Telerehabilitation of aphasia: A systematic review of the literature

Abstract

Background/Aims: This review aims to describe the rapidly developing field of telerehabilitation of post-stroke aphasia. In doing so, it considered the impact of telerehabilitation on the treatment literature for aphasia from different perspectives: Treatment classification and description; outcome measurement; feasibility; acceptability; efficacy and quality assessment. Methods & Procedures: Four electronic databases (MEDLINE, PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL) were searched to identify eligible studies published between January 2000 and December 2022. The review was conducted in line with the PRISMA guidelines. Methodological quality was evaluated using the Single-Case Experimental Design (SCED), the Physiotherapy Evidence Database (PEDro) and the National Institutes of Health (NIH) quality assessment rating scales. Outcomes & Results: A total of 1844 records were considered for the review and 31 studies met the selection criteria and were included. The most frequently used treatment approaches were multimodal treatment (n=17) and lexical treatment (n=6). Amongst 37 outcomes measures, the most preferred primary outcome measures in the studies were the Western Aphasia Battery-Revised (WAB-R), the Boston Naming Test (BNT), and Communicative Effectiveness Index (CETI). Telerehabilitation was found to be both feasible and acceptable to people with aphasia. There was evidence of clinical benefit across many studies, though few studies utilised trial designs which could robustly demonstrate efficacy. The included studies were found to be of moderate to high quality based on the quality assessment tools. Conclusions: Evidence has shown that telerehabilitation can be used as an alternative or additional method to in-person therapy. Furthermore, it offers improved access to treatment options by reducing cost and travel time. In terms of acceptability and feasibility, the accumulating evidence supports telerehabilitation approaches. This field would be helped by standardisation and consensus in implementation of assessment protocols. Furthermore, the foci of telerehabilitation have been relatively narrow so far, e.g. lexical or reading or discourse skills etc. There has been a lack of holistic telerehabilitation focusing in parallel on symptoms, confidence and social engagement, despite the obvious potential of technology in supporting such wider applications.