Effectiveness of Intensive Aphasia Therapy Under Routine Clinical Conditions

NCT ID: NCT01540383

Last Updated: 2017-09-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

156 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-04-30

Study Completion Date

2015-01-31

Brief Summary

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The purpose of this study is to examine whether 3 weeks of intensive language therapy provided in clinical in- and outpatient settings is effective in improving everyday communication in postacute/chronic post-stroke aphasia, as measured by performance on the Amsterdam Nijmegen Everyday Language Test (ANELT).

Detailed Description

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Aims of the study:

This multicenter randomized placebo-controlled study aims to examine whether integrative intensive (\> 10 hours/week for at least 3 weeks) language and communication therapy administered under routine clinical conditions translates into a statistically significant functional improvement of everyday communication in patients with chronic aphasia (i.e., aphasia persisting for 6 or more months after the stroke). A further aim is to examine whether therapy-induced improvements are still maintained over a period of six months. The study's results may lead to more targeted treatment regimens and thus to an enhancement of health-related quality of life in persons with chronic aphasia. The data will further provide evidence-based guidelines of best practice in the rehabilitation of persons with chronic aphasia.

Methods:

Fourteen in- and outpatient rehabilitation centres across Germany participate in the study. Via a digital randomization procedure, patients are allocated to one of two groups: an experimental group, starting as soon as feasible with treatment lasting 3 to 6 weeks, and a waiting list control group, whose therapy begins after a three-week delay. Both groups receive a combination of language systematic and communicative-pragmatic language therapy. Everyday language ability will be examined with a standardized outcome measure, and compared between groups at several points: immediately before as well as immediately after and 6 months after completion of (3-6 weeks) intensive language therapy.

Statistical analyses:

The primary analysis compares the changes in functional communication ability (as indicated by changes of pre- to post-therapy functional communication scores on the primary outcome measure, the ANELT) between the experimental and the waiting list control group in an intention-to-treat (ITT) design. To balance for unequal treatment durations across patient ("naturalistic treatment setting"), the critical pre- to post therapy interval is fixed at three weeks, with the option of extension of therapy (provided it is granted by the sickness fund) and re-test after termination of therapy. The long-term stability of potential treatment gains will be re-evaluated 6 months post therapy.

Further exploratory analyses will examine therapy-induced changes in secondary outcome measures (see below) in the experimental compared to the waiting list control group.

Considering that age, gender, time post stroke onset, aphasia type (fluent, non-fluent), aphasia severity (based on the Aachen Aphasia Test \[AAT\] profile score), the total hours of therapy provided, type of stroke (cortical strokes with or without subcortical involvement), the amount of therapy-concomitant self-administered language practice (e.g. computer-aided practice), and concurrent physio- and neuropsychological therapies might influence functional outcome, the above factors will be included in a multivariate analysis with variable selection. The amount of outpatient therapy provided after discharge from intensive treatment will be statistically controlled by covariate analyses.

Finally, the investigators expect that therapy effects in the waiting list control group will be comparable to those of the experimental group. Thus, after initiation of therapy in the control group after a three-week delay, outcome data will be collected in analogy to the experimental group, and will serve to replicate potential effects of intensive language therapy under routine clinical conditions.

Conditions

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Aphasia Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Intensive aphasia therapy group

Group starts intensive integrative aphasia therapy within 3 workdays (or as soon as possible) after baseline exam

Group Type EXPERIMENTAL

Intensive integrative aphasia therapy

Intervention Type BEHAVIORAL

Intensive language therapy (3 weeks, 5 days/week, \>=2 hours/day) provided in regular clinical setting and consisting of a combination of language systematic and communicative-pragmatic treatment

Waiting list control group

Group starts intensive integrative aphasia therapy after a waiting period of at least three weeks

Group Type OTHER

Waiting list control group

Intervention Type BEHAVIORAL

Control group starts intensive language therapy after a 3-week waiting period.

Interventions

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Intensive integrative aphasia therapy

Intensive language therapy (3 weeks, 5 days/week, \>=2 hours/day) provided in regular clinical setting and consisting of a combination of language systematic and communicative-pragmatic treatment

Intervention Type BEHAVIORAL

Waiting list control group

Control group starts intensive language therapy after a 3-week waiting period.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* presence of aphasia for at least 6 months after non-hemorrhagic or hemorrhagic cortical or subcortical-cortical stroke
* native language German
* participant's comprehension ability needs to be sufficiently high to give informed consent
* participant's language abilities have to allow the administration of the Aachen Aphasia Test (AAT)

Exclusion Criteria

* aphasia due to non-vascular etiology
* no evidence for aphasia (based on AAT subtests 'Token Test' and 'Written Language'
* severe untreated medical conditions which prohibit participation in intensive language therapy
* severe vision or hearing problems (uncorrected)
* participation in another interventional or language therapy study within four weeks before potential enrollment
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fresenius University of Applied Science

