De Letter et al. (2007)

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: De Letter, M., Santens, P., Estercam, I., Van Maele, G., De Bodt, M., Boon, P., & Van Borsel, J. (2007). Levodopa induced modifications of prosody and comprehensibility in advanced Parkinson’s disease as perceived by professional listeners. Clinical Linguistics and Phonetics, 21, 783-791.

REVIEWER(S): pmh

 

DATE: May 22, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade, based on the design of the investigation, was C+.)

 

TAKE AWAY: This was not an intervention study; rather, it is classified as a clinically related investigation. Speakers of Dutch from Belgium with Parkinson’s disease (PD) were measured off (Pre-test) and on (Post Test) the medication Levodopa. Participants (Ps) produced significantly better pitch, loudness, and comprehensibility while using Levodopa. There was not a significant change in speaking rate on and off Levodopa conditions.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing
  • What was the level of support associated with the type of evidence? Level = C+

                                                                                                           

  1. Group membership determination:
  • Were participants randomly assigned to groups? Not applicable (NA), there was only one group.
  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes ß

                                                                    

 

  1. Was the group adequately described? Yes

How many participants were involved in the study?

  • total # of participant: 10
  • # of groups: 1
  • # of participants in each group: 10 participants (Ps) in the one group
  • List names of group: Ps with Parkinson’s disease (PD) were evaluated without (pretesting) and with (post testing) Levodopa.

 

The following variables were described:

  • age: 63 -80 years; mean 68 years
  • gender: 5m; 5f
  • cognitive skills: A psychiatrist administered a variety of tests and evaluated all Ps’ cognitive skills; none of the Ps were judged to be impaired.
  • therapy: None of the Ps were enrolled in speech therapy at the time of the investigation. No one was involved with deep brain stimulation and/or lesioning.
  • co-morbidity: No comorbidity was identified using neuroimaging and clinical judgment
  • medication: All Ps had been prescribed Levodopa previous to the investigation. Most of the Ps also were prescribed other medication(s) but none of the medication interfered with muscle movement.
  • diagnosis: advanced PD

 

– Were the groups similar before intervention began? NA, there was only one group.

                                                         

– Were the communication problems adequately described? No

  • disorder type: hypokinetic dysarthria

 

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? NA, there was only one group.

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful?

– The outcomes (dependent variables) were

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read passage
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read passage

All the outcome measures are subjective,

– None ofthe outcome measures are objective. None

                                         

 

  1. Were reliability measures provided?

– Interobserver for analyzers? Yes. Overall Interobserver reliability for all Ps and all outcomes was 0.78.

 

Intraobserver for analyzers?

 

–  Treatment fidelity for clinicians? No

 

 

  1. What were the results of the statistical (inferential) testing.

PRE (without medications) VS POST (with Levadopa) TREATMENT:

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage: With Levodopa was significantly better (p < 0.01) than without Levodopa.
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage: With Levodopa was significantly better ( p < 0.01) than without Levodopa.
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read narrative No significant differences
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read narrative With Levodopa was significantly better ( p = 0.01) than without Levodopa.

– What was the statistical test used to determine significance? Wilcoxon

 

– Were confidence interval (CI) provided? No

 

           

  1. What is the clinical significance? Not provided

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To investigate the effectiveness of the medication Levodopa on the perception of pitch, loudness, rate, and comprehensibility of read passages of Ps with PD.

POPULATION: PD; adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness, rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: comprehensibility

 

DOSAGE: Single dosage of Levodopa.

 

ADMINISTRATOR: medical professional

 

MAJOR COMPONENTS:

  • In the pre condition, Ps had been off their medication for 12 hours. They reviewed a 182 syllable passage in Dutch prior to reading it aloud for audiorecording.
  • After the audiorecording, Ps were administered their regular dosage of Levodopa.
  • The Ps then waited one hour and re-read the same 182 syllable passage aloud for audiorecording.
  • Four speech-language pathologists (SLPs) listened to the audiorecodings. The audiorecordings for each of the Ps were randomized with respect to whether the sample was of the speaker with or without the Levodopa.
  • The SLPs rated each audiorecording for the following characteristics on a 10 point scale: pitch, loudness, rate, and comprehensibility.
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