McDonald et al. (2012)

EBP THERAPY ANALYSIS

Comparing Treatment of Groups

 

SOURCE:  McDonald, S. , Togher, L., Tate, R., Randall, R., English, T., & Gowland, A (2012). A randomised controlled trial evaluating a brief intervention for deficits in recognising emotional prosody following severe ABI. Neuropsychological Rehabilitation: An International Journal DOI:10.1080/09602011.2012.751340

REVIEWER(S):  pmh

 

DATE:  3.03.13

ASSIGNED GRADE FOR OVERALL QUALITY:  B-

 

TAKE AWAY:  Fair to weak support for the effectiveness of this promising program to treat comprehension of affective prosody problems in speakers with non-progressive brain injury (traumatic brain injury, cerebral vascular accident, medical injury). This is the first investigation that I have found that provides empirical research to support the effectiveness of treating the comprehension of affective prosody. The limited effectiveness of the program may have been associated with the small number of patients and the small dosage.

 

1.  What type of evidence was identified?

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

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

                                                                                                           

2.  Group membership determination:

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

b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers?  varies, judges for post-intervention assessments were  unaware of status of Ps.

                                                                    

4.  Were the groups adequately described?  Yes

a.         How many participants were involved in the study?

•  total # of participant:  20

•  # of groups:  2

•  # of participants in each group:  10

•  List names of groups:  Treatment group (T), Waitlist group (W)

b.  Inclusion/exclusion criteria:

Inclusion criteria

•  severe chronic acquired nonprogressive brain injury

•  chronic social isolation or awkward social interactions or inattention to regard social cues or inappropriate social responses.

Exclusion criteria

•  recent episodes of depression or psychosis  or

•  low scores on estimates of premorbid cognitive functioning or

•  if comprehension of comprehension of affect was less than 1 standard deviation below the mean or

•   if onset was less than 9 months prior to initiation of the investigation

–  The authors following characteristics of the Ps:                               

•  age:  mean 45.62

•  gender:  15m, 5f

•  nationality:  Austrailian

•  estimated mean premorbid IQ:  T = 110.40; C = 104.60

•  time since injury:  mean 9.41

•  duration of post injury amnesia:  mean 54.53 (for Ps with TBI)

•  results of brain imaging:  varied

•  educational level of clients:  mean years of education 13.38

•  etiology:  16 Ps traumatic brain injury (TBI); 3 Ps cerebrovascular accident (CVA); 1 P medical mishap

c.   Were the groups similar before intervention began?  Yes.  There were significant differences in pre-intervention score for T and W for only all subtests of the Depression Anxiety Stress Scale (DASS).  T’s DASS scores were significantly higher and the T group perceived their communication skills to be higher than the C group.

d.  Were the communication problems adequately described?  Yes

•  disorder type:  Impaired perception of emotion

 

5.  Was membership in groups maintained throughout the study?

                                                                                                             

a.  Did each of the groups maintain at least 80% of their original members?  Yes

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

 

6.   Were the groups controlled acceptably?

a.  Was there a no intervention group?  Yes.  The no intervention group was waitlisted.

b.  Was there a foil intervention group? No

c.  Was there a comparison group?  No

d.  Was the time involved in the foil/comparison and the target groups constant? Not applicable

 

7.  Were the outcomes measure appropriate and meaningful?

a.  The outcomes were

•  OUTCOME #1:  Improved performance on an audio only presentation of  The Awareness of Social Inference Test (TASIT) B Part 1

•  OUTCOME #2:  Increase percentage of accuracy on  Prosody Test

•  OUTCOME #3:  Decreased reaction time on the Prosody Test

•  OUTCOME #4:  Improved rating of intensity of prosody on the Prosody Test

•  OUTCOME #5:  P’s improved perception of P’s communication skills

•  OUTCOME #6:  Relatives’ improved perception of P’s communication skills

b.  The subjective outcome measures were Outcomes #1-6

c.  None of the outcomes were objective outcome.

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  Yes. Only Outcome #6 was associated with data. The authors cited the literature =  0.84

b.  Intraobserver for analyzers?   Yes. Only Outcome #5 was associated with data. The authors cited the literature  = 0.90

c.  Treatment fidelity for clinicians?  No.

 

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

a.  The following comparison between T and C groups yielded significant differences:

•  OUTCOME #5:  P’s improved perception of P’s communication skills  significance level  p =  0.013; T improved more than C

b.  What was the statistical test used to determine significance?  List the outcome number after the appropriate statistical test:

•  ANOVA:  p = 0.013

 Other: 

—  Because there was so little  significant change from pre- to post- scores using ANOVA, the investigators calculated additional measures:  reliable change scores for individual participants and a regression-based measure of unusual change

Reliable change:    

•  8 Ps in T group and 1 P in the C group improved on at least one prosodic outcome.  The outcome(s) that changed varied.

Regression based measure:

•  4 Ps in T group and 1 P in C group improved on measures of perceived communicative improvement by the P but not by a relatives.

c.  Were confidence interval (CI) provided? No

           

10.  What is the clinical significance?  (List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.)

a.  Results of EBP testing

•  ETA: ranged from .167-.299 for Outcomes #2, 4, 5

b.  Interpretation of EBP testing.

•  Large/Strong:  Self-rating on communication adequacy questionnaire (Outcome #5)

•  Moderate:  Prosody Test:   accuracy and intensity rating  (Outcomes #2  & 4)

•  No:  Outcomes #1, 3, 6

11.  Were maintenance data reported?  Yes. One-month post intervention results indicated that for T group, for the most part, positive changes were not maintained although they were regularly better (but not significantly better)  than pretest scores.

 

12.  Were generalization data reported?  Yes. Performance on the self and relative questionnaires can be considered generalization data. Several of the Ps in the T group reported improved perception of the their own communicative competence.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: __B-_

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of a brief (six hour) intervention to improve the comprehension of affective prosody.

POPULATION:  Adults with acquired brain injury (TBI, CVA, medical mishap)

 

MODALITY TARGETED:  Comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Affective prosody

DOSAGE:  2  hour sessions, 1 time a week for 3 weeks, small group (N = 2)

 

ADMINISTRATOR:  therapist (not clear if was an SLP)

 

STIMULI:  verbal

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

 

Tasks:

  Group activities–games

•  Review tasks

•  Home practice

Content:

•  Prosodic cues associated with specific emotions

Structure of Sessions:

•  Establishment of a core vocabulary for terms (7 emotions and associated words) used in therapy.

– Discuss meaning of terms.

– Categorize emotion terms.

•  Discrimination of prosody associated with targeted emotions.

– Initially begin with gross discriminations and simple patterns.

– Gradually increase complexity and present finer discriminations including production tasks.

– Activities include C’s modeling, reviewing audiotapes, role playing, games involving production.

Techniques:

•  Derived from programs designed to remediate TBI.

– Errorless learning (repeated practice, guessing is discouraged)

– Massed varied practice

– Cross modal practice (voice and verbal context)

– Rehearsal (role playing, games)

– Positive reinforcement

– Provision of immediate feedback

– Reviews (outlines and schedules for homework)

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