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This review aims to evaluate how well word- and sentence-level interventions for poststroke aphasia generalize to dialogue contexts.

March 28, 2026

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Do Word- and Sentence-Level Treatments Generalize to Dialogue? A Systematic Review and Synthesis of the Evidence in Poststroke Aphasia Interventions

KSKristina SchultzLa Trobe University CLChelsea S. LarkmanLa Trobe University MRMiranda L. RoseLa Trobe University

Key Points

This review aims to evaluate how well word- and sentence-level interventions for poststroke aphasia generalize to dialogue contexts.
Conducted a systematic review across six electronic databases up to September 2023.
Identified 2,906 studies, with 33 meeting the inclusion criteria for analysis.
Performed a descriptive synthesis due to heterogeneity of studies, rather than meta-analysis.
55% of studies focused on word-level treatment, 21% on sentence-level, and 24% on mixed approaches.
Only 27% of studies reported treatment ingredients aimed at promoting generalization.
111 different dialogue measures were identified, with lexical measures being the most common (38%).

Abstract

Purpose: This systematic review aimed to synthesize evidence related to the effects of word- and/or sentence-level poststroke aphasia interventions on dialogue. Method: Six electronic databases were searched up to September 13, 2023. A total of 2,906 studies were identified, 33 of which met inclusion criteria. Risk of bias assessment was completed using appraisal tools according to study design. The studies were not sufficiently homogeneous for meta-analysis; therefore, descriptive synthesis was completed. Results: Treatment targeted the word level (55%), sentence level (21%), and mixed word and sentence levels (24%). Few studies (27%) explicitly reported treatment ingredients hypothesized to facilitate generalization. Methodological quality was variable. There was considerable variability in the range of methods used for the collection and analysis of dialogue data. A total of 111 different dialogue measures were identified, with lexical measures being the most common (38%), followed by structural (17%), informativeness (18%), and interaction (21%). Psychometric data for the dialogue measures were rarely reported. Generalization to dialogue was more likely demonstrated by structural or informativeness measures. Conclusions: Generalization from word- and sentence-level interventions to dialogue is evident, but infrequent. This may reflect underspecification of treatment ingredients to facilitate generalization, low treatment dose, poor sensitivity of dialogue measures to generalization, or lack of psychometrically sound dialogue measures. Although lexical measures of dialogue were most prevalent, structural or informativeness measures may be more sensitive to change in dialogue following word- and/or sentence-level aphasia interventions. Implications for supporting generalization to dialogue are discussed. Supplemental Material: https://doi.org/10.23641/asha.31448701

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Do Word- and Sentence-Level Treatments Generalize to Dialogue? A Systematic Review and Synthesis of the Evidence in Poststroke Aphasia Interventions

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