Research

Sam Harvey; Miranda L Rose; Emily Brogan; John E Pierce; Erin Godecke; Sonia L E Brownsett; Leonid Churilov; David Copland; Michael Walsh Dickey; Jade Dignam; Natasha A Lannin; Lyndsey Nickels; Julie Bernhardt; Kathryn S Hayward

doi:10.1016/j.apmr.2022.12.002

Examining Dose Frameworks to Improve Aphasia Rehabilitation Research

Arch Phys Med Rehabil. 2023 May;104(5):830-838. doi: 10.1016/j.apmr.2022.12.002. Epub 2022 Dec 24.

Authors

Affiliations

¹ NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
² NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia. Electronic address: m.rose@latrobe.edu.au.
³ NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
⁴ NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
⁵ NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
⁶ NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA; Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA.
⁷ NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Brain Recovery and Rehabilitation Group, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
⁸ NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia.

PMID: 36572201
DOI: 10.1016/j.apmr.2022.12.002

Abstract

The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research-the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.

Keywords: Rehabilitation.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Aphasia* / etiology
Aphasia* / rehabilitation
Humans
Rehabilitation Research
Stroke Rehabilitation* / methods
Stroke* / complications