Building clinically meaningful and implementable interventions for persons with primary progressive aphasia and their communication partners: Lessons from the Communication Bridge Trials
Bibliographic record
Abstract
BACKGROUND: Primary progressive aphasia (PPA) is a currently incurable language-based neurodegenerative dementia syndrome, which negatively impacts communication and quality of life. The Communication Bridge-2 (CB2) trial was the first international telemedicine speech-language (RCT) to show efficacy for persons with PPA. Despite the promising results of the CB2 trial, translating these findings into routine clinical practice poses an urgent and significant challenge. Primary, secondary, and stakeholder data were used to assess readiness for pragmatic randomized controlled trials and implementation. METHOD: CB2 was an internationally enrolling, single enrollment site, Phase 2, Stage 2, parallel-group, active control, behavioral RCT delivered via video-chat to individuals with PPA and their communication partners. Participation was ∼12 months. A custom web application supported CB2 delivery. Post-study interviews (PSI) conducted with the dyad and a research clinician blinded to intervention arm captured participant experiences and informed Readiness Assessment for Pragmatic Trials (RAPT) ratings. Outcomes were compared between arms qualitatively and using the cumulative logit link in which groups were compared using proportional odds at each evaluation. RESULT: Ninety-five PPA participant dyads (mean enrollment age of PPA participants: 67.1 years, 48% female) were randomized (n = 4 countries). Dropout was <10%. PSI assessed the dyad-perceived impact of the intervention on everyday life and provided data regarding the feasibility and acceptability of the intervention, aligned with the RAPT model. Reports were positive for both arms; however, responses favored the Experimental arm for positive changes in communication in daily activities (Odds Ratio (OR):2.9, p = 0.073), positive changes in emotional wellbeing (OR:1.4, p = 0.47), overall helpfulness of the speech therapy intervention (OR:4.4, p = 0.083), and reached between group significance in meeting overall expectations of the intervention (OR:5.4, p = 0.005). Participants in both groups showed high usage and feasibility in using the home exercise app. CONCLUSION: Improving outcomes for PPA, Alzheimer's disease, and Related Dementias (ADRD) requires ensuring that evidence-based interventions are accessible, scalable, and integrated into real-world settings. Evidence from CB2 and stakeholder feedback indicates the intervention is on a strong path towards implementation. These data provide a model for developing future ADRD non-pharmacologic interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.163 | 0.222 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.004 | 0.006 |
| Research integrity | 0.006 | 0.008 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".