Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions

School-based healthy eating interventions for adolescents aged 10-19 years: an umbrella review

BACKGROUND

The benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear.

AIM

This umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10-19 years old).

METHODS

Using Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation's Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement.

RESULTS

Seventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents' knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap.

CONCLUSION

School-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries.

A systematic review of Intensive Comprehensive Aphasia Programmes - who takes part, what is measured, what are the outcomes?

PURPOSE

This study synthesizes participant and outcome data from peer-reviewed Intensive Comprehensive Aphasia Programme (ICAP) studies.

METHODS

A systematic review was conducted following PRISMA guidelines. Study eligibility criteria were specified in relation to population, intervention, comparison, outcome, and design considerations. Data were extracted according to six research questions. Narrative synthesis was used.

RESULTS

Twenty-one studies were included covering 13 ICAPs (N = 485, aged 18-86 years, between 11 and 335 months post-stroke). Twenty-seven participant selection criteria were identified. Fifty-six outcome measures spanning the WHO-ICF were used, with the majority assessing the body function domain. Only eight studies employed an experimental design with data appropriate for analysis and synthesis. Risk of bias was noted across this sub-group. Participants improved in word-finding, communication, activity/participation, and communication-related quality of life, and maintained their gains; however, except for word finding, evidence of effect came from isolated studies. Factors influencing outcomes were rarely considered. Some drop-outs, missed sessions, and fatigue were noted. Some studies reported IPD alongside group analyses.

CONCLUSIONS

ICAP selection criteria need justification and should contribute to the understanding of candidacy for this treatment model. Rationalisation of ICAP treatment content and outcome measurement is required, spanning all WHO-ICF domains. Employment of the core outcome set for aphasia would enable data synthesis and facilitate comparisons between the ICAP and other therapy models.

A Tutorial for Enhancing Clarity and Transparency in Speech-Language-Hearing Sciences Intervention Research With the TIDieR

PURPOSE

The speech-language-hearing sciences (SLHS) field relies on rigorous research to inform clinical practice and improve outcomes for individuals with communication, swallowing, and hearing needs. However, a significant challenge in our field is the lack of accessibility, transparency, and reproducibility of this research. Such insufficiencies limit the generalizability and impact of study findings, particularly intervention research, as it becomes difficult to replicate and use the interventions in both clinical practice and research. In this tutorial, we highlight one particularly useful tool, the Template for Intervention Description and Replication (TIDieR; Hoffmann et al., 2014) checklist, which researchers can follow to improve reproducibility practices in SLHS.

CONCLUSIONS

We provide an overview and guide on using the TIDieR checklist with a practical example of its implementation. Additionally, we discuss the potential benefits of increased transparency and reproducibility for SLHS, including improved clinical outcomes and increased confidence in the effectiveness of interventions. We also provide specific recommendations for scientists, journal reviewers, editors, and editorial boards as they seek to adopt, implement, and encourage using the TIDieR checklist.

Making oral comprehension interventions TIDieR: A narrative synthesis of interventions improving comprehension in children from 1 to 5 years with language difficulties

BACKGROUND

Oral comprehension difficulties are prevalent in preschool children with language difficulties and are frequently the target of speech and language therapy (SLT) intervention. To support the implementation of research to practice, there is a need to identify effective interventions for this population and to describe their components. To date, reviews of oral comprehension intervention have not used inclusion criteria aligned with common clinical practice, particularly in the United Kingdom. No studies have previously used the Template for Intervention Description and Replication (TIDieR) checklist to describe developmental SLT interventions.

AIMS

To identify intervention studies effective for oral comprehension in preschool children with language difficulties, using the UK definition of 'preschool' as children under 5 years; to describe the components of these interventions.

METHOD

This followed two phases: (1) an International Prospective Register of Systematic Reviews registered search, which identified 20 systematic reviews; and (2) an exploration of individual studies within these reviews. Seventeen individual studies described effective intervention for children from 1 to 5 years old with language difficulties. Data were extracted from each study against headings from the TIDieR checklist. Findings were analysed and reported using narrative synthesis.

MAIN CONTRIBUTION

A wide variety of rationales, techniques, procedures, settings and intensities were associated with effective intervention. The TIDieR checklist highlighted components that were unreported or under-described.

