The "I" in ICAPs: examining treatment intensity under the microscope

BackgroundIntensive Comprehensive Aphasia Programs (ICAPs) provide high doses of treatment over short periods. Treatment intensity in post-stroke aphasia rehabilitation and research is not well understood and is typically underspecified, including within ICAPs and modified Intensive Comprehensive Aphasia Programs (mICAPs), in which intensity is a fundamental design component. One recently developed model of treatment conceptualisation, the Multidimensional Dose Articulation Framework (MDAF), may offer a systematic, comprehensive, and granular method of characterising treatment intensity, though this framework has not yet been used to capture elements of intensity and dose during an ICAP or mICAP.AimsThe purpose of this paper is to examine and describe increasingly specific details of treatment intensity for both an ICAP and mICAP delivered at the University of Montana (UMT).Methods & ProceduresFourteen participants with aphasia attended an 84-hour ICAP (n = 8) or a 24-hour mICAP (n = 6) delivered by graduate student clinicians at UMT. Ethics approval was obtained from the UMT IRB (#13-23). We examined intensity and dose using components of the MDAF including broad temporal parameters, and episode-specific length and intensity. Descriptive statistics were used to report group-level, participant-level, and treatment-level parameters.Outcomes & ResultsIn this descriptive manuscript, we use a series of vignettes to report temporal parameters from the MDAF including treatment duration, days, sessions, and session density, and episode-level characteristics including episode length and episode intensity. Vignette one examines ICAP and mICAP planned versus actual temporal parameters. Vignette two describes episode-level detail across two evidence-based treatments administered during the ICAP. Vignette three details differences in delivery of a single treatment approach between two participants. In each vignette, we discuss the benefits and challenges of tracking treatment intensity with fine detail.ConclusionsComprehensive specification of dose and intensity parameters is essential to compare efficacious treatment programs and to understand variability in treatment response across individuals with aphasia. The MDAF is a promising tool, though detailed treatment intensity remains a challenging construct to measure, particularly at the level of the episode. Clinical researchers interested in dose and intensity and authors of evidence-based therapy approaches must continue to work to define and describe active ingredients within therapy approaches.