The news that one of the Hollywood superstars was diagnosed the aphasia drew everyone’sattention on the causes and effects of such disease. According to the medical statistics in the USA,approximately one-third of stroke survivors suffer from impaired communication abilities, and 30%– 42% of these patients have longstanding symptoms of aphasia, and the most common, Broca’saphasia, is caused by lesions on anterior brain regions, which often require long-term care, leading tosubstantial economic and mental health burdens on the family and society.
       Community medical resources have confirmed that promoting full engagement withrehabilitation treatment for post-stroke patients has reduced the disability rate below 40% andincreased activities of daily living by 35%. In addition, intensive speech and language therapy (SLT)improves the functional reorganization of the central nervous system； however, high-intensity andhigh-dose interventions may not be acceptable to all patients. Therefore, other treatments adjunct toSLT might be useful. More specifically, while intensive SLT is effective, recent evidence suggeststhat scalp acupuncture therapy (SAT) may have beneficial effects on comprehension, oral expression,repetition, denomination, reading and writing in postapoplectic aphasia (Tang, Tang, & Yang, 2019).One research group from Taiwan (Liu, Huang, Xu, Wu, Tao, & Chen, 2021) tried to appraise the costeffectiveness of combining SAT with SLT community patients with Broca’s aphasia after stroke, compared to SLT alone. They found that combination therapy was cost-effective and reduced the useof non-standard treatments and medications, leading to lower direct non-medical costs and self-paidexpenses.
       In Liu et al.’s (2021) research, a within-trial cost-effectiveness analysis was applied among 203participants with Broca’s aphasia after stroke who had been randomly assigned to receive scalpacupuncture with SLT (intervention) or SLT alone (control). Both groups underwent SLT, whichroughly last 30 minutes each day, 5 days a week for 4 weeks； while the intervention groupsimultaneously received scalp acupuncture. Moreover, outcomes were measured using informalassessments and self-report questionnaires and the incremental cost-effectiveness ratios (ICERs) werecalculated as a measure of the additional costs necessary to achieve greater treatment outcomes. Theresults of this economic analysis revealed that patients receiving combination therapy reduced theiruse of non-standard treatment interventions and medications, reflected in reduced direct non-medicalcosts and self-paid expenses. Combination therapy was less costly than SLT alone calculatedaccording to the modified intention-to-treat principle. In other words, SAT is a cost-effectivetreatment option for patients with Broca’s aphasia after stroke, compared to SLT alone.
       In short, the study, which included the first economic evaluation of acupuncture treatment inpatients with Broca’s aphasia after stroke, had valuable findings and methodological limitations.There are only a few studies on acupuncture treatment in patients with Broca’s aphasia after stroke,Liu et al. (2021) concluded that acupuncture seems to be effective in improving post-stroke aphasia,functional communication and language function, and the best curative effect was achieved with thecombination of acupuncture with speech and language training. Potential limitations included lack ofblinding, variability of treatment regimens, and a heterogeneous patient sample. While SAT appearsto be an effective treatment for post-stroke aphasia, the real-world implementation of SAT in lowincome and middle-income countries and regions may be restricted by poor acupuncture services,inefficient systems, and a deficiency of therapists. Standardized education and training for the public,community physicians, and government agencies are needed to improve awareness of the benefitsand cost-effectiveness of SAT. Still, although the effects of acupuncture appear to be persistent as thedifferences between the groups were slightly larger after 12 weeks follow-up investigation than thosewho received immediately post-treatment, long-lasting health economic effects require further study.
【題組】46. Which of the following is NOT a methodological limitation of the study?
(A) Heterogeneous patient sample
(B) Variability of treatment regimens
(C) Bias due to the treatment for each group was blinded
(D) Long-term health economic effects