CONCLUSIONS

Studies show that intervention can be effective for improving oral comprehension in preschool children with language difficulties. Analysis of intervention components has relevance to clinical practice and research, and highlights the importance of naturally occurring interactions, cross-over between oral comprehension and expressive language and the variety in delivery models and dosage.

WHAT THIS PAPER ADDS

What is already known on this subject There is a reported lack of research into interventions developing oral comprehension in children with language difficulties. Intervention checklists such as the Template for Intervention Description and Replication are valuable tools for understanding interventions and supporting the application of research to practice, but none have been used to describe interventions for children with language difficulties. What this study adds There is evidence that intervention developing oral comprehension in preschool children (using UK definition, those under 5 years) with language difficulties can be effective. Analysing intervention components reveals key points for consideration by clinicians. What are the clinical implications of this work? Intervention components identified by this study support the implementation of research to practice by highlighting particular areas for consideration by clinicians. For researchers, gaps in reporting demonstrate the need to describe all aspects of intervention to support replication and implementation.

Experiences of People with Aphasia Receiving Enhanced Community-Based Speech-Language Pathology Provided by Speech-Language Pathology Students

INTRODUCTION

Treatment intensity for people with aphasia (PWA) is a significant factor in enhancing recovery. Personal factors such as fatigue, physical endurance, and motivation as well as clinician availability have been described as barriers to increased intensity. The use of student therapists has been shown to assist with addressing service gaps.

METHODS

The aim of the study was to explore the experiences of PWA who received enhanced community-based treatment delivered by speech-language pathology (SLP) students. Enhanced community-based treatment was defined as three or more treatment sessions per week targeting communication. Semi-structured interviews were conducted with 10 PWA living in New Zealand. Interview data were analysed with reflexive thematic analysis.

RESULTS

Two themes and six sub-themes were developed. Theme 1 related to intensity and included more treatment is better than less (sub-theme 1), there's a "right time" for more intensive treatment (sub-theme 2), the hard work is worth the effort (sub-theme 3). Theme 2 related to working with SLP students; it didn't feel like they were students (sub-theme 4), we just got on so well (sub-theme 5), and they listened to what I wanted (sub-theme 6).

CONCLUSIONS

The findings confirm that PWA value access to more intensive treatment and desire involvement in decisions about flexible treatment schedules. PWA have positive experiences when treatment is provided by SLP students. Implications for clinical practice and future research directions are discussed.

Intensive and comprehensive aphasia therapy-a survey of the definitions, practices and views of speech and language therapists in the United Kingdom

BACKGROUND

Research evidence suggests aphasia therapy must be delivered at high intensity to effect change. Comprehensive therapy, addressing all domains of the International Classification of Functioning, Disability and Health, is also called for by people with aphasia and their families. However, aphasia therapy is rarely intense or comprehensive. Intensive Comprehensive Aphasia Programmes (ICAPs) were designed to address this challenge, but such programmes are not widely implemented.

AIMS

This study surveyed the views of UK-based speech and language therapists (SLTs) regarding intensive and comprehensive aphasia therapy. It explored definitions of intensive and comprehensive therapy, patterns of provision, views about candidacy and barriers/facilitators. It also investigated awareness of ICAPs and perceived potential of this service model. Differences across UK regions and workplace settings were explored.

METHODS & PROCEDURES

An e-survey ran for 5 months. Quantitative data were analysed using descriptive and inferential statistics. Qualitative free text comments were analysed using content analysis.

OUTCOMES & RESULTS

Two hundred twenty-seven respondents engaged in the e-survey. Definitions of intensive aphasia therapy did not reach UK clinical guideline/research-level thresholds for most of the sample. Those providing more therapy provided definitions with higher standards of intensity. Mean therapy delivered was 128 min/week. Geographical location and workplace setting influenced the amount of therapy delivered. The most frequently delivered therapy approaches were functional language therapy and impairment-based therapy. Cognitive disability and fatigue were concerns for therapy candidacy. Barriers included lack of resources and low levels of optimism that issues could be solved. 50% of respondents were aware of ICAPs and 15 had been involved in ICAP provision. Only 16.5% felt their service could be reconfigured to deliver an ICAP.

