Efficacy of early cognitive-linguistic treatment and communicative treatment in aphasia after stroke: a randomised controlled trial (RATS-2)
Efficacy of early cognitive-linguistic treatment and communicative treatment in aphasia after stroke: a randomised controlled trial (RATS-2)
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DOI：
10.1136/jnnp.2010.210559
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发表时间：
2011-04-01
影响因子：
11
通讯作者：
Visch-Brink, E. G.
中科院分区：
文献类型：
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作者：
de Jong-Hagelstein, M.;van de Sandt-Koenderman, W. M. E.;Visch-Brink, E. G.
背景 失语症治疗的两种主要方法是认知语言治疗（CLT），旨在恢复受影响的语言水平、语义、音系或句法；以及交际治疗，旨在通过训练补偿策略和使用残余语言技能来优化信息传递。本研究检验了 CLT 在中风后早期阶段比沟通治疗更有效的假设。 方法 在这项采用盲法结果评估的多中心、随机、平行组试验中，纳入了 80 名中风后 3 周内患有中风后失语症的患者。患者接受了 6 个月的 CLT，包括语义和/或语音训练，或每周至少 2 小时的沟通治疗。他们在治疗前以及治疗后 3 个月和 6 个月时通过阿姆斯特丹-奈梅亨日常语言测试（ANELT-A，主要结果）以及语义和语音测试（次要结果）进行评估。通过协方差分析评估干预效果，并调整基线评分。 结果 CLT组（n=38）和沟通治疗组（n-42）的平均ANELT-A评分在3个月（调整差值1.5，95% CI -2.6至5.6）或6个月（调整差值1.6，95% CI -2.3至5.6）时没有差异。中风后。在六项特定语义和语音测试中的两项，平均得分显着差异，均支持 CLT。 结论 这项研究并没有证实这样的假设：与一般的非特异性沟通治疗相比，中风后失语症患者从旨在激活潜在语义和语音过程的 CLT 中获益更多（ISRCTN67723958 当前对照试验）。
Background The two main approaches in aphasia treatment are cognitive-linguistic treatment (CLT), aimed at restoring the linguistic levels affected, semantics, phonology or syntax, and communicative treatment, aimed at optimising information transfer by training compensatory strategies and use of residual language skills. The hypothesis that CLT is more effective than communicative treatment in the early stages after stroke was tested in this study.Methods In this multicentre, randomised, parallel group trial with blinded outcome assessment, 80 patients with aphasia after stroke were included within 3 weeks post-stroke. Patients received 6 months of CLT, comprising semantic and/or phonological training, or communicative treatment for at least 2 h per week. They were assessed before treatment and at 3 and 6 months with the Amsterdam-Nijmegen Everyday Language Test (ANELT-A, primary outcome) and semantic and phonological tests (secondary outcomes). The intervention effect was evaluated by means of analysis of covariance, with adjustment for baseline scores.Results There was no difference between the mean ANELT-A score of the CLT group (n=38) and the communicative treatment group (n-42), at 3 months (adjusted difference 1.5, 95% CI -2.6 to 5.6) or at 6 months (adjusted difference 1.6, 95% CI -2.3 to 5.6) post-stroke. On two of six specific semantic and phonological tests, the mean scores differed significantly, both in favour of CLT.Conclusion This study does not confirm the hypothesis that patients with aphasia after stroke benefit more from CLT, aimed at activation of the underlying semantic and phonologic processes, than from general, non-specific communicative treatment (ISRCTN67723958 Current Controlled Trials).