Jarrett, Jordan

Petroski, Taylor

Rock, Marissa

Carolina Digital Repository

Life Participation Outcomes in Group versus Individual Therapy for Adults with Aphasia: A Systematic ReviewJordan Jarrett – jordan_jarrett@med.unc.eduTaylor Petroski – taylor_petroski@med.unc.eduMarissa Rock – marissa_rock@med.unc.eduContact ReferencesResearch QuestionIn individuals with aphasia as a result of a stroke, how does participation in group therapy compared to individual therapy influence life participation?BackgroundWhen evaluating the status of individuals post-stroke, their extracurricular participation in activities is often underreported (Skolarus, Burke, Brown, & Freedman, 2014). Within speech-language pathology, there has been a push for usage of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework (Galletta & Barrett, 2014). The ICF focuses on functional communication goals, activity participations, and limitations (Papathanasiou & Coppens, 2016). Therefore, targeting the restrictions that individuals are feeling in social settings should be an aspect of intervention. Therapy models, specifically individual versus group therapy sessions, are important to consider as therapists seek to include more opportunities for functional communication. This systematic review set out to explore this idea by analyzing available evidence on life participation outcomes in individual versus group therapy for individuals with aphasia following a stroke.MethodsDatabases Searched: • ComDisDome, CINAHL Plus, and PubMed(See Figure 1)Search Terms Utilized:• Persons with aphasia (PWA) and post-stroke• Group therapy and individual therapy• Life participation and quality of life (QOL)Inclusion Criteria: • Individual speech/language therapy, group speech/language therapy, or combined speech/language therapy• Primary diagnosis of aphasia• Any language of participantExclusion Criteria: • Traumatic brain injury• Progressive diseases (i.e. PPA)• Children (0 - 18 years old)Appraisal Process• The research team used the LEGEND Appraisal Forms for Intervention and Diagnosis (Cincinnati Children’s Hospital Medical Center, 2012) aligned with the study design of the article being reviewed. Jordan Jarrett, Taylor Petroski and Marissa RockDivision of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill Literature Search Flow ChartReliabilityStudy TypeDiscussion• Given the multitude of ways to phrase “life participation” and “group therapy,” additional search terms might be necessary to encompass more research related to our initial question.• Group therapy is defined in different ways: It can include different participants and leaders.• Life participation is measured in different subjective and objective ways: It can be measured using scales, surveys, questionnaires, etc., making the comparison between studies difficult. • Treatment structure was vague, which hindered the analysis of the content covered in the sessions. Article Conclusion and Appraisal 30%20%20%10%10%10%Case StudiesCross-SectionalsRandomized-Control TrialsCohort StudiesMeasure ReviewsControlled Clinical TrialsResults• The two RCTs showed group therapy is beneficial for life participation. • The non-RCT studies supported group therapy for individuals with aphasia; however, comparisons were not made to individual therapy.• Our conclusion from this systematic review is that group therapy improves life participation equally or more than individual therapy. Records identified through database searching(n = 182)Records after duplicates removed(n = 171)Records screened(n = 171)Records excluded(n = 134)Full-text articles assessed for eligibility(n = 37)Full-text articles excluded(n = 27)Studies included in qualitative synthesis(n = 10)Studies included in quantitative synthesis (meta-analysis)(n = 10)ScreeningIncludedEligibilityIdentificationReferences available upon request.Acknowledgements This systematic review was completed as a project for SPHS 701 Introduction to Research Methods, under the guidance of Dr. Jessica Steinbrenner and Thomas PageReview Reliability % of ArticlesTitle/Abstract 90% 20%Full Text 85% 20%Quality Appraisal 100% 40%Data Extraction 100% 40%Future Directions• In order to answer our research question, further high quality research is needed to determine life participation results via direct comparison of these therapy models. Figure 1Author Study DesignGroup/Ind Conclusion Quality a b c dVan HaaranCase Study Ind Communication and interaction are main concerns of PWA Lesser N Y Y NVan der GaagCohort StudyGroup PWA experienced more confidence after attending group sessions at centerGood Y Y Y YKong Cross-SectionalBoth Satisfaction ratings were highest for community group activitiesGood Y Y Y NRose Cross-SectionalBoth All ICAPs schedules included ind and group therapy in their program designsGood Y Y Y NCiccone Randomized Control TrialBoth Group therapy may be more practical and efficient because 2-4 people are treated at onceLesser Y N Y NGrohn Case Study Both Group therapy is highly valued because of the support given from others in the groupGood Y Y Y NHoover Case Study Both Both therapy models with intensive and individualized treatment get improvementGood Y Y N YMayo Randomized Control TrialGroup Participants made gains of 2-5 hours in life participation; increased HRQL scoresGood N Y Y YAttard Controlled Clinical TrialGroup Group therapy supports ICF domains of activity and participationLesser N Y Y NCarod-ArtalMeasure ReviewInd Stroke specific measures are more helpful to apply to ICF domainsLesser Y Y Y NKEY:a.  Were instruments used to measure the outcomes reliable? b.  Was the study long enough to fully study effects of the treatment?c.  Was there freedom from conflict of interest? d.  Did the study have a sufficiently large sample size?

Life Participation Outcomes in Group Versus Individual Therapy for Adults with Aphasia: A Systematic Review

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Life Participation Outcomes in Group Versus Individual Therapy for Adults with Aphasia: A Systematic Review

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