Flaugnacco et al. (2015)

 

 

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

MT = music training

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PT = painting training

SLP = speech–language pathologist

 

 

SOURCE:  Flaugnacco, E., Lopez, L., Terribili, C., Montico, M, Zoia, S., Schön, D. (2015). Music training Increases phonological awareness and reading skills in developmental dyslexia: A randomized control trial. PLoS ONE, 10 (9), e0138715. doi:10.1371/ journal.pone.0138715

 

 

REVIEWER(S): pmh

 

DATE: February 29, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+  (Highest possible grade based on the design was A+.)

 

TAKE AWAY: Italian children who had been diagnosed with dyslexia participated in this randomized control trial investigation the effectiveness of 7 months of Music Training on literacy skills. The results revealed significant improvement in text reading, pseudo-word reading, word reading accuracy, phonemic blending, temporal anisochrony, temporal rise time, rhythm reproduction, tapping reproduction, overall cognitive performance, auditory attention, backward digit recall, and self-esteem.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Randomized Clinical/Controlled Trial

                                                                                                           

  • 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? Unclear, the investigators claimed they employed pseudo -randomization on the basis of their baseline scores. There is some acceptance of this procedure in the literature. A more conservative interpretation would not consider quasi-randomization to be true randomization. Nevertheless, the investigators reported that their were no significant differences between the group in the dependent variables or in several characteristics of the Ps prior to intervention.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? Yes
  • from clinicians? No
  • from analyzers? Yes

                                                                    

 

  1. Were the groups adequately described?

Yes _x__       No ___       Unclear___       Variable _______

 

  • How many Ps were involved in the study?
  • total # of Ps:   48
  • # of groups: 2
  • List names of groups and the # of participants in each group: (

   – Music Training (MT) = 12

– Painting Training (PT) = 12 (2 participants, Ps, dropped out during post testing)

 

  • The following P characteristics were CONTROLLED
  • age: 8 – 11 years
  • cognitive skills: IQ >85
  • residence: Trieste and Rome (Italy):
  • diagnosis: dyslexia
  • language: native speaker of Italian
  • reading: failed 2 of 3 standardized Italian reading tests (accuracy and/or speed)
  • hearing: within normal limits
  • neurological status: within normal limits
  • vision: within normal limits or correct to normal limits
  • speech-language status: excluded developmental speech and language disorders (including using tests of Italian grammar and receptive vocabulary)
  • psycho-social status: excluded several disorders listed in ICD-10 (see 3/17-4/17)

 

  • The following P characteristics were DESCRIBED:
  • age:

MT group = mean age 10 years

     – PT group = mean age 10 years

 

  • gender:

MT group = 71% were male

     – PT group = 77% were male

 

  • handedness:

MT group =  right handed – 92%

     – PT group =  right handed – 86%

 

  • painting practice:

MT group = 0%

     – PT group = 4%

  • music practice:

MT group = 21%

     – PT group = 18%

 

  • educational level of clients:

MT group = median is 5

     – PT group =  median is 5

 

  • educational level of parents:

MT group = mean level for mothers was high school

     – PT group = mean level for mothers was high school

 

  • Were the groups similar before intervention began? Yes

                                                         

  • Were the communication problems adequately described? Yes, the Ps were diagnosed with dyslexia in the absence of developmental speech and language disorders.  

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes, the MT group maintained 100% and PT group maintained approximately 92%.

                                                               

  • 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
  • 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 were

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)
  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test
  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test
  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test
  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)
  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task
  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)
  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task
  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)
  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)
  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3)
  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations
  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome
  • OUTCOME #14: Improved performance on a task of metrical perception
  • OUTCOME #15: Improved overall cognitive performance on a standardized test
  • OUTCOME #16: Improved digit span on a standardized test
  • OUTCOME #17: Improved auditory attention (BIA Battery)
  • OUTCOME #18: Improved digit span forward
  • OUTCOME #19: Improved digit span backward
  • OUTCOME #20: Improved Arithmetic
  • OUTCOME #21: Improved Block Design
  • OUTCOME #22: Improved Picture Arrangement
  • OUTCOME #23: Improved Vocabulary (comprehension)
  • OUTCOME #24: Improved Similarities
  • OUTCOME #25: Improved self-esteem
  • OUTCOME #26: Improved working memory on WISC

 

All the outcome measures were subjective.

 

None of the outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? Yes, the investigators reported interobserver reliability for one outcome.

OUTCOME #16: Improved repetition of rhythm represented by tones and durations =   0.89

 

  • Intraobserver for analyzers?

 

– Treatment fidelity for clinicians? Yes, The investigators did not provide treatment fidelity data but they reported that the administrators of the interventions, or clinicians (C), attended intensive training session in the respective interventions, were supervised by a neuropsychologist, and regularly communicated with the other C who was administering the intervention.

