Poststroke Aphasia Frequency, Recovery, and Outcomes: a systematic review and meta-analysis

Publication date: Available online 8 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Heather L. Flowers, Stacey A. Skoretz, Frank L. Silver, Elizabeth Rochon, Jiming Fang, Constance Flamand-Roze, Rosemary Martino
ObjectiveWe conducted a systematic review to elucidate the frequency, recovery, and associated outcomes for poststroke aphasia over the long-term.Data SourcesUsing the Cochrane Stroke Strategy, we searched 10 databases, 13 journals, 3 conferences, and the grey literature.Study SelectionOur a priori protocol criteria included unselected samples of adult stroke patients from randomized controlled trials or consecutive cohorts. Two independent reviewers rated abstracts and articles for exclusion or inclusion, resolving discrepancies by consensus.Data ExtractionWe documented aphasia frequencies by stroke type and setting and computed odds ratios (OR) with their 95 percent confidence intervals (CI) for outcomes.Data SynthesisWe retrieved 2168 citations, reviewed 248 articles, and accepted 50. Median frequencies for mixed stroke (ischemic and hemorrhagic) were 30 and 34 percent for acute and rehabilitation settings, respectively. Frequencies by stroke type were lowest for acute subarachnoid hemorrhage (9%) and highest for acute ischemic stroke (62%) when arrival to hospital was ≤3 hours from stroke onset. Articles monitoring aphasia for one year demonstrated aphasia frequencies 2 to 12 percent lower than baseline. Negative outcomes associated with aphasia included greater odds of in-hospital death (OR 2.7, CI 2.4-3.1) and longer mean length of stay in days (M 1.6, CI 1.0-2.3) in acute settings. Patients with aphasia had greater disability from 28 days (OR 1.5, CI 1.3-1.7) to two years (OR 1.7, CI 1.6-2.0) than those without aphasia. By two years, they used more rehabilitation services (OR 1.5, CI 1.3-1.6) and returned home less frequently (OR 1.4, CI 1.2-1.7).ConclusionsReported frequencies of poststroke aphasia range widely, depending on stroke type, and setting. Because aphasia is associated with mortality, disability, and use of health services, we recommend long-term interdisciplinary vigilance in the management of aphasia.



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