van de Sandt-Koenderman et al. (2013)

 

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

f = female

m = male

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: van de Sandt-Koenderman, M., van der Meulen, I., Heijenbrok-Kal, M., Visch-Brink, E. G., & M Ribbers, G. (2013). Melodic Intonation Therapy in subacute aphasia. In 43rd Clinical Aphasiology Conference 2013. Tucson, AZ (May 28- June 2, 2013.) On February 20, 2016 retrieved from http://aphasiology.pitt.edu/archive/00002477/

 

REVIEWER(S): pmh

 

DATE: February 23, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+  (The highest possible design, based on the design of the investigation was A. The paper was a summary of a presentation at a conference. Accordingly, it is short and some information probably was omitted due to length constraints).

 

TAKE AWAY: This investigatiom of the effectiveness of Melodic Intonation Therapy (MIT) with Dutch participants (Ps) with subacute aphasia revealed that MIT was more effective than a control intervention on a language repetition task and that MIT, but not the control intervention, generalized to measures of naming, story retelling, and everyday conversation.

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

– If there was more than one group, were participants (Ps) randomly assigned to groups? Yes

 

  1. Was administration of intervention status concealed? (NOTE: The paper was a summary of a presentation at a conference. Accordingly it wass short and some information probably was omitted due to length constraints.)

                                                                                                           

– from participants? Unclear

– from clinicians? Unclear

from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Variable. The overall description was good but communication skills could have been more thorough

 

– How many Ps were involved in the study?

  • total # of Ps:   27
  • # of groups: 2
  • List names of groups and the # of participants in each group:

     – Direct Melodic Intonation Therapy (MIT) = 16

– Delayed MIT = 11

 

– The P characteristics that were controlled CONTROLLED were

  • age: 18 years to 80 years
  • cognitive skills: no premorbid dementia
  • hearing: no severe hearing loss
  • socio-emotional status: no “psychiatric history relevant to language communication”
  • site of lesion: left hemisphere; no bilateral lesions
  • diagnosis: Aphasia following left hemisphere stroke; no prior strokes
  • time post stroke: 2 to 3 months
  • language spoken: native speaker of Dutch
  • prior therapy: no “intensive MIT prior to start of study”
  • Other: Candidate for MIT (i.e., nonfluent aphasia, severely impaired language repetition, articulation errors, auditory comprehension at least moderate, right-handed prior to stroke)

 

– No other P characteristics were DESCRIBED.

 

– Were the groups similar before intervention began? Unclear _x___   NA ______, the investigators did not present statistical evidence that the groups were similar prior to the therapy. However, for 2 outcomes, the pretest scores were the same or close to the same and they reported that several of the controlled characteristics were not identified as determinants.

 

– Were the communication problems adequately described? No Unclear ____

  • disorder type: Aphasia following left hemisphere stroke

 

 

  1. Was membership in groups maintained throughout the study?

 

 Did each of the groups maintain at least 80% of their original members? Yes, but the Direct MIT group lost 2 members (i.e., maintained about 88%) and the Delayed MIT group lost 1 member (i.e., maintained about 91%.)

                                                               

– Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? Yes

                                                                                                             

– Was there a no intervention group? No

                                   

– Was there a foil intervention group? Yes. The control group consisted of language treatment that did not involve speech production followed by delayed administration of MIT.

                                   

– Was there a comparison group? No

 

– Was the time involved in the foil and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

                                                                                                             

–   The outcomes (dependent variables) were

 

  • OUTCOME #1: Improved performance on a Dutch naming test
  • OUTCOME #2: Improved performance on the ANELT, a Dutch test of everyday language
  • OUTCOME #3: Improved performance on the Sabadel, a Dutch story retelling task
  • OUTCOME #4: Improved performance on the naming, repetition, and comprehension subtest of the Aachen Aphasia test.
  • OUTCOME #5: Improved performance on the MIT repetition task consisting of 11 trained and 11 untrained utterances.

