Article

OBJECTIVES: To conduct a systematic review to elucidate the frequency, recovery,
and associated outcomes for poststroke aphasia over the long-term. DATA SOURCES:
Using the Cochrane Stroke Strategy, we searched 10 databases, 13 journals, 3
conferences, and the gray literature. STUDY SELECTION: Our 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 EXTRACTION: We documented aphasia frequencies by stroke type and
setting, and computed odds ratios (ORs) with their 95% confidence intervals (CIs)
for outcomes. DATA SYNTHESIS: We retrieved 2168 citations, reviewed 248 articles,
and accepted 50. Median frequencies for mixed stroke (ischemic and hemorrhagic)
were 30% and 34% 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 the hospital was </=3 hours from
stroke onset. Articles monitoring aphasia for 1 year demonstrated aphasia
frequencies 2% to 12% lower than baseline. Negative outcomes associated with
aphasia included greater odds of in-hospital death (OR=2.7; 95% CI, 2.4-3.1) and
longer mean length of stay in days (mean=1.6; 95% CI, 1.0-2.3) in acute settings.
Patients with aphasia had greater disability from 28 days (OR=1.5; 95% CI,
1.3-1.7) to 2 years (OR=1.7; 95% CI, 1.6-2.0) than those without aphasia. By 2
years, they used more rehabilitation services (OR=1.5; 95% CI, 1.3-1.6) and
returned home less frequently (OR=1.4; 95% CI, 1.2-1.7). CONCLUSIONS: Reported
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.
CI - Copyright A(c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS