Groß, Linder, & Ostermann (2010).

EBP THERAPY ANALYSIS

 

SOURCE:  Groß, W., Linder, U., & Ostermann, T. (2010).   Effects of music therapy in the treatment of children with delayed speech development—Results of a pilot study.  BMC Complementary and Alternative Medicine, 10, 39.  Retrieved 11.10 from http://biomedcentral.com/1472-6882/10/39

 

REVIEWER: pmh

 

DATE: 11.15.10

 

ASSIGNED  GRADE FOR OVERALL QUALITY:  C  (B+ was the highest possible grade based on the level of evidence.)

 

TAKE AWAY:  This investigation provides limited support for the use of Music Therapy in conjunction with speech-language therapy to improve selected communication and cognitive outcomes.

 

1.  What type of evidence was identified?                              

a.  What was the type of evidence?  Prospective, Single Group with Pre and Post Testing  using ABAB Administrations

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?  N/A, there was only one group

 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?  No

a.         How many participants were involved in the study?

•  total # of participant:  18

•  # of groups:  1

•  # of participants in each group:  18

b.  The following variables were controlled or described: 

CONTROLLED:

•  presence of speech disorders:  all classified in at least one ICD code: F80.1, F80.2, F83

•  medical condition:  all passed medical examination

•  Test performance:  <50% on German PGN—phonological STM and one subtest of SETK 3-5

•  Excluded:  diagnosis of ASD or organic speech disorder, previous Music Therapy

DESCRIBED:

•  age:  3 years 5 months to 5 years

•  gender:  6f, 12m

•  physical skills: no problems

•  language:  German

c.   Were the groups similar before intervention began?  Not Applicable; there was only one group

d.  Were the communication problems adequately described?  No

•  disorder type:  (List)  ICD code: F80.1, F80.2, F83

 

5.  Was membership in groups maintained throughout the study?  Yes

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?  NA. There was only one group.

 

7.  Were the outcomes measure appropriate and meaningful?

a.  The outcome measures were

• OUTCOME #1:  Improved comprehension of speech (VS)

• OUTCOME #2:  Improved speech production (morphological rules; MR)

• OUTCOME #3:  Improved memory for speech (PGN, SG, GW)

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; DS, cognitive structures)

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales *(CTR)

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age

NOTE:  Outcomes #1-4 were derived from subtest scores on formal tests.

b.  All the outcome measures were subjective.

c.  None of the outcome measures were objective.    

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  Yes. For the most part, the reported reliability data were from previous research, not this investigation. However, the outcomes associated with the Nordoff-Robbins Scale (Outcomes #6 and 7) may be original. The interrater reliability was reported to be 82%.

b.  Intraobserver for analyzers?  Not provided

c.  Treatment fidelity for clinicians? Not provided 

 

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

                                                                                                             

a.  PHASE OF TREATMENT (treatment or waiting block)  COMPARISIONS:

• OUTCOME #1:  Improved comprehension of speech (VS)  significant improvement overall, more improvement after treatment block than waiting period;  p ≤ 0.002

• OUTCOME #2:  Improved speech production (morphological rules; MR)  did not improve significantly

• OUTCOME #3:  Improved memory for speech (PGN, SG, GW) 

     –  PGN  significant improvement overall, more improvement after treatment block than waiting period;  p = 0.001

      –  SG significant improvement overall; p = 0.028

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; DS, cognitive structures)

     –  All measures improved significantly

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales (CTR)

–  Only reported descriptive differences.  P improved, especially after treatment blocks.

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

–  Only reported descriptive differences.  P improved, especially after treatment blocks.

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age

–  Descriptive results only.  Difference between developmental and biological age reduced from 1 year to 7 months, variability decreased also.

b.  The statistical test used to determine significance were the Friedman and  Wilcoxan (nonparametric tests).

c.  Were confidence interval (CI) provided?  Yes but only for age data.  These data were reported in a figure.

d. The % for the confidence interval was 95% CI.

                                   

10.  What is the clinical significance?

a.  Results of EBP testing were reported in  Standardized Mean Difference: 

b.  Interpretation of EBP testing:

MODERATE:

• OUTCOME #3:  Improved memory for speech  (SG, only)

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; only)

 

 

SMALL/NEGLIGIBLE:

• OUTCOME #1:  Improved comprehension of speech (VS)

• OUTCOME #3:  Improved memory for speech (PGN, only)

• OUTCOME #4:  Improved nonverbal intelligence scores (DS, cognitive structures, only)

NOT APPLICABLE:

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales *(CTR)

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age

 

11.  Were maintenance data reported? No

 

12.  Were generalization data reported? Yes. The noncommunication outcomes (listed below) could be considered to represent generalization outcomes. The extent of the improvement in these outcomes varied from small/negligible to moderate. The noncommunication outcomes were

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; DS, cognitive structures)

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales *(CTR)

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age         

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of music therapy on a child’s verbal reasoning abilities, sentence comprehension, and communication intent.

POPULATION:  children with delayed language impairment

 

MODALITY TARGETED:  production and comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  musical rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  language comprehension, language production, memory for speech, musical communication performance

 

OTHER TARGETS:  nonverbal intelligence, clinician-participant relationship

DOSAGE:  individual 25 minute sessions; 2 sets of 8-week treatment  (all speech-language therapy continued during this time)

 

ADMINISTRATOR:  music therapist

 

STIMULI:  auditory, musical,

 

MAJOR COMPONENTS:

•  Nordoff-Robbins approach (cited but not explained in detail)

•  C and P sang and played percussion instrument

•  C composed original songs about play activities that were of interest to the child.

•  The nature of the songs varied for the individual children. For example, some children like to be sung to and other liked to participate more actively (e.g., dance and sing themselves)

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