Joyal et al. (2016)




C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review


Source: Joyal, M., Bonneau, A., & Frecteau. S. (2016.) Speech and language therapies to improve pragmatics and discourse skills in patients with schizophrenia. Psychiatry Research, 240, 88-95.


Reviewer(s): pmh


Date: May 25, 2016


Overall Assigned Grade: B-


Level of Evidence: B (Systematic Review (SR) with broad criteria)


Take Away: This SR investigated the effectiveness of speech and language therapy with patients (Ps) with schizophrenia. Only 3 of the sources reviewed in the SR were concerned with prosody. In 2 of the 3 sources, Ps with schizophrenia did not exhibit progress in prosodic therapy. The results were not clear in the third source. Therefore, current evidence does not support the treatment of prosody in Ps with schizophrenia. Apparently, the therapies were not administered by speech-language pathologist s (SLPs.) Accordingly, the authors of the SR recommended that SLPs consider researching the treatment of Ps with schizophrenia by SLPs.


What type of secondary review? Narrative Systematic Review


NOTE: Only 3 of the 18 sources were concerned with an aspect of prosody. For the most part, the analysis of this this secondary review pertains to all 18 sources. When the analysis is restricted to only the 3 prosodic investigations, it will be so noted on this form.



  1. Were the results valid? Yes


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


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


  • The authors of the secondary research noted that they reviewed the following resource: internet based databases


  • Did the sources involve only English language publications? Yes


  • Did the sources include unpublished studies? No


  • Was the time frame for the publication of the sources sufficient? Yes


  • Did the authors of the secondary research identify the level of evidence of the sources? No


  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? No, but the strategy for evaluating the sources could be inferred from the article.


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


  • Did the authors of the secondary research or review teams rate the sources independently?   No


  • Were interrater reliability data provided? No


If there were no interrater reliability data, was an alternate means to insure reliability described? No ___


  • Were assessments of sources sufficiently reliable? Unclear


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


  • Did the sources that were evaluated involve a sufficient number of participants? Yes, for the overall review of 18 sources but No for the 3 prosodic sources.


  • Were there a sufficient number of sources? Yes, for the overall review of 18 sources but No for the 3 prosodic sources


  1. Description of outcome measures:


  • Outcome #1: Improved loudness and “voice tone” (Kawakubo et al., 2007; p.
  • Outcome #2: Improve prosody (Hoffman & Satel, 1993)
  • Outcome #3: Improve speed of responding (Bailey 1978)



  1. Description of results:


–  What measures were used to represent the magnitude of the treatment/effect size?

  • Glass’s Delta. Investigators’ interpretation guide for Glass’s Delta:
  • ≤ 0.50 = the change was not significant
  • 0.05 to 1.0 = small positive effect
  • 1.0 to 2.0 = clinically effective


  • Summary of overall findings of the secondary research:


– The systematic review (SR) explored the effectiveness of speech and language therapy with patients with schizophrenia on a range of pragmatic and discourse outcomes. This review will focus only on sources that targeted prosody outcomes which accounted for only 3 of the 18 sources.


– The results of the 3 prosody based sources were


  • Outcome #1: Improved loudness and “voice tone”: no noticeable improvement; Glass’s Delta = 0.07 (change was not significant)
  • Outcome #2: Improved prosody; results were unclear. Investigators noted there were “qualitative improvements” in some of the outcomes but did not specify which outcomes improved.
  • Outcome #3: Improve speed of responding; no noticeable improvement, effect size was not noted.


  • Were the results precise? Unclear/Variable _x__


  • 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? Not Applicable (NA)


  • Were the results of individual studies clearly displayed/presented? Yes


  • For the most part, were the results similar from source to source? Unclear


  • Were the results in the same direction? Unclear


  • Did a forest plot indicate homogeneity? NA


  • Was heterogeneity of results explored? No


  • Were the findings reasonable in view of the current literature?
  • Were negative outcomes noted? Yes



  1. Were maintenance data reported? No None of the 3 prosodic sources included maintenance data although some of the nonprosodic sources in the SR did explore maintenance.



  1. Were generalization data reported? No







Population:  Schizophrenia; Adults


Prosodic Targets: loudness, “tone,” overall prosody, speed of response


Nonprosodic Targets:


Aspects of Prosody Used in Treatment of Nonprosodic Targets:




Description of Source #1— Kawakubo et al. (2007)


  • Outcome #1: Improved loudness and “voice tone”


  • The authors of the SR described the intervention as psychiatric intervention involving a social skills training with medication and self management.


Evidence Contraindicating Source #1— Kawakubo et al. (2007)


  • The improvement was not significant.




Description of Source #2— Hoffman & Satel (1993)


  • Outcome #2: Improved prosody.


  • The authors of the SR described the intervention as including metacomprehension (explicit communication skill training) and metalearning (self monitoring and self learning) tasks.


Evidence Contraindicating Source #2— Hoffman & Satel (1993)


  • The SR review noted that there was improvement in a “range” of outcomes. It was not clear that the prosody outcome




Description of Procedure/Source #3—Bailey (1978)


  • Outcome #3: Improve speed of responding


  • The authors of the SR reported that the intervention used vestibular stimulation which involves sensory integration activities.


Evidence Contraindicating Procedure/Source #3— Bailey (1978)


  • The speed of responding did not improve as the result of this intervention.


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