OTHER

Sponsor Role collaborator

Charite University, Berlin, Germany

OTHER

Sponsor Role collaborator

Entwicklungsgruppe Klinische Neuropsychologie, Klinikum Bogenhausen, München

UNKNOWN

Sponsor Role collaborator

Institut für Biometrie und Klinische Epidemiologie, Charité Campus Benjamin Franklin, Berlin

UNKNOWN

Sponsor Role collaborator

RWTH Aachen University

OTHER

Sponsor Role collaborator

Bundesverband für die Rehabilitation der Aphasiker e.V.

UNKNOWN

Sponsor Role collaborator

Universitätsklinikum Leipzig

OTHER

Sponsor Role collaborator

MEDIAN Klinik Grünheide

UNKNOWN

Sponsor Role collaborator

Brandenburgklinik Berlin-Brandenburg GmbH

UNKNOWN

Sponsor Role collaborator

St. Mauritius Therapieklinik

UNKNOWN

Sponsor Role collaborator

Aphasie- und Seniorenzentrum Josef Bergmann Vechta

UNKNOWN

Sponsor Role collaborator

Behandlungs- und Rehabilitationszentrum für Intensiv-Therapie Lindlar

UNKNOWN

Sponsor Role collaborator

Wickerklinik Bad Homburg v.d.H.

UNKNOWN

Sponsor Role collaborator

Asklepios Neurological Clinic Falkenstein

OTHER

Sponsor Role collaborator

Akademische Praxis für Sprachtherapie / Praxis für Rehabilitationswesen Aschaffenburg

UNKNOWN

Sponsor Role collaborator

Städtisches Klinikum München, Klinikum Bogenhausen

UNKNOWN

Sponsor Role collaborator

Schoen Clinic Bad Aibling

OTHER

Sponsor Role collaborator

m&i-Fachklinik Bad Liebenstein

UNKNOWN

Sponsor Role collaborator

m&i-Fachklinik Enzensberg

UNKNOWN

Sponsor Role collaborator

m&i-Fachklinik Herzogenaurach

UNKNOWN

Sponsor Role collaborator

mediclin Klinikum Soltau

UNKNOWN

Sponsor Role collaborator

Moritz Klinik, Bad Klosterlausnitz

UNKNOWN

Sponsor Role collaborator

Klinikum Christophsbad, Göppingen

UNKNOWN

Sponsor Role collaborator

P.A.N.-Zentrum

OTHER

Sponsor Role collaborator

University Hospital Muenster

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Annette Baumgaertner, PhD

Role: PRINCIPAL_INVESTIGATOR

Hochschule Fresenius University of Applied Science

Caterina Breitenstein, PhD

Role: PRINCIPAL_INVESTIGATOR

Neurology, University of Muenster

Agnes Floel, MD

Role: STUDY_DIRECTOR

Neurology, Universitätsmedizin Charite, CCM, Berlin

Wolfram Ziegler, PhD

Role: PRINCIPAL_INVESTIGATOR

Clinical Neuropsychology Research Group (EKN), Klinikum Bogenhausen, München

Tanja Grewe, PhD

Role: PRINCIPAL_INVESTIGATOR

Hochschule Fresenius University of Applied Sciences

Locations

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University of Muenster

Münster, North Rhine-Westfalia, Germany

Site Status

Countries

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Germany

References

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Breitenstein C, Grewe T, Floel A, Ziegler W, Springer L, Martus P, Huber W, Willmes K, Ringelstein EB, Haeusler KG, Abel S, Glindemann R, Domahs F, Regenbrecht F, Schlenck KJ, Thomas M, Obrig H, de Langen E, Rocker R, Wigbers F, Ruhmkorf C, Hempen I, List J, Baumgaertner A; FCET2EC study group. Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting. Lancet. 2017 Apr 15;389(10078):1528-1538. doi: 10.1016/S0140-6736(17)30067-3. Epub 2017 Mar 1.

Reference Type DERIVED
PMID: 28256356 (View on PubMed)

Baumgaertner A, Grewe T, Ziegler W, Floel A, Springer L, Martus P, Breitenstein C. FCET2EC (From controlled experimental trial to = 2 everyday communication): How effective is intensive integrative therapy for stroke-induced chronic aphasia under routine clinical conditions? A study protocol for a randomized controlled trial. Trials. 2013 Sep 23;14:308. doi: 10.1186/1745-6215-14-308.

Reference Type DERIVED
PMID: 24059983 (View on PubMed)

Other Identifiers

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EA1/234/11

Identifier Type: -

Identifier Source: org_study_id