 

  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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • OUTCOME #1: Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)

– MT yielded significantly fewer Ps categorized as severely impaired than PT

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test

– MT yielded significantly fewer Ps categorized as severely impaired than PT

 

  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test

– no significant differences between MT and PT groups following intervention; however,

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task

– MT significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)

– MT significantly better than PT following intervention

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations

– MT significantly better than PT following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception

– no significant differences

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test

– Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test

– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (BIA Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #19: Improved digit span backward

– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design

     – PT significantly better than MT following intervention

  • OUTCOME #22: Improved Picture Arrangement

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary (comprehension)

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem

– no significant difference between groups following intervention but

     – both MT and PT improved significantly following intervention

  • OUTCOME #26: Improved working memory on WISC

– MT significantly better than PT following intervention

 

  • What statistical tests were used to determine significance?
  • Mann-Whitney U
  • Wilcoxon
  • Fisher’s Exact Test

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The measures used to describe clinical significance

– the Effect Size derived from Odds Ratio or Interval Data (

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)—Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)—small treatment effect in favor of the MT group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task—small treatment effect in favor of the MT group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity) —small treatment effect in favor of the MT group

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations—small treatment effect in favor of the MT group

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #16: Improved digit span on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #17: Improved auditory attention (BIA Battery) —small treatment effect in favor of the MT group

 

  • OUTCOME #19: Improved digit span backward—small treatment effect in favor of the MT group

 

  • OUTCOME #21: Improved Block Design—small treatment effect in favor of the PT group

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

  • Several of the measures could be considered to be generalization data including

–OUTCOME #1 (generalization for both groups): Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2) Although MT treatment yielded significantly fewer Ps categorized as severely impaired than PT following intervention, both the MT and PT groups improved following intervention

 

–OUTCOME #2 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test– MT treatment yielded significantly fewer Ps categorized as severely impaired than PT.

 

–OUTCOME #3 (generalization for both groups): Increased speed of reading text on a standardized Italian reading test–Both the MT and PT groups improved following intervention.

 

  • OUTCOME #4 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test– Both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #6 (generalization for both groups): Increased accuracy on an Italian phonemic segmentation task — both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (generalization for both groups)- significant changes were not observed in either group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (generalization for both groups) – significant changes were not observed in either group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (generalization for PT group) – The PT group did not improve significantly on this task

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (generalization for PT group) —PT group improved significantly following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations (generalization for PT group) — PT did not improve significantly following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome (generalization for PT group)– PT group improved significantly following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception (generalization for PT group): – no significant improvement for the PT

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test (generalization for both groups) – Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test (generalization for both groups)– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (generalization for PT group) –MT group was significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward (generalization for both groups) – scores did not improve significantly following intervention for either group

 

  • OUTCOME #19: Improved digit span backward (generalization for both groups)– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic (generalization for both groups)– scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design (generalization for MT group) – PT significantly better than MT following intervention
  • OUTCOME #22: Improved Picture Arrangement (generalization for both groups): – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary comprehension (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem (generalization for both groups)- both MT and PT improved significantly following intervention
  • OUTCOME #26: Improved working memory on WISC (generalization for both groups) – MT significantly better than PT following intervention

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators also explored whether certain skills predicted other skills. This part of the investigation will not be analyzed or summarized in this review, but the findings are interesting.

 

  • The investigators recruited children who had been diagnosed as dyslexic from Trieste and Rome, Italy.
  • Following the application of the inclusion and exclusion criteria, 48 Ps were assigned to one of the two treatment groups (MT, PT.) The investigators labeled the assignment procedure as quasi-random.

 

  • Prior to intervention, the investigators administered a battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem. (The administration of the pretests to all 48 Ps took approximately 5 weeks.)

 

  • The two interventions lasted the same amount of time. The clinicians (Cs) who administered each intervention had received special training and they were supervised throughout the interventions.

 

  • Following intervention, the investigators administered the same battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem as in the pretest. The administration of the posttests to 46 Ps (2 of the Ps dropped out of the investigation during this time) took approximately 5 weeks.

 

  • The investigators used nonparametric statistics to compare pre and post scores and differences between the two groups (MT, PT) in the changes following intervention.

 

  • The investigators also explored predictors of outcomes but this is neither critiqued or summarized in this review.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music training on the reading skills of children with dyslexia

 

POPULATION: Dyslexia (without comorbid language impairment); Children

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome):   music (rhythm, tempo/timing.)

 

OTHER TARGETS: reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem.

 

DOSAGE: 2 times a week, group (5-7 Ps) sessions, 1 hour session, 7 weeks for a total of 30 sessions

 

ADMINISTRATOR: teacher trained in MT or PT intervention. The teacher will be will referred to as the clinician (C.)

 

MAJOR COMPONENTS:

 

  • There were 2 interventions: MT and PT.

 

  • In addition to MT or PT intervention, each P received a “ ‘conventional’ rehabilitation program” (p. 8/17) which involved

– daily work at home,

– 20 minutes in length,

– parental supervision, and

– activity forms.

 

MUSIC TRAINING (MT)

 

  • An adaptation of Kodaly and Orff programming targeting rhythm and timing.

 

  • The intervention included

– playing percussion instruments

– producing syllables with specificed rhythm

– music paired with movement

– games involving “sensorimotor synchronization” (8/17)

 

 

PAINTING TRAINING (PT)

 

  • An adaptation of Bruno Munari programming targeting visual-spatial skills, “hand” skills, and creativity.
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: