Sapir et al. (2002)

EBP THERAPY ANALYSIS

Comparing Treatment of Groups

 

SOURCE:  Sapir, S., Ramig, L., Hoyt, P., Countryman, S., O’Brien, C., & Hoehn, M. (2002).  Speech loudness and quality 12 months after intensive voice treatment (LSVT®) for Parkinson’s disease: A comparison with an alternative speech treatment. Folia Phoniatrica et Logopaedica, 54, 296-303.

 

REVIEWERS:  Jessica Jones (Minnesota State University, Mankato), Amy Anderson (Minnesota State University, Mankato), pmh

 DATE:  2009

ASSIGNED GRADE FOR OVERALL QUALITY:  B

TAKE AWAY:  This prospective, randomized group design provides good support for the long term effectiveness of Lee Silverman Voice Treatment (LSVT®) for improving loudness and voice quality in speakers with Parkinson’s disease.  The research is part of a body of literature that provides strong support for LVST.

1.  What type of evidence was identified?

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

b.  What was the level of support associated with the type of evidence?  Level = B+

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  Yes.  After the Ps were stratified, they were randomly assigned to groups.

 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? Yes

                                                                    

4.  Were the groups adequately described?

a.         How many participants were involved in the study?

•  total # of participant:  35

•  # of groups:  2

•  # of participants in each group:  22, 13

•  Names of groups:  Lee Silverman Voice Treatment (LVST®); high effort respiratory treatment program (RET)

b.  The following variables actively controlled or described: 

•  mean age:  63.23 years; 65.31 years

•  diagnosis:  Parkinson’s disease

•  mean time since diagnosis:  6.55 years; 4.77 years

•  mean rating on the Unified Parkinson’s Disease Rating Scale:  26.08; 20.30

•  mean stage of PD (scale 1-5): 2.63; 2.25

•  neuropharmacological status:  all stable

•  other details:  cited previous research

c.   Were the groups similar before intervention began?  Yes.  There were no significant differences between groups on the measures  in 4b.

d.  Were the communication problems adequately described?   Unclear.

•  disorder type:  (List)

•  functional level

•  other (list)

•  severity level of speech/voice concerns on 1-5 scale:  2.64; 2.54 (no significant difference)

 

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?  No

b.  Was there a foil intervention group?  No 

c.  Was there a comparison group?  Yes

d.  Was the time involved in the foil/comparison and the target groups constant?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?

a.  The outcomes were

OUTCOME #1:  more likely to be judged louder at the 12 month follow up assessment

OUTCOME #2:  more likely to be judged louder the RET group at the 12 month follow up

OUTCOME #3:  Quality more likely to be judged better  at the 12 month follow up assessment

OUTCOME #4:  Quality more likely to be judged better than the RET group at the 12 month follow up

b.   All the outcome measures  were subjective.

c.  None  of the outcome measures were objective.

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  No

b.  Intraobserver for analyzers?   No

c.  Treatment fidelity for clinicians?  No 

 

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

a.

TREATMENT AND FOIL/COMPARISION/NO TREATMENT GROUP COMPARISION

OUTCOME #2:  more likely to be judged louder at the 12 month follow up assessment than RET;

•  significance level 0.001; LVST louder than RET

OUTCOME #4:  Quality more likely to be judged better than the RET group at the 12 month follow up

•  significance level 0.01; LSVT better quality than RET

PRE VS POST TREATMENT

OUTCOME #1:  more likely to be judged louder at the 12 month follow up assessment

•  LSVT:  significantly louder at pre compared to 12 month follow up; p = 0.0001

•  RET not significantly louder at pre compared to 12 month follow up

OUTCOME #3:  Quality more likely to be judged better at the 12 month follow up assessment

  LSVT:  significantly better voice quality at pre compared to 12 month follow up; p = 0.0001

•  RET not significantly better voice quality at pre compared to 12 month follow up 

b.  What was the statistical test used to determine significance?  Chi square

c.  Were confidence interval (CI) provided?  No

 

10.  What is the clinical significance?   NA

11.  Were maintenance data reported?  Yes.  The comparisons were preintervention versus follow up at 12 months post intervention.

 

12.  Were generalization data reported?  No.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness of Lee Silverman Voice Treatment (LSVT) and high effort respiratory treatment (RET) in improving loudness and voice quality in speakers with Parkinson’s disease.

POPULATION:  speakers with Parkinson’s disease

MODALITY TARGETED:  expressive

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:   voice quality

DOSAGE:  50 minutes sessions, 4 times a week, 4 weeks

ADMINISTRATOR:  SLP

STIMULI:  auditory, visual, tactile/kinesthetic

GOAL ATTACK STRATEGY:  not clear

MAJOR COMPONENTS:

COMMON FEATURES OF LVST AND RET

•  C elicited high effort from P

•  C encouraged P to attend to sensory feedback

•  Session structure:

–  Phase 1:  reiterated exercises

–  Phase 2:  speech tasks

RET:

•  target = increase respiratory effort; did not focus on phonation, phonatory effort, pitch, or vocal fold adduction

•  tasks:

–  maximum inspiration

–  maximum expiration

–  maximum prolongation of continuants (/f/, /s/)

–  maintaining intraoral air pressure

–  reading tasks

–  conversational speaking tasks

•  techniques:

–  maximize respiratory effort

–  cues to “breathe” before prolongation tasks and during pauses in reading and conversational speaking

–  visual feedback for breathing using Respigraph

LSVT:

•  target = maximize phonatory effort

•  tasks:

–  high-effort loud phonation

–  avoid hyperadduction, strain

–  initial pushing and lifting tasks during phonation were gradually faded

–  maximum phonation of /a/

–  extending fo range

–  reading

–  conversational speech

•  techniques

–  drills

–  C encouraged P to increase phonatory effort

–  C cued effort with ‘think loud’ during task

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