European Stroke Organisation (ESO) guideline on aphasia rehabilitation

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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Publication Details

Journal
European Stroke Journal
Published
2025-05-22
DOI
https://doi.org/10.1177/23969873241311025
Citations
10
Primary Topic
Neurobiology of Language and Bilingualism
Type
article
Field-Weighted Citation Impact
14.31

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article

European Stroke Organisation (ESO) guideline on aphasia rehabilitation

Marian Brady, Katerina Hilari, Caroline Jagoe, Jytte Isaksen et al.
10 citations
European Stroke Journal
Neurobiology of Language and Bilingualism
14.31
article

European Stroke Organisation (ESO) guideline on aphasia rehabilitation

Marian Brady, Katerina Hilari, Caroline Jagoe, Jytte Isaksen, Luís M. T. Jesus, Pauline Campbell, Natalia Pelizari Novaes, Agnes Flöel, Hege Prag Øra, Katharina Stibrant Sunnerhagen, Ineke van der Meulen, Frank Becker, Leonard Ho, Paola Marangolo, Marcus Meinzer, Fofi Constantinidou, Claire Mills, Salman Hussain
article en
10 citations

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.

European Stroke JournalVol. 10(4)
University of Leeds (GB), St George's, University of London (GB), University of Southern Denmark (DK), City, University of London (GB), University of Oslo (NO), Glasgow Caledonian University (GB), Trinity College Dublin (IE), Universitätsmedizin Greifswald (DE), Leeds Teaching Hospitals NHS Trust (GB), Sunnaas sykehus (NO), Sahlgrenska University Hospital (SE), European CanCer Organisation (BE), Codarts Rotterdam (NL), Erasmus MC (NL), Rigshospitalet (DK), University of Cyprus (CY), Federico II University Hospital (IT), Centre Hospitalier Sainte-Anne (FR), European Stroke Organisation (CH), City St George's, University of London (GB), University of Aveiro (PT), Erasmus University Rotterdam (NL), University of Edinburgh (GB)
National Institute for Health and Care Research, Department of Health and Social Care, European Stroke Organisation, Chief Scientist Office, Scottish Government Health and Social Care Directorate
Quality Education
Openalex Percentile: Top 1%
Neurobiology of Language and Bilingualism
14.31
DOIOpen Access PDFOpenAlex
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