Scott & Caird (1983)

 

EBP THERAPY ANALYSIS

For Group Designs

 

SOURCE:  Scott, S., & Caird, F.  (1983).  The speech therapy for Parkinson’s disease to speech therapy.  Journal of Neurology, Neurosurgery, and Psychiatry, 46, 140-144.

 

REVIEWER(S):  pmh

 

DATE: 7.06.12          ASSIGNED  GRADE FOR OVERALL QUALITY:  B

 

TAKE AWAY:  moderate support for short term therapy (1 hour per day; 5 days a week; 2 weeks) resulting in improved prosody.  The degree of change does not persist over 3 months but the group that received both types of therapy (and extended time) was significantly better for some measures.

 

1.  What type of evidence was identified?                              

a.  What was the type of design? Prospective, Randomized Group Design with Controls

b.  What was the level of support associated with the type of evidence?  A           

                                                                                                           

2.  How was group membership determined?                      

If there were groups, were participants randomly assigned to groups?  Yes

3.  Was administration of intervention status concealed? 

a.  from participants?  No  

b.  from clinicians?  No      

c.  from analyzers?  Varies; yes for Outcome #3; for Outcomes #2, 4 raters were aware of status; for Outcome #1, one rater was aware and the other was  unaware

 

4.  Were the groups adequately described?  Yes

a.         How many participants were involved in the study?

•  total # of participants:  26

•  # of groups:  2

•  # of participants in each group:  Group A =  13, Group B = 13

b.  The following variables actively controlled (i.e., inclusion/exclusion criteria) or described:              

•  age:  mean 66 both groups (described)

•  gender:  Grp A = 7m, 8f; Grp B =  11m, 2f (described)

•  cognitive skills:  WNL (controlled)

•  history of stroke:  none (controlled)              

•  duration of PD: Grp A-13 years; Grp B-10 years (described)

•  drugs:  all Ps were receiving a variety of drugs  and prescriptions were not likely to be changed  during intervention (described)

•  hearing:  WNL (controlled)

•  cooperativeness:  all likely to cooperate (controlled)

c.  Were the groups similar before intervention began?  No.  The data were       

not subjected to statistical analysis but physician’s intelligibility ratings (visual analogue) differed.  Group B was worse.

d.  Were the communication problems adequately described?  Yes

List:  Parkinson’s disease         

                                                   

5.  Was membership in groups maintained throughout the study?

                                                                                                             

a.  Did each of the groups maintain at least 80% of their original members?  No.  Group A maintained only 77% from post test to follow up due to death or stroke

b.  Were data from outliers removed from the study?  No

 

6.  Were the groups controlled acceptably?

a.  Was there a no intervention group?  No

b.  Was there a foil intervention group?  No

c.  Was there a comparison group?  Yes

d.  Was the time involved in the comparison and the target groups constant?  Varies.  Yes, for the 1st posttest.  After 1st post test Group B received 1 week of Vocalite therapy.  Therefore, if using the 3 month follow-up outcomes, the answer is No.

 

7.  Were the outcomes measure appropriate and meaningful?Yes

a.  Outcome(s) (dependent variable):

1.  Prosodic abnormality score

2.  Intelligibility rating by SLPs

3.  Intelligibility rating by physicians (visual analogue)

4.  Family members’ ratings of communication

b.  Which the outcomes measure are subjective?  All           

c.  Which the outcome measures are  objective?  None        

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  Yes for Outcome #1 only; there was 85% agreement.  Agreements = +/- 1 point

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinicians?  No

 

9.  What were the results of the statistical (inferential) testing? 

a.  List significant differences:

•  Groups A and B saw significant improvement in prosody abnormality and clinician intelligibility rating from pretest to posttest1.

•  Group B had a significant improvement in physician intelligibility at posttest1 but they were worse at initiation of therapy.

•  family ratings were not subjected to significance testing.

•  differences between groups A and B were not statistically analyzed.

•  NOTE:  relatively small numbers in the groups.

b.  What were the p values?

•  Using student t-test the values from pretest to posttest were

Pretest to Posttest #1 (first # is for Group A; second is for Group B)

OUTCOME #1= 0.001, 0.005

OUTCOME #2= 0.024, 0.05

OUTCOME #3= NS, 0.025

Pretest to Follow Up (first # is for Group A; second is for Group B)

OUTCOME #1= NS, 0.01

OUTCOME #2= NS, 0.05

OUTCOME #3= NS, NS

c.  Were confidence intervals (CI) provided?  No

                                                                   

10.  What is the clinical effect?  (i.e., EBP measures)  Not provided

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___B____

 

NOTE:  This research included a 3 month follow-up.   The authors did not develop this point but only Group B (the group that had received an extra week of therapy) maintained gains in some behaviors.  This suggests that longer term interventions may be of benefit—not immediate but to insure maintenance.  Descriptive analysis suggested that more severely involved Ps would benefit from visual feedback intervention (Vocalite).  Also, all Ps who died before the follow-up assessment had not benefited from the interventions.

SUMMARY OF INTERVENTION FOR SCOTT AND CAIRD (1983)

PURPOSE:  investigate the effectiveness of speech on the prosody of speakers with Parkinson’s disease

POPULATION:  adults withParkinson’s disease

MODALITY:  expressive

ELEMENTS OF PROSODY TARGETED (Dependent variable):  abnormality rating

OTHER ASPECTS OF LANGUAGE TARGETED (Dependent variable):  intelligibility rating by SLPs; intelligibility ratings by physicians (visual analogue)

OTHER TARGETS:  family  members perception of communication

DOSAGE:  5 one-hour sessions per week in P’s home for 2 weeks.  The group that did not use the Vocalite during the 2 weeks of therapy also received an additional one week of therapy with the Vocalite.  \ During the 2 weeks, both groups also participated in 5 one-hour group therapy sessions for a week.

ADMINISTRATOR:  SLP

STIMULI:  visual feedback (Vocalite:  P receives feedback about selected prosodic measures using this voice activated light source), auditory feedback and stimuli

GOAL ATTACK STRATEGY:  not clear

MAJOR COMPONENTS: 

•  based on the work of  Halliday  –Halliday, M. A. K.  (1970). A course in spoken English: Intonation. London: Oxford University Press.  (See pages 73-118 for a more thorough description of these “prosodic exercises.”)

•  techniques:  self monitoring, “practice”

•  C worked with P to develop awareness of his/her prosodic problems

•  P practiced producing typical prosodic patterns found in conversation.

DEPENDENT VARIABLE(S)/OUTCOME(S):

1.  Prosodic abnormality score

2.  Intelligibility rating by SLPs

3.  Intelligibility rating by physicians (visual analogue)

4.  Family members’ ratings of communication

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