How fatiguing is high intensity treatment for people with aphasia? An analysis of 140 participants from the compare trial.

Abstract

Background and Objectives: The evidence base for high intensity interventions for aphasia continues to grow. However, participant withdrawal rates are typically greater in high intensity interventions Participant fatigue is presumed to be one explanation for withdrawals. A small amount of data has identified that clinicians believe participant fatigue to be a significant challenge in providing intensive intervention and there are reports of withdrawals due to fatigue (Gunning et al., 2016). Some high intensity programs specify adequate 'stamina' to complete the treatment as an inclusion criterion (Rose et al. 2021). However, there is a lack of direct data on fatigue levels of people with aphasia during high intensity interventions. Patterns of fatigue across interventions are important to guide dose schedules and allow more evidence-based criteria for programs. We aim to examine three hypotheses relating to fatigue during high intensity therapy: 1. Self-reported fatigue will increase from start to the end of each therapy day 2. The magnitude of daily change in self-reported fatigue will increase across the intervention 3. Self-reported fatigue at the start of the day will increase overall across the intervention Method: We will analyse data from the completed COMPARE trial, a three arm randomised control trial of two high intensity interventions for chronic aphasia. Of the 216 participants recruited, 146 were randomised to an intervention arm. Six withdrew prior to intervention and thus, data from 140 participants who commenced 30 hours of intervention over two weeks was collected. Participants completed a fatigue scale at the beginning and end of each therapy day. Linear Mixed Models will be used to investigate the impact of intervention time on self-reported fatigue. Withdrawals from intervention will also be examined Results: The completed analysis of the COMPARE data will provide evidence from a large cohort of people with chronic aphasia (n=140) who were scheduled to receive three hours of treatment per day for ten consecutive business days. Patterns of fatigue over time and withdrawals will be demonstrated Conclusion(s): Fatigue is an important consideration for high intensity intervention and could be a barrier to participation for some people with aphasia. Our analysis provides large scale data on fatigue over time which will inform future therapy design and patient inclusion criteria.