JMIR Publications

ABSTRACT

Background:

Although the efficacy of high dose speech-language therapy (SLT) for individuals with post-stroke aphasia has been established in the literature, there is a gap in translating these research findings to clinical practice. As a result, patients are continuing to receive suboptimal amounts of SLT, with negative consequences for their recovery of functional communication. Recent research has identified self-managed digital health technology as one way to close the dosage gap by enabling high intensity therapy unrestricted by clinician availability or other practical constraints. However, there is limited empirical evidence available to rehabilitation professionals to guide dose prescriptions for self-managed SLT despite their increasing use in the COVID-19 era and likely beyond.

Objective:

The current study leverages real-world mobile health data to investigate the effects of varied dose frequency on performance outcomes for individuals with post-stroke speech, language and/or cognitive deficits following a 10 week period of self-managed treatment via a commercially available digital health platform.

Methods:

Anonymized data from 2,249 post-stroke survivors who used the Constant Therapy application between late 2016 - 2019 were analyzed. Data included therapy tasks spanning 13 different language and cognitive skill domains. For each patient, weekly therapy dosage was calculated based on the median number of days per week of app usage over the 10 week therapy period, binned into groups of 1, 2, 3, 4, or 5+ days/week. Linear mixed-effects models (LMMs) were run to examine change in performance over time as a function of dosage group, with post-hoc comparisons of slopes to evaluate the performance gain associated with each additional day of practice.

Results:

Across all skill domains, LMM results showed that performance improvement was significantly greater for patients who practiced 2 (β = 0.001, t = 2.37, P = .02), 3 (β = 0.003, t = 5.21, P < .001), 4 (β = 0.005, t = 7.82, P < .001), or 5+ (β = 0.005, t = 8.14, P < .001) days per week compared to one day per week only. Post-hoc comparisons confirmed an incremental dosage effect accumulating with each day of practice (i.e., 1 v. 2, 2 v. 3, 3 v. 4), apart from 4 versus 5+ days per week of practice. The result of greater improvement for higher versus lower dosage frequency groups was true not only across all domains, but also within a majority of individual subdomains.

Conclusions:

Study findings demonstrated that increased dosage frequency is associated with greater therapy gains over a 10 week treatment period of self-managed digital therapy. The use of real-world data maximizes the ecological validity of study results and makes findings more generalizable to clinical settings. The study represents an important step toward the development of optimal dose recommendations for self-managed SLT.