Rehabilitation specialists from Norway and Scotland present results from a single-blinded randomized controlled pilot study that compares the effectiveness – for persons with aphasia (PWA) – of speech-language telerehabilitation additive to usual care for following stroke, vs. usual care alone. It reports subject recruitment and drop-out numbers, plus improvements in impairment assessment scores and functional communication. The authors’ aims are to demonstrate approach feasibility, refine study methodology, and prepare for a follow-on, large-scale, randomized controlled trial (RCT) with high statistical power.

Sixty-two persons with post-stroke aphasia were randomly assigned to: [i] five hours/week of telerehabilitation via videoconference combined with usual care; or [ii] usual care alone. The videoconference work, covering four weeks, aimed to improve subjects’ functional expressive communication. Assessments occurred at baseline, four weeks, and four months after intake. For impairment scores, the Norwegian Basic Aphasia Assessment subtests for naming, repetition, auditory verbal comprehension, verb- and sentence-production were used; for ratings of functional communication in everyday live, the authors used the Communicative Effectiveness Index. Details of subjects’ normal care (type, frequency, intensity) were documented at the subjects’ various treatment centers around Norway.

Results show significant additional improvements in the ‘teletherapy + normal care’ group over normal care in three assessment areas: repetition, verb-, and sentence-production. No additional gains were found in naming or auditory verbal comprehension, nor in subjects’ functional communication.

Though improvements were uneven, the authors point out that a pilot study is by nature preliminary, and that only a large-scale follow-on RCT can establish benefit magnitudes and distributions with adequate statistical power. They report that their practical experiences have prepared them to conduct such an RCT. Work to date has demonstrated feasibility of the research design, helped them establish relationships with Norwegian clinics that serve as practical working models, and shown how to handle subject identification and recruitment. They do not mention tracking marginal costs of their approach, but those data would be useful for conducting initial cost-benefit analyses, which are likely to affect the policymaking and clinical practices of medical service providers.

For further reading:   H. P. Øra, M. Kirmess, M. C. Brady et al., 2020,

The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia — a pilot randomized controlled trial.  Clinical Rehabilitation, 34(3): 1–12.

https://doi.org/10.1177/0269215519896616

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