The Methodological Quality of Short-Term/Working Memory Treatments in Poststroke Aphasia: A Systematic Review

J Speech Lang Hear Res. 2019 Jun 19;62(6):1979-2001. doi: 10.1044/2018_JSLHR-L-18-0057. Epub 2019 May 21.

Abstract

Purpose The aims of this systematic review are to provide a critical overview of short-term memory (STM) and working memory (WM) treatments in stroke aphasia and to systematically evaluate the internal and external validity of STM/WM treatments. Method A systematic search was conducted in February 2014 and then updated in December 2016 using 13 electronic databases. We provided descriptive characteristics of the included studies and assessed their methodological quality using the Risk of Bias in N-of-1 Trials quantitative scale ( Tate et al., 2015 ), which was completed by 2 independent raters. Results The systematic search and inclusion/exclusion procedure yielded 17 single-case or case-series studies with 37 participants for inclusion. Nine studies targeted auditory STM consisting of repetition and/or recognition tasks, whereas 8 targeted attention and WM, such as attention process training including n-back tasks with shapes and clock faces as well as mental math tasks. In terms of their methodological quality, quality scores on the Risk of Bias in N-of-1 Trials scale ranged from 4 to 17 ( M = 9.5) on a 0-30 scale, indicating a high risk of bias in the reviewed studies. Effects of treatment were most frequently assessed on STM, WM, and spoken language comprehension. Transfer effects on communication and memory in activities of daily living were tested in only 5 studies. Conclusions Methodological limitations of the reviewed studies make it difficult, at present, to draw firm conclusions about the effects of STM/WM treatments in poststroke aphasia. Further studies with more rigorous methodology and stronger experimental control are needed to determine the beneficial effects of this type of intervention. To understand the underlying mechanisms of STM/WM treatment effects and how they relate to language functioning, a careful choice of outcome measures and specific hypotheses about potential improvements on these measures are required. Future studies need to include outcome measures of memory functioning in everyday life and psychosocial functioning more generally to demonstrate the ecological validity of STM and WM treatments.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aphasia / etiology
  • Aphasia / therapy*
  • Female
  • Humans
  • Language Therapy / methods
  • Language Therapy / standards*
  • Male
  • Memory, Short-Term
  • Middle Aged
  • Quality of Health Care*
  • Stroke / psychology*
  • Stroke Rehabilitation / methods
  • Stroke Rehabilitation / standards*
  • Treatment Outcome