CONCLUSIONS & IMPLICATIONS

This e-survey evidences a mismatch between an SLT's concept of intensity and that espoused by clinical guidelines/research. Geographical variations in intensity are concerning. Although a wide range of therapy approaches are offered, certain aphasia therapies are delivered more frequently. Awareness of ICAPs was relatively high, but few respondents had experience of this model or felt it could be executed in their context. Further initiatives are needed if services are to move from a low-dose or non-comprehensive model of delivery. Such initiatives might include but not be confined to wider uptake of ICAPs. Pragmatic research might also explore which treatments are efficacious with a low-dose model of delivery, given that this model is dominant in the United Kingdom. These clinical and research implications are raised in the discussion.

WHAT THIS PAPER ADDS

What is already known on this subject There is a gap between the high intensity of aphasia treatment provided in research versus mainstream clinical settings. A lower standard of 45 min/day set by UK clinical guidelines is also not achieved. Although speech and language therapists (SLTs) provide a wide range of therapies, they typically focus on impairment-based approaches. What this study adds This is the first survey of UK SLTs asking about their concept of intensity in aphasia therapy and what types of aphasia therapy they provide. It explores geographical and workplace variations and barriers and facilitators to aphasia therapy provision. It investigates Intensive Comprehensive Aphasia Programmes (ICAPs) in a UK context. What are the clinical implications of this work? There are barriers to the provision of intensive and comprehensive therapy in the United Kingdom and reservations about the feasibility of ICAPs in a mainstream UK context. However, there are also facilitators to aphasia therapy provision and evidence that a small proportion of UK SLTs are providing intensive/comprehensive aphasia therapy). Dissemination of good practice is necessary and suggestions for increasing intensity of service provision are listed in the discussion.

Defining, quantifying, and reporting intensity, dose, and dosage of neurorehabilitative interventions focusing on motor outcomes

Introduction

Determining the minimal amount of therapy needed for positive neurorehabilitative outcomes is important for optimizing active treatment interventions to improve motor outcomes. However, there are various challenges when quantifying these relationships: first, several consensuses on the definition and usage of the terms intensity, dose, and dosage of motor interventions have been proposed, but there seems to be no agreement, and the terms are still used inconsistently. Second, randomized controlled trials frequently underreport items relevant to determining the intensity, dose, and dosage of the interventions. Third, there is no universal measure to quantify therapy intensity accurately. This "perspectives" paper aims to increase awareness of these topics among neurorehabilitation specialists.

Defining quantifying and reporting

We searched the literature for definitions of intensity, dose, and dosage and adapted the ones we considered the most appropriate to fit the needs of neurorehabilitative interventions. Furthermore, we suggest refining the template for intervention description and replication (TIDieR) to enhance the reporting of randomized controlled trials. Finally, we performed a systematic literature search to provide a list of intensity measures and complemented these with some novel candidate measures.

Discussion

The proposed definitions of intensity, dose, and dosage could improve the communication between neurorehabilitation specialists and the reporting of dose and dosage in interventional studies. Quantifying intensity is necessary to improve our understanding of the minimal intensity, dose, and dosage of therapy needed to improve motor outcomes in neurorehabilitation. We consider the lack of appropriate intensity measures a significant gap in knowledge requiring future research.

Humor-based interventions for patients undergoing hemodialysis: A scoping review

OBJECTIVES

There is evidence that humor interventions can impact chronic kidney disease (CKD) patients. Synthesize relevant literature to understand the elements and mechanisms of implementation of humor interventions.

METHODS

Relevant peer-reviewed articles were searched. Data were extracted according to the Template for Intervention Description and Replication (TIDieR) checklist.

RESULTS

The initial search yielded 261 articles. Nine were included in the scoping review. The studies included laughter (n = 5) and humorous video interventions (n = 4) in a face-to-face group format. The tailoring and fidelity process needs to be more detailed in most studies. None of the studies mentioned the theoretical basis. The humor videos were provided by nurses and required various types of equipment. The video interventions were conducted during dialysis. The laughter intervention consisted of 3-4 themes guided by qualified therapists. The timing of the laughter intervention is chosen based on the patient's dialysis schedule and is maintained for 30 min.

CONCLUSION

The characteristics of the current study somewhat limit the understanding, replication, and implementation of evidence-based humor interventions. Future studies need to clarify the theoretical basis, tailoring, fidelity, and control groups.

PRACTICE IMPLICATIONS

Ongoing reporting and evaluation of the implementation of humor interventions may help better understand their underlying mechanisms.