 

All the outcome measures were subjective.

 

None of the outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

Intraobserver for analyzers?   No

 

– Treatment fidelity for clinicians? No

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

  • Summary Of Important Results

 

  • What level of significance was required to claim significance? p = 0.05

 

NOTE: There were 3 assessment periods:

– T1 = preintervention

– T2 = following the first round of intervention (Direct MIT received MIT; Delayed MIT received the control intervention)

– T3 = six weeks after the end of the first round of intervention. During those 6 weeks, Direct MIT received their choice of interventions and Delayed MIT received MIT.

 

  • OUTCOME #1: Improved performance on a Dutch naming test

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #2: Improved performance on the ANELT, a Dutch test of everyday language

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #3: Improved performance on the Sabadel, a Dutch story retelling task

– Direct MIT: difference was not significant from T1 to T2

 

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #4: Improved performance on the naming, repetition, and comprehension subtest of the Aachen Aphasia test.

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #5: Improved performance on the MIT repetition task consisting of 11 trained and 11 untrained utterances.

– Direct MIT:            

  • significant improvement from T1 to T2

     – Delayed MIT:

  • significant improvement from T1 to T2

     – Direct MIT vs Delayed MIT: regression analysis indicated Direct MIT improved significantly more than Delayed MIT at T2

Trained vs Untrained items: The difference between treatment groups at T2 was significantly better for trained but not for untrained items.

 

 

  • What was the statistical test used to determine significance? ANOVA and Linear regression analysis

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance? NA, data not provided

 

 

  1. Were maintenance data reported? Yes. Figure 2 presents evidence that Ps continued to improve on Outcomes #1, 2, and 3 six weeks after the termination of MIT therapy.

 

 

  1. Were generalization data reported?

Yes.

  • At T2, Direct MIT and Delayed MIT Ps performed significantly better in the repetition of trained but not untrained items from Outcome #5 which is not supportive of generalization.
  • However, at T2 the Direct MIT group performed significantly better on the ANELT (Outcome #2) which is a measure of functional language. This suggests that there was generalization.

 

 

  1. Describe briefly the experimental design of the investigation.
  • The investigator enlisted 15 Dutch aphasia centers to recruit Ps.
  • Twenty-seven Ps with aphasia who met the inclusion/exclusion criteria (see item 4 –Controlled Characteristics) were enrolled in the investigation.
  • Ps were randomly assigned to either the Direct MIT group or the Delayed MIT group.
  • The investigation involved 3 phases:

– Pretesting (T1): Outcome measures were administered to both Direct MIT and Delayed MIT groups prior to intervention.

– T2: Outcome measures were administered following the first period of 6 weeks of intervention. The interventions were

  • For Direct MIT—MIT
  • For Indirect MIT – the control intervention

– T3: Outcome measures were administered following the second period of 6 weeks of intervention. The interventions were

  • For Direct MIT – a choice of interventions
  • For Delayed MIT – MIT
  • The results of the assessments were analyzed using ANOVA and linear regression analysis. Most of the reported comparisons were of T1 vs T2 for either Direct MIT or Delayed but there were some comparisons of Direct MIT vs Delayed MIT.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of MIT with Ps diagnosed with subacute aphasia. (NOTE: The investigators also explored the timing of intervention with subacute P and determinants of outcome, but these are not part of this review.)

 

POPULATION: Aphasia, Nonfluent, Subacute; Adults

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable):   music (rhythm, intonation/pitch)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): naming, story retelling, repetition, conversation, comprehension

 

DOSAGE: 5 hours per week for 6 weeks.

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • There were 2 treatments: MIT and the control treatment.

 

MIT

 

  • The P and the clinician (C) sing phrases in unison while tapping with their left hand.

 

  • C’s support gradually decreases and the singing gradually transitions to speaking.

 

 

CONTROL TREATMENT

 

  • The focus of the intervention was on writing, nonverbal communication, and comprehension but NOT on verbal production.

 

 

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