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Cahill PT, Ferro MA, Ng S, Turkstra LS, Campbell WN. Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework. BMC Health Serv Res 2024; 24:347. [PMID: 38491356 PMCID: PMC10943816 DOI: 10.1186/s12913-024-10821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Establishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context. METHODS Using a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately. RESULTS We identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve. CONCLUSIONS The seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Mark A Ferro
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
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Cahill PT, Ng S, Dix L, Ferro MA, Turkstra L, Campbell WN. Outcomes management practices in tiered school-based speech-language therapy: A Canadian example. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:786-801. [PMID: 36426768 DOI: 10.1111/1460-6984.12822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/28/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. AIMS The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. METHODS & PROCEDURES A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. FINDINGS & RESULTS Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. CONCLUSIONS & IMPLICATIONS School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended. WHAT THIS PAPER ADDS What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, ON, Canada
| | - Leah Dix
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Mark A Ferro
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lyn Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
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Moll D, Edwards L, Kelly G, Hamilton C, Price H. Using therapy outcome measures to identify the speech and language therapy needs of children and young people with severe acquired brain injury. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background/Aims Children and young people often require speech and language therapy input following severe acquired brain injury. However, there is limited understanding of the impact of post-acute neurorehabilitation on children and young people's communication and swallowing, and how to measure this. The aim of this study was to evaluate the initial and ongoing speech and language therapy needs of children and young people in one specialist paediatric neurorehabilitation centre, and to determine the usefulness of therapy outcome measures for this population. Methods A retrospective review was performed of routinely collected data, including therapy outcome measures for children and young people admitted to the centre. Descriptive analysis was completed for all therapy outcome measures data, and statistical significance of change during rehabilitation was determined on those with sufficient data using Wilcoxon signed-rank tests. Results A total of 165 records of children and young people aged between 1 and 17 years were reviewed. The average length of stay at the centre was 19.7 weeks. The most prevalent therapy outcome measures were cognition and dysphagia. Highly significant differences were found between admission and discharge in all therapy outcome measures scores, including participation (Wilcoxon Z=-9.523, P<0.001) and wellbeing (Wilcoxon Z=-7.656, P<0.001). Median discharge scores did not exceed 4 (from a maximum of 5) for any scales. Conclusions Therapy outcome measures were able to capture the complex profiles of these children and young people and could measure changes during post-acute neurorehabilitation. Children and young people presented with a range of speech and language therapy needs following severe acquired brain injury. They made significant improvements in impairment, activity, participation and wellbeing scales during rehabilitation. Children and young people left with ongoing speech and language therapy needs in all areas, which require input from community services.
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Affiliation(s)
- Deborah Moll
- Research and Development, Oxford Health NHS Foundation Trust, Oxford, UK
| | | | | | - Colin Hamilton
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Price
- Independent Speech and Language Therapist, Norwich, UK
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Cunningham BJ, Cermak C, Head J, Oram Cardy J. Clinical feasibility, utility, and usability of the Profile of Preschool Communication: A pilot test in community settings. JOURNAL OF COMMUNICATION DISORDERS 2022; 98:106232. [PMID: 35689872 DOI: 10.1016/j.jcomdis.2022.106232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/20/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
AIM . This study aimed to pilot test, assess usability and utility of, and identify barriers to implementation for the Profile of Preschool Communication (PPC) - a new data collection tool designed to support outcome monitoring in preschool speech-language programs and practice-based research. METHODS . This pilot study was conducted with three sites in the Ontario Preschool Speech and Language (PSL) program. Twenty-three speech-language pathologists used the PPC for all outcome monitoring assessments for 2-3-months and provided feedback about their experience using it in practice. Then, 18 of the 23 speech-language pathologists completed online surveys to rate usability and utility, and report their perceived implementation barriers and facilitators. RESULTS . Speech-language pathologists reported difficulties completing some sections of the PPC, most notably obtaining data related to maternal education and family history of mental health concerns. Usability and utility were generally rated favorably with some items rated as neutral. Barriers to implementation included the paper format, completion time, requirement to ask personal questions, and the perception by some that data were useful for outcome monitoring but not practice. Facilitators included ease of use, an improvement over the existing tool, and the collection of data to support service planning. CONCLUSIONS . The PPC shows potential as an outcome monitoring data collection tool in preschool speech-language pathology programs. Findings will be of interest to researchers engaged in practice-based research and those interested in engaging end users to develop clinically meaningful tools.
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Affiliation(s)
- Barbara Jane Cunningham
- School of Communication Sciences and Disorders, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton ON, L8S1C7, Canada.
| | - Carly Cermak
- School of Communication Sciences and Disorders, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Julianna Head
- School of Health Studies, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Janis Oram Cardy
- School of Communication Sciences and Disorders, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada
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Whillans C, Lawrie M, Cardell EA, Kelly C, Wenke R. A systematic review of group intervention for acquired dysarthria in adults. Disabil Rehabil 2020; 44:3002-3018. [PMID: 33356634 DOI: 10.1080/09638288.2020.1859629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing. MATERIALS AND METHODS A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University's Critical Review Form, and the TIDieR template for intervention description and replication. RESULTS 21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson's disease (PD) (97%; n = 321). Treatment approaches included singing therapy (n = 10), loudness therapy (n = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) (n = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches. CONCLUSION There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment.IMPLICATIONS FOR REHABILITATIONGroup therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson's disease.Studies' employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures.Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD.PROSPERO registration number: CRD42015029374.
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Affiliation(s)
- Chelsea Whillans
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia
| | - Melissa Lawrie
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia.,School of Allied Health Sciences, Griffith University, Southport, Australia
| | - Elizabeth A Cardell
- School of Allied Health Sciences, Griffith University, Southport, Australia.,Menzies Institute Queensland, Southport, Australia
| | - Crystal Kelly
- School of Allied Health Sciences, Griffith University, Southport, Australia
| | - Rachel Wenke
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia.,School of Allied Health Sciences, Griffith University, Southport, Australia
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Enderby P, Sutton L. Where are we now with aphasia after Stroke? Ann Indian Acad Neurol 2020; 23:S57-S62. [PMID: 33343127 PMCID: PMC7731688 DOI: 10.4103/aian.aian_666_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To provide a brief review of research literature relating to the current state of knowledge regarding speech and language therapy for people with aphasia and place these research findings within the context of outcome data of non-selected patients receiving usual therapy in the UK. METHODS Part 1 presents a literature search aimed at exploring up-to-date information related to the nature and evolution of aphasia, the impact of therapy and the changing nature of therapy. This provides the context of what may be achieved in rehabilitation. Part 2 examines of the impact of speech and language therapy on 1664 prospective patients receiving therapy for aphasia after stroke by 3 different types of service provision was collected and statistically analysed. The Therapy Outcome Measure was used to identify change in impairment, activity, participation and well-being at the beginning and end of therapy. RESULTS The findings from the non-selected group of patients supports the conclusions of the reported randomised control trials in that speech and language therapy for post stroke aphasia is associated with gains in one or more of the domains of the International Classification of Functioning.
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Affiliation(s)
- Pam Enderby
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, United Kingdom
| | - Laura Sutton
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, United Kingdom
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Palmer R, Dimairo M, Latimer N, Cross E, Brady M, Enderby P, Bowen A, Julious S, Harrison M, Alshreef A, Bradley E, Bhadhuri A, Chater T, Hughes H, Witts H, Herbert E, Cooper C. Computerised speech and language therapy or attention control added to usual care for people with long-term post-stroke aphasia: the Big CACTUS three-arm RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32369007 PMCID: PMC7232133 DOI: 10.3310/hta24190] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with aphasia may improve their communication with speech and language therapy many months/years after stroke. However, NHS speech and language therapy reduces in availability over time post stroke. OBJECTIVE This trial evaluated the clinical effectiveness and cost-effectiveness of self-managed computerised speech and language therapy to provide additional therapy. DESIGN A pragmatic, superiority, single-blind, parallel-group, individually randomised (stratified block randomisation, stratified by word-finding severity and site) adjunct trial. SETTING Twenty-one UK NHS speech and language therapy departments. PARTICIPANTS People with post-stroke aphasia (diagnosed by a speech and language therapist) with long-standing (> 4 months) word-finding difficulties. INTERVENTIONS The groups were (1) usual care; (2) daily self-managed computerised word-finding therapy tailored by speech and language therapists and supported by volunteers/speech and language therapy assistants for 6 months plus usual care (computerised speech and language therapy); and (3) activity/attention control (completion of puzzles and receipt of telephone calls from a researcher for 6 months) plus usual care. MAIN OUTCOME MEASURES Co-primary outcomes - change in ability to find treated words of personal relevance in a bespoke naming test (impairment) and change in functional communication in conversation rated on the activity scale of the Therapy Outcome Measures (activity) 6 months after randomisation. A key secondary outcome was participant-rated perception of communication and quality of life using the Communication Outcomes After Stroke questionnaire at 6 months. Outcomes were assessed by speech and language therapists using standardised procedures. Cost-effectiveness was estimated using treatment costs and an accessible EuroQol-5 Dimensions, five-level version, measuring quality-adjusted life-years. RESULTS A total of 818 patients were assessed for eligibility and 278 participants were randomised between October 2014 and August 2016. A total of 240 participants (86 usual care, 83 computerised speech and language therapy, 71 attention control) contributed to modified intention-to-treat analysis at 6 months. The mean improvements in word-finding were 1.1% (standard deviation 11.2%) for usual care, 16.4% (standard deviation 15.3%) for computerised speech and language therapy and 2.4% (standard deviation 8.8%) for attention control. Computerised speech and language therapy improved word-finding 16.2% more than usual care did (95% confidence interval 12.7% to 19.6%; p < 0.0001) and 14.4% more than attention control did (95% confidence interval 10.8% to 18.1%). Most of this effect was maintained at 12 months (n = 219); the mean differences in change in word-finding score were 12.7% (95% confidence interval 8.7% to 16.7%) higher in the computerised speech and language therapy group (n = 74) than in the usual-care group (n = 84) and 9.3% (95% confidence interval 4.8% to 13.7%) higher in the computerised speech and language therapy group than in the attention control group (n = 61). Computerised speech and language therapy did not show significant improvements on the Therapy Outcome Measures or Communication Outcomes After Stroke scale compared with usual care or attention control. Primary cost-effectiveness analysis estimated an incremental cost per participant of £732.73 (95% credible interval £674.23 to £798.05). The incremental quality-adjusted life-year gain was 0.017 for computerised speech and language therapy compared with usual care, but its direction was uncertain (95% credible interval -0.05 to 0.10), resulting in an incremental cost-effectiveness ratio of £42,686 per quality-adjusted life-year gained. For mild and moderate word-finding difficulty subgroups, incremental cost-effectiveness ratios were £22,371 and £28,898 per quality-adjusted life-year gained, respectively, for computerised speech and language therapy compared with usual care. LIMITATIONS This trial excluded non-English-language speakers, the accessible EuroQol-5 Dimensions, five-level version, was not validated and the measurement of attention control fidelity was limited. CONCLUSIONS Computerised speech and language therapy enabled additional self-managed speech and language therapy, contributing to significant improvement in finding personally relevant words (as specifically targeted by computerised speech and language therapy) long term post stroke. Gains did not lead to improvements in conversation or quality of life. Cost-effectiveness is uncertain owing to uncertainty around the quality-adjusted life-year gain, but computerised speech and language therapy may be more cost-effective for participants with mild and moderate word-finding difficulties. Exploring ways of helping people with aphasia to use new words in functional communication contexts is a priority. TRIAL REGISTRATION Current Controlled Trials ISRCTN68798818. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 19. See the NIHR Journals Library website for further project information. The Tavistock Trust for Aphasia provided additional support to enable people in the control groups to experience the intervention after the trial had ended.
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Affiliation(s)
- Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Munyaradzi Dimairo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nicholas Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elizabeth Cross
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marian Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pam Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Audrey Bowen
- Division of Neuroscience & Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Steven Julious
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Madeleine Harrison
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Abualbishr Alshreef
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ellen Bradley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Arjun Bhadhuri
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tim Chater
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Speech and Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Helen Witts
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Speech and Language Therapy, Derbyshire Community Health Services NHS Foundation Trust, Chesterfield, UK
| | - Esther Herbert
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Palmer R, Dimairo M, Cooper C, Enderby P, Brady M, Bowen A, Latimer N, Julious S, Cross E, Alshreef A, Harrison M, Bradley E, Witts H, Chater T. Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial. Lancet Neurol 2019; 18:821-833. [PMID: 31397288 PMCID: PMC6700375 DOI: 10.1016/s1474-4422(19)30192-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Post-stroke aphasia might improve over many years with speech and language therapy; however speech and language therapy is often less readily available beyond a few months after stroke. We assessed self-managed computerised speech and language therapy (CSLT) as a means of providing more therapy than patients can access through usual care alone. METHODS In this pragmatic, superiority, three-arm, individually randomised, single-blind, parallel group trial, patients were recruited from 21 speech and language therapy departments in the UK. Participants were aged 18 years or older and had been diagnosed with aphasia post-stroke at least 4 months before randomisation; they were excluded if they had another premorbid speech and language disorder caused by a neurological deficit other than stroke, required treatment in a language other than English, or if they were currently using computer-based word-finding speech therapy. Participants were randomly assigned (1:1:1) to either 6 months of usual care (usual care group), daily self-managed CSLT plus usual care (CSLT group), or attention control plus usual care (attention control group) with the use of computer-generated stratified blocked randomisation (randomly ordered blocks of sizes three and six, stratified by site and severity of word finding at baseline based on CAT Naming Objects test scores). Only the outcome assessors and trial statistician were masked to the treatment allocation. The speech and language therapists who were doing the outcome assessments were different from those informing participants about which group they were assigned to and from those delivering all interventions. The statistician responsible for generating the randomisation schedule was separate from those doing the analysis. Co-primary outcomes were the change in ability to retrieve personally relevant words in a picture naming test (with 10% mean difference in change considered a priori as clinically meaningful) and the change in functional communication ability measured by masked ratings of video-recorded conversations, with the use of Therapy Outcome Measures (TOMs), between baseline and 6 months after randomisation (with a standardised mean difference in change of 0·45 considered a priori as clinically meaningful). Primary analysis was based on the modified intention-to-treat (mITT) population, which included randomly assigned patients who gave informed consent and excluded those without 6-month outcome measures. Safety analysis included all participants. This trial has been completed and was registered with the ISRCTN, number ISRCTN68798818. FINDINGS From Oct 20, 2014, to Aug 18, 2016, 818 patients were assessed for eligibility, of which 278 (34%) participants were randomly assigned (101 [36%] to the usual care group; 97 [35%] to the CSLT group; 80 [29%] to the attention control group). 86 patients in the usual care group, 83 in the CSLT group, and 71 in the attention control group contributed to the mITT. Mean word finding improvements were 1·1% (SD 11·2) in the usual care group, 16·4% (15·3) in the CSLT group, and 2·4% (8·8) in the attention control group. Word finding improvement was 16·2% (95% CI 12·7 to 19·6; p<0·0001) higher in the CSLT group than in the usual care group and was 14·4% (10·8 to 18·1) higher than in the attention control group. Mean changes in TOMs were 0·05 (SD 0·59) in the usual care group (n=84), 0·04 (0·58) in the CSLT group (n=81), and 0·10 (0·61) in the attention control group (n=68); the mean difference in change between the CSLT and usual care groups was -0·03 (-0·21 to 0·14; p=0·709) and between the CSLT and attention control groups was -0·01 (-0·20 to 0·18). The incidence of serious adverse events per year were rare with 0·23 events in the usual care group, 0·11 in the CSLT group, and 0·16 in the attention control group. 40 (89%) of 45 serious adverse events were unrelated to trial activity and the remaining five (11%) of 45 serious adverse events were classified as unlikely to be related to trial activity. INTERPRETATION CSLT plus usual care resulted in a clinically significant improvement in personally relevant word finding but did not result in an improvement in conversation. Future studies should explore ways to generalise new vocabulary to conversation for patients with chronic aphasia post-stroke. FUNDING National Institute for Health Research, Tavistock Trust for Aphasia.
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Affiliation(s)
- Rebecca Palmer
- Deparment of Health Service Research, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Munyaradzi Dimairo
- Clinical Trials Research Unit (CTRU), ScHARR, The University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Clinical Trials Research Unit (CTRU), ScHARR, The University of Sheffield, Sheffield, UK.
| | - Pam Enderby
- Deparment of Health Service Research, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Marian Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, The University of Manchester MAHSC, Manchester, UK
| | - Nicholas Latimer
- Department of Health Economics and Decision Science, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Steven Julious
- Department of Design, Trials and Statistics, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Elizabeth Cross
- Clinical Trials Research Unit (CTRU), ScHARR, The University of Sheffield, Sheffield, UK
| | - Abualbishr Alshreef
- Department of Health Economics and Decision Science, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Madeleine Harrison
- Deparment of Health Service Research, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Ellen Bradley
- Clinical Trials Research Unit (CTRU), ScHARR, The University of Sheffield, Sheffield, UK
| | - Helen Witts
- Deparment of Health Service Research, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK; Speech and Language Therapy, Derbyshire Community Health Services NHS Foundation Trust, Chesterfield, UK
| | - Tim Chater
- Clinical Trials Research Unit (CTRU), ScHARR, The University of Sheffield, Sheffield, UK
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Steele CM, Namasivayam-MacDonald AM, Guida BT, Cichero JA, Duivestein J, Hanson B, Lam P, Riquelme LF. Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. Arch Phys Med Rehabil 2018; 99:934-944. [PMID: 29428348 PMCID: PMC5961739 DOI: 10.1016/j.apmr.2018.01.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. DESIGN Participants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. SETTING Web-based survey. PARTICIPANTS Respondents (N=170) from 29 countries. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Consensual validity (percent agreement and Kendall τ), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). RESULTS The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (>70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. CONCLUSIONS This initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians to capture diet texture restriction and progression in people with dysphagia.
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Affiliation(s)
- Catriona M Steele
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada; Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, Australia.
| | - Ashwini M Namasivayam-MacDonald
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada; Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, Australia
| | - Brittany T Guida
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Julie A Cichero
- International Dysphagia Diet Standardisation Initiative, Brisbane, QLD, Australia; School of Pharmacy, University of Queensland, Brisbane, QLD, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Janice Duivestein
- International Dysphagia Diet Standardisation Initiative, Brisbane, QLD, Australia; Access Community Therapists, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Ben Hanson
- International Dysphagia Diet Standardisation Initiative, Brisbane, QLD, Australia; University College London, London, UK
| | - Peter Lam
- International Dysphagia Diet Standardisation Initiative, Brisbane, QLD, Australia; University of British Columbia, Vancouver, BC, Canada; Peter Lam Consulting, Vancouver, BC, Canada
| | - Luis F Riquelme
- International Dysphagia Diet Standardisation Initiative, Brisbane, QLD, Australia; New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY; New York Medical College, Valhalla, NY
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Does the NRS Capture Changes in Communication during Inpatient Stroke Rehabilitation? J Stroke Cerebrovasc Dis 2017; 26:2181-2190. [PMID: 28595967 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/29/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Ontario, the National Rehabilitation Reporting System (NRS) is mandated for use as a measurement of change for stroke patients after admission to and discharge from rehabilitation. The NRS includes the functional independence measure (FIM) and supplementary measurement items developed by the Canadian Institute for Health Information (CIHI). Uncertainty exists regarding the efficacy of the NRS as the sole measure of outcome for communication in stroke rehabilitation patients. The use of additional speech-language pathology outcome measurement tools for this population has therefore been suggested. OBJECTIVES This study sought to establish whether the FIM and CIHI communication items capture quantifiable gains during stroke rehabilitation and therefore whether additional measures are needed to assess outcomes. METHODS A retrospective analysis was completed of 1252 complete data records of stroke patients discharged from inpatient rehabilitation at Hamilton Health Sciences between 2006 and 2011. RESULTS AND IMPACT Statistically significant improvements were observed in all total matched FIM scores (M = 72.68 to M = 96.39, P < .001) and for each expression (M = 4.61 to M = 5.35, P < .001) and comprehension (M = 4.69 to M = 5.33, P < .001) subscale. The most severely affected group demonstrated the greatest gains. These findings were independent of stroke severity. Additional outcome measurement tools for communication are therefore not required to assess outcomes in rehabilitation of stroke patients, although additional research is necessary to evaluate the clinical significance of the improvements that are observed using existing measurements of change.
