• Widevarietyofoutcomemeasuresusedinaphasiatreatmentresearch(Brady,Kelly,Godwin,Enderby,Campbell,2016;Wallace,Worrall,Rose&LeDorze,2014;Xiong,Bunning,Horton&Hartley,2011)

• NosystemaNcally-establishedbenchmarksonthesemeasurestoshowchange• Createschallengesforcliniciansandresearchersalike

NatalieGilmore,MichaelaDwyer,SwathiKiranBostonUniversityAphasiaResearchLaboratory

Asystema)creviewofoutcomemeasuresu)lizedinaphasiatreatmentresearch,includingmeta-analysis

WorldHealthOrganizaNon(WHO)ICFmodel(WHO,2002)

A-FROM(Kaganetal.,2008)

Usefulframeworksforclassifyingaphasiaassessmentsandinterven)ons

Group Use Ac)on

Loca)on

Associa)on Proper)es

Boyle&Coehlo,1995 Aten,Caligiuri,Holland,1982 Elman,2016

Kertesz,2006 Holland,Fra\ali,&Fromm,1999 Hilari,Byng,Lamping&Smith,2003

Manydifferenttreatmentapproaches

Manydifferentassessmentmeasures

BodyStructure/Func)on Ac)vity/Par)cipa)on QualityofLife

BodyStructure/Func)on Ac)vity/Par)cipa)on QualityofLife

Showingchangefrominterven)onisessen)al

•  Inconsistencyinmeasurementuse•  Clinicians(Hesketh&Hopcu\,1997;Worrall&Egan,2001;Simmons-Mackie,Threats&Kagan,2004)

•  Researchers(Bradyetal.,2016,Wallaceetal.,2014)

•  Stepstomanagethischallenge•  ImprovingResearchOutcomeMeasurementinAphasia(ROMA)&CoreOutcomeSet(COS)(Wallaceetal.,2014)

• Yet,whatistheaveragechangeonthesemeasures?<-ourprimaryaim•  Clinicians->Chooseappropriatetools->Efficacy&reimbursement•  Researchers->Selectbestmeasures->Appropriately-poweredstudies&easiermeta-analyses

SpecificAimsofthisproject

Iden)fica)onofoutcomemeasuresusedinbehavioralaphasiatreatmentresearch1

Classifica)onofinterven)onsandoutcomemeasuresaccordingtotheirassocia)onwithhealthandhealth-relateddomainsusingICF&A-FROM

2

Calcula)onofthemeansignificantchangereportedonthemostfrequently-usedandmostrelevantoutcomemeasures3

Methods

•  PreferredReporNngItemsforSystemaNcReviewandMeta-analysisProtocol(PRISMA-P)•  RegisteredonInternaNonalProspecNveRegisterofSystemaNcReviews(PROSPERO)•  Comprehensiveliteraturesearch

•  Screening,dataextracNonandraNngofqualityofevidence•  2independentreviewers

LiteratureSearch

•  PubMed•  CINAHL•  PsychInfo•  SpeechBite•  EMBASE•  SCOPUS• WebofScience

•  PLoS• Worldcat•  NARIC•  GoogleScholar•  LinguisNc&LanguageBehaviorAbstracts(LLBA)

12databases:

‘aphasia’AND‘treatment’OR‘therapy’OR’intervenNon’OR‘rehabilitaNon’OR‘outcome’OR‘training’OR‘educaNon’AND‘adult’NOT‘primaryprogressiveaphasia’OR‘demenNa’OR‘degluNNondisorders’OR‘transcranialmagneNcsNmulaNon’OR‘transcranialdirectcurrentsNmulaNon’NOT‘pharmaceuNcalpreparaNons’

SampleSearchStrategy:

EligibilityCriteria

Included:•  Behavioralaphasiatreatmentstudies•  Usedstandardizedoutcomemeasuretomeasurechange•  Randomized-controlledtrials,quasi-experimentalstudies,single-subjectdesignsandcasereports(i.e.,Nof3)

Excluded:

•  Diagnosesofprimaryprogressiveaphasia,demenNa,traumaNcbraininjury(TBI),voiceimpairment,dysarthriaandapraxiaofspeech(AOS)

•  Drugtreatmentsorneuro-modulaNon(e.g.,repeNNvetranscranialmagneNcsNmulaNon(rTMS))

•  QualitaNveresearchdesigns•  StudiesevaluaNngthevalidityofanassessmenttool

Screening

Included

Eligibility

Iden)fica)on

Recordsiden)fiedthroughdatabasesearching(n=15,809)

Addi)onalrecordsiden)fiedthroughothersources(n=151)

Recordsa[erduplicatesremoved(n=9285)

Titlesandabstractsscreened(n=9285)

Excluded(n=8428)

Full-textar)clesassessedforeligibility(n=858)

Studiesincludedinqualita)vesynthesis(n=310)

Studiesincludedinquan)ta)vesynthesisTBDajerIARC2016

Excludedwithreasons(n=548)Wrongpopula)on=60Notbehavioraltreatment=3Nottreatmentstudy=80Nof1=3Nof2=7Non-English=11Notpeer-reviewed=9Duplicate=9Other=2Nostandardizedmeasure=330Duplicatedataset=29Ongoingstudy=5

MoherD,LiberaNA,TetzlaffJ,AltmanDG,ThePRISMAGroup(2009)PRISMAFlowDiagram

Nextsteps

SelectmeasuresfromeachICFdomainformeta-analysisLikelyopNons:

•  RevisedWesternAphasiaBa\ery(WAB)(Kertesz,2006)•  CommunicaNveEffecNvenessIndex(CETI)(Lomasetal.,1989)

Conductmeta-analysesforselectsetofmeasures

THANKYOUFORYOURATTENTION!NatalieGilmore,MichaelaDwyer&SwathiKiranBostonUniversityAphasiaResearchLaboratoryPleaseforwardques)onstongilmore@bu.edu