The “I” in ICAPs: examining treatment intensity under the microscope

Background: Intensive 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. Aims: The 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 & Procedures: Fourteen 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 & Results: In 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. Conclusions: Comprehensive 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.