Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia

Journal article


Rose, Miranda L., Nickels, Lyndsey, Copland, David, Togher, Leanne, Godecke, Erin, Meinzer, Marcus, Rai, Tapan, Cadilhac, Dominique A., Kim, Joosup, Hurley, Melanie, Foster, Abby, Carragher, Marcella, Wilcox, Cassie, Pierce, John E. and Steel, Gillian. (2022). Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia. Journal of Neurology, Neurosurgery and Psychiatry. 93(6), pp. 573-581. https://doi.org/10.1136/jnnp-2021-328422
AuthorsRose, Miranda L., Nickels, Lyndsey, Copland, David, Togher, Leanne, Godecke, Erin, Meinzer, Marcus, Rai, Tapan, Cadilhac, Dominique A., Kim, Joosup, Hurley, Melanie, Foster, Abby, Carragher, Marcella, Wilcox, Cassie, Pierce, John E. and Steel, Gillian
Abstract

Background While meta-analyses confirm treatment for chronic post-stroke aphasia is effective, a lack of comparative evidence for different interventions limits prescription accuracy. We investigated whether Constraint-Induced Aphasia Therapy Plus (CIAT-plus) and/or Multimodality Aphasia Therapy (M-MAT) provided greater therapeutic benefit compared with usual community care and were differentially effective according to baseline aphasia severity.

Methods We conducted a three-arm, multicentre, parallel group, open-label, blinded endpoint, phase III, randomised-controlled trial. We stratified eligible participants by baseline aphasia on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ). Groups of three participants were randomly assigned (1:1:1) to 30 hours of CIAT-Plus or M-MAT or to usual care (UC). Primary outcome was change in aphasia severity (WAB-R-AQ) from baseline to therapy completion analysed in the intention-to-treat population. Secondary outcomes included word retrieval, connected speech, functional communication, multimodal communication, quality of life and costs.

Results We analysed 201 participants (70 in CIAT-Plus, 70 in M-MAT and 61 in UC). Aphasia severity was not significantly different between groups at postintervention: 1.05 points (95% CI −0.78 to 2.88; p=0.36) UC group vs CIAT-Plus; 1.06 points (95% CI −0.78 to 2.89; p=0.36) UC group vs M-MAT; 0.004 points (95% CI −1.76 to 1.77; p=1.00) CIAT-Plus vs M-MAT. Word retrieval, functional communication and communication-related quality of life were significantly improved following CIAT-Plus and M-MAT. Word retrieval benefits were maintained at 12-week follow-up.

Conclusions CIAT-Plus and M-MAT were effective for word retrieval, functional communication, and quality of life, while UC was not. Future studies should explore predictive characteristics of responders and impacts of maintenance doses.

Trial registration number ACTRN 2615000618550.

Year2022
JournalJournal of Neurology, Neurosurgery and Psychiatry
Journal citation93 (6), pp. 573-581
PublisherBMJ Publishing Group
ISSN0022-3050
Digital Object Identifier (DOI)https://doi.org/10.1136/jnnp-2021-328422
PubMed ID35396340
Scopus EID2-s2.0-85128510074
PubMed Central IDPMC9148985
Open accessPublished as ‘gold’ (paid) open access
Page range573-581
FunderNational Health and Medical Research Council (NHMRC)
La Trobe University
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online08 Apr 2022
Publication process dates
Accepted09 Mar 2022
Deposited01 Nov 2023
Grant ID1083010
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