Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions

Aphasia is an acquired language disorder that typically occurs as a result of a stroke. People with aphasia experience communication difficulties and risk secondary impacts, for example, affecting social and work life and mental health. Intensive Comprehensive Aphasia Programmes (ICAPs) aims to address the multiple consequences of aphasia using intensive intervention and a wide range of therapy approaches. Although basic parameters of ICAP intervention have been defined, a fuller characterisation is needed. This systematic scoping review aimed to determine what constitutes an ICAP. Peer-reviewed and Grey databases were searched for articles on ICAPs using Joanna Brigg’s Institute methodology. Data was extracted following the Template for Intervention Description and Replication (TIDieR) checklist for reporting interventions and synthesised using a narrative synthesis. 17 ICAPs were reported in 20 peer-reviewed literature sources (9 ICAPs supplemented by Grey literature sources). There were high degrees of variation in dose, professionals involved, and no qualitative data from participants. Of note, ICAP intervention was highly tailored to individual participants on the same ICAP, and intervention content varied between ICAPs. ICAPs appear to be rationalised as intensive impairment-based programmes with other components added for comprehensiveness. Stronger rationale and a logic model are required to justify the core components of ICAPs. The input of stakeholders into designing future ICAP interventions is recommended.IMPLICATIONS FOR REHABILITATIONThe ICAP model is in its infancy when it comes to mainstream clinical application as only the intensity component of the ICAP has clear theoretical underpinning as reported in the peer-reviewed literature.There have been clinical uptakes of the ICAP model which is likely to continue and is valid in the context of an under-researched area of aphasia therapy and on a background of a less than perfect relationship between evidence base and practice.Aspects of the ICAP model are valid for clinicians to implement, for example, intensive evidence-based aphasia therapy in combination with therapy which addresses some of the broader implications of aphasia, for example, social isolation.Clinicians can use the ICAP model to review their existing service provision and explore whether their service provides aphasia therapy that addresses the multiple aspects of aphasia (i.e., ensuring the focus is not only on impairment-based therapy). The ICAP model is in its infancy when it comes to mainstream clinical application as only the intensity component of the ICAP has clear theoretical underpinning as reported in the peer-reviewed literature. There have been clinical uptakes of the ICAP model which is likely to continue and is valid in the context of an under-researched area of aphasia therapy and on a background of a less than perfect relationship between evidence base and practice. Aspects of the ICAP model are valid for clinicians to implement, for example, intensive evidence-based aphasia therapy in combination with therapy which addresses some of the broader implications of aphasia, for example, social isolation. Clinicians can use the ICAP model to review their existing service provision and explore whether their service provides aphasia therapy that addresses the multiple aspects of aphasia (i.e., ensuring the focus is not only on impairment-based therapy).

失语症（Aphasia）是一种后天获得性语言障碍，通常由脑卒中引发。失语症患者会出现沟通困难，并面临继发不良影响，例如对社交、工作生活及心理健康造成损害。强化综合失语症项目（Intensive Comprehensive Aphasia Programmes, ICAPs）旨在通过强化干预与多样化治疗手段，应对失语症带来的多维度影响。尽管ICAP干预的基本参数已得到界定，但仍需对其进行更全面的特征刻画。本系统范围综述旨在明确ICAP的核心内涵。研究采用乔安娜·布里格斯研究所（Joanna Briggs’s Institute）方法学，对同行评审文献及灰色文献数据库中有关ICAPs的研究进行检索。依据干预描述与复制模板（Template for Intervention Description and Replication, TIDieR）报告清单提取数据，并采用叙事综合法进行分析整合。17项ICAP相关研究被纳入20篇同行评审文献（其中9项ICAP辅以灰色文献来源）。研究发现，干预剂量、参与专业人员均存在较大差异，且缺乏来自参与者的质性数据。值得注意的是，即便在同一ICAP框架下，干预方案也会高度个体化，且不同ICAP的干预内容也存在显著差异。现有研究将ICAP归类为以损伤为基础的强化项目，并额外添加其他组件以实现综合性。但仍需更充分的理论依据与逻辑模型，来论证ICAP核心组件的合理性。研究建议应吸纳利益相关方参与未来ICAP干预方案的设计。康复实践启示：就主流临床应用而言，ICAP模型尚处于起步阶段——正如同行评审文献所述，目前仅ICAP的强度维度具备明确的理论支撑。已有临床机构开始采用ICAP模型，且该趋势有望持续；鉴于失语症治疗领域研究尚欠充分，且现有证据基础与临床实践之间的关联仍存在不足，该模型的应用具备合理性。ICAP模型的部分内容可供临床医师落地实施，例如将基于证据的强化失语症治疗，与针对失语症所引发的更广泛影响（如社交孤立）的治疗相结合。临床医师可借助ICAP模型审视现有服务提供情况，判断其是否开展了覆盖失语症多维度的治疗（即确保治疗不仅局限于损伤层面的干预）。ICAP模型尚处于起步阶段，就主流临床应用而言，目前仅ICAP的强度维度具备明确的理论支撑（如同行评审文献所述）。已有临床机构开始采用ICAP模型，且该趋势有望持续；鉴于失语症治疗领域研究尚欠充分，且现有证据基础与临床实践之间的关联仍存在不足，该模型的应用具备合理性。ICAP模型的部分内容可供临床医师落地实施，例如将基于证据的强化失语症治疗，与针对失语症所引发的更广泛影响（如社交孤立）的治疗相结合。临床医师可借助ICAP模型审视现有服务提供情况，判断其是否开展了覆盖失语症多维度的治疗（即确保治疗不仅局限于损伤层面的干预）。