Blake et al. (2013)

SECONDARY REVIEW (SNR) CRITIQUE

Source:  Blake, M. L., Frymark, T., & Venedictov, R. (2013). An evidence-based systematic review on communication treatment for individuals with right hemisphere brain damage. American Journal of Speech-Language Pathology, 22, 146-160.

 

Reviewer(s): pmh

 

Date:  7.25.13

 

Overall Assigned Grade:  A-

 

Level of Evidence:   A+

 

Take Away: This systematic review focused on 4 outcomes for treating individuals with right hemisphere brain damage. Only one of the outcomes was concerned with prosody and only that outcome is reviewed here. This is a well-executed systematic review but a major limitation is the limited number of qualifying sources. Nevertheless, two approaches to teaching the production of sentence with prosody that are appropriate for designated affective states were identified.

 

What type of secondary review?  Narrative Systematic Review

 

1.  Were the results valid?

a.  Was the review based on a clinically sound clinical question?  Yes

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?  Yes

c.  The authors noted that they reviewed the following resources:

•  hand searches

•  electronic databases

•  references from identified literature

•  searched authors identified in conference proceedings, conference proceedings, dissertations, and grey literature x

d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  No

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  Yes

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  Yes

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  Yes

j.  Did the reviewers or review teams rate the sources independently?  Yes

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA 

m.  If there were no interrater reliability data, was an alternate means to insure reliability described?  Yes. Differences were resolved by consensus.

n.  Were assessments of sources sufficiently reliable?  Unclear/Variable

o.  Was the information provided sufficient for the reader to undertake a replication?  Yes

p.  Did the sources that were evaluated involve a sufficient number of participants?  No

q.  Were there a sufficient number of sources?  No

2.  Description of outcome measures:

The outcomes

NOTE:  Only Outcome #1 will be discussed because it is the only one concerned with prosody.

•  Outcome #1:  Changes in prosody associated with sentence or discourse level communication intervention

•  Outcome #2:  Changes in receptive language associated with sentence or discourse level communication intervention

•  Outcome #3:  Changes in expressive language associated with sentence or discourse level communication intervention

•  Outcome #4:  Changes in pragmatic language associated with sentence or discourse level communication intervention

 

3.  Description of results: 

NOTE:  Only Outcome #1 will be discussed because it is the only one concerned with prosody.

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?

•  standardized mean difference (d) with confidence intervals

b.  Summarize overall findings of the secondary review:

Only one source qualified for review (Rosenbek et al., 2006). The review revealed that both interventions (imitative and cognitive-linguistic) yielded improvements in affective prosody. The differences between the two interventions was small. The reviewers called for additional research in improving of prosody of speakers with right hemisphere brain damage.

c.  Were the results precise?  Unclear/Variable  _x__ 

d.  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval?  Yes 

e.  Were the results of individual studies clearly displayed/presented? Unclear/Variable

f.  For the most part, were the results similar from source to source?  Not applicable, there was only one source.

g.  Were the results in the same direction?  Not applicable, there was only one source.

h.  Did a forest plot indicate homogeneity?  Not applicable, there was only one source.

i.  Was heterogeneity of results explored?  Not applicable, there was only one source.

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted  No

                                                                                                                   

4.  Were maintenance data reported?  No

 

SUMMARY OF INTERVENTION

DESCRIPTION OF PROCEDURE #1—Rosenbek’s 6 Step Continuum—Imitation

Target:  To produce emotional prosody at the sentence level

Procedure:  At the first step, C models sentences with appropriate prosody for P and directs him/her to imitate. C gradually removes cues until P produces sentences in response to question with appropriate emotional prosody.

 

Evidence Supporting Procedure #1— Overall, Ps improved following at least one of the interventions (imitation or cognitive/linguistic).

 

Evidence Contraindicating Procedure #1—(provide title)— Although there were not statistically significant differences, Imitative intervention was slightly less effective  (d = 0.24) than Cognitive/Linguistic. Blake et al. noted the CI crossed null making interpretation difficult.

 

DESCRIPTION OF PROCEDURE #2— Rosenbek’s 6 Step Continuum—Cognitive/Linguistic

Target:  To produce emotional prosody at the sentence level

Procedure:  C presents cues associated with affective states (prosodic features, emotional states, and pictures representing emotional states) and gradually reduces support until P produces sentences in which prosodic behaviors are appropriate for the signified affect.

 

Evidence Supporting Procedure #2— Overall, Ps improved following at least one of the interventions (imitation or cognitive/linguistic)

 

Evidence Contraindicating Procedure #2— Although there were not statistically significant differences, Cognitive-Linguistic intervention was slightly more effective  (d = 0.24) than Imitative.  Blake et al. noted the CI crossed null making interpretation difficult.

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