Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)
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Introduction: One third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial. Methods and patients: Stroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test. Results: Of the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [−2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either. Conclusion: Four weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.
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A negative group-randomised RCT in early post-stroke aphasic patients (n=80) could have failed due to low dose (median 25 h over 4 weeks), despite the authors assuming it reflected early timing.
“A negative, group-randomised RCT in early post-stroke aphasic patients (n = 80) was assumed by the authors to reflect the early timing of therapy but could clearly have failed due to low dose (median dose = 25 h over 4 weeks) [18].”
From Aphasia Recovery: When, How and Who to Treat? (2018) · cites this paper as [18]
VERSE provides compelling evidence to challenge the intensive mindset in early stroke language and communication recovery.
“Together, these trials3–6 provide compelling evidence to challenge the ‘intensive’ mindset in early stroke language and communication recovery.”
From A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study (2021) · cites this paper as [3]
RATS-3 demonstrated no benefit of early therapy consisting of 24.5 h over four weeks when compared to no therapy in the first month, measured at 4, 12, and 26 weeks post stroke.
“The more recent RATS-3 trial 3 (N = 153) demonstrated no benefit of early therapy consisting of 24.5 h over four weeks (6.1 h per week) when compared to no therapy in the first month, measured at 4, 12, and 26 weeks post stroke.”
From A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study (2021) · cites this paper as [3]
RATS-3 suggested that early intervention is no better than starting therapy after the first month post stroke.
“the most recent study (Rotterdam Aphasia Therapy Study-3 (RATS-3)) 3 suggested that early intervention is no better than starting therapy after the first month post stroke.”
From A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study (2021) · cites this paper as [3]
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References 27 · Cited by 57
- Authors
- Nouwens, F., de Lau, L. M. L., Visch-Brink, E. G., van de Sandt-Koenderman, W. M. E. (., Lingsma, H. F., Goosen, S., Blom, D. M. J., Koudstaal, P. J., & Dippel, D. W. J.
- Affiliations
- Erasmus MC (NL)
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands 1
- Research Department, Rijndam Rehabilitation, The Netherlands 3
- Amphia Ziekenhuis (NL)
- Revant (Netherlands) (NL)
- Corresponding author
- Nouwens, Femke
- Venue
- European Stroke Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-06-01
- Volume
- 2
- Issue
- 2
- Pages
- 126-136
- ISSN
- 2396-9873 (ISSN-L)
- 2396-9881
- PMC
- PMC5992741
- OpenAlex
- W2594488045
- Cited by
- 57
- References
- 27
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 8 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 1
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Stroke Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by-nc)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
- Keywords
- post-stroke aphasia, treatment timing, speech therapy, everyday language, stroke rehabilitation, treatment efficacy
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