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Is There a Research-Practice Dosage Gap in Aphasia Rehabilitation?
Cavanaugh, Robert; Kravetz, Christina; Jarold, Lillian; Quique, Yina; Turner, Rose; Evans, William S.
Afiliação
  • Cavanaugh R; Department of Communication Sciences and Disorders, University of Pittsburgh, PA.
  • Kravetz C; Centers for Rehab Services, University of Pittsburgh Medical Center, PA.
  • Jarold L; Department of Communication Sciences and Disorders, University of Pittsburgh, PA.
  • Quique Y; Communication Sciences and Disorders, University of South Carolina, Columbia.
  • Turner R; Center for Education in Health Sciences, Northwestern University, Chicago, IL.
  • Evans WS; Health Sciences Library System, University of Pittsburgh, PA.
Am J Speech Lang Pathol ; 30(5): 2115-2129, 2021 09 23.
Article em En | MEDLINE | ID: mdl-34411485
Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research-practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5-20 sessions). Sessions occurred 1-2 times a week over 4-14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75-15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12-30 hr) over the course of 15 sessions (interquartile range: 10-24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research-practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Afasia / Qualidade de Vida Tipo de estudo: Diagnostic_studies Aspecto: Patient_preference Limite: Humans Idioma: En Revista: Am J Speech Lang Pathol Assunto da revista: PATOLOGIA DA FALA E LINGUAGEM Ano de publicação: 2021 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Afasia / Qualidade de Vida Tipo de estudo: Diagnostic_studies Aspecto: Patient_preference Limite: Humans Idioma: En Revista: Am J Speech Lang Pathol Assunto da revista: PATOLOGIA DA FALA E LINGUAGEM Ano de publicação: 2021 Tipo de documento: Article País de publicação: Estados Unidos