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Roulstone SE, Marshall JE, Powell GG, Goldbart J, Wren YE, Coad J, Daykin N, Powell JE, Lascelles L, Hollingworth W, Emond A, Peters TJ, Pollock JI, Fernandes C, Moultrie J, Harding SA, Morgan L, Hambly HF, Parker NK, Coad RA. Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2015. [PMID: 26312364 DOI: 10.3310/pgfar03050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BackgroundThe Child Talk study aimed to develop an evidence-based framework to support the decision-making of speech and language therapists (SLTs) as they design and plan interventions appropriate to the needs of individual children with primary speech and language impairments and their families. The need for early identification and effective intervention for these children continues to be a government policy priority because of the link between children’s early speech and language skills and their broader well-being and outcomes in later life. The first phase of Child Talk sought to map and describe current SLT practice for these children; identify and summarise the existing research evidence relating to practice; and investigate the perspectives of parents, early years practitioners, preschool children and ‘underserved’ communities on speech and language therapy. The second phase of Child Talk focused on the development of a toolkit – assessment tools, outcome measures and a data set – to support future service and economic evaluations of the framework.MethodsChild Talk adopted a mixed-methods design. Quantitative methods included surveys and investigated the prevalence and patterns of intervention usage; qualitative data collection methods included focus groups, interviews and reflection to investigate participants’ perspectives and understandings of interventions. Data analysis methods included descriptive and inferential statistics, thematic and content analysis and framework analysis. Participants were recruited nationally through six NHS sites, professional bodies, parent groups and advertising. Participants included SLTs (n = 677), parents (n = 84), preschool children (n = 24), early years practitioners (n = 31) and ‘underserved’ communities (n = 52).Key findingsSpeech and language therapy interventions were characterised in terms of nine themes, viewed as comprehensive and inclusive by practitioners. Relevant assessments, interventions and outcome domains were identified for the nine themes. Areas of tacit knowledge and underspecified processes contributed to variability in the detail of the framework. Systematic reviews identified 58 relevant and robust studies (from 55,271 papers retrieved from the initial literature search). The number of studies relevant to each theme varied from 1 to 33. Observational data on preschool children’s perspectives on speech and language therapy interventions revealed the dynamic nature of their interaction with different activities and people within therapy sessions. Parents’ experiences of speech and language therapy were generally positive although some reported that the rationale for therapy was not always clear. Parental perspectives in underserved communities suggested that, although parents were confident about how to support children’s language development, they were less informed about the nature of language impairments and the function of speech and language therapy. The availability of information regarding resources directed towards speech and language therapy services was poor. In particular, services lacked both a culture of collecting outcome data routinely and measures of professional input and costs associated with their activities.ConclusionA descriptive framework of SLT practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures. Further research is needed to address gaps in the intervention framework and evaluate its effectiveness and cost-effectiveness in improving outcomes for preschool children with primary speech and language impairments.Study registrationThis study is registered as PROSPERO CRD42013006369.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Sue E Roulstone
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Julie E Marshall
- Research Institute for Health and Social Change, Manchester Metropolitan University, Manchester, UK
| | | | - Juliet Goldbart
- Research Institute for Health and Social Change, Manchester Metropolitan University, Manchester, UK
| | - Yvonne E Wren
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
| | - Jane Coad
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| | - Norma Daykin
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Jane E Powell
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | | | - Alan Emond
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jon I Pollock
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Jenny Moultrie
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
| | - Sam A Harding
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
| | - Lydia Morgan
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
| | - Helen F Hambly
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
| | - Naomi K Parker
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
| | - Rebecca A Coad
- Bristol Speech & Language Therapy Research Unit, Frenchay Hospital, Bristol, UK
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Isaksen JK. 'It really makes good sense': the role of outcome evaluation in aphasia therapy in Denmark. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2014; 49:90-99. [PMID: 24112797 DOI: 10.1111/1460-6984.12049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Measuring or evaluating outcomes is a common activity for many speech-language therapists (SLTs). A major focus has been on external forces claiming outcome evaluation to optimize quality and the use of resources without integrating the viewpoints of SLTs. AIMS To identify the purpose of outcome evaluation by letting SLTs identify not only the actual demands for outcome evaluation, but also the role of outcome evaluation in aphasia therapy in the clinic. METHODS & PROCEDURES Twelve SLTs participated in semi-structured interviews to identify the demands they met for outcome evaluation as well as the role the outcome evaluation had in their work with people with aphasia. The interviews were transcribed verbatim and analysed by means of qualitative thematic analysis. OUTCOMES & RESULTS Six themes corresponding with the aims of this study were identified. These show that the SLTs initially evaluated outcomes because of external demands and interests. However, they also describe the process as a necessary activity inherent to therapy and state that they would not want to be without it. The outcome evaluation is seen as an interactive process between SLTs, clients and possibly significant others. Not only it is seen as a product in which outcome and/or client satisfaction is documented, but also it is described as a dynamic process that benefits the clients, significant others, the therapy and the SLTs themselves in various ways. This role of outcome evaluation ranges from enhancement of insight and promotion of acceptance for the clients and significant others to planning the next step in therapy or in life with aphasia after therapy. In all of which the clients play a significant role, since their active participation is sought throughout the sessions. CONCLUSION & IMPLICATIONS The results suggest an interesting relationship between treatment policy and treatment practice, where an initial administrative initiative to conduct outcome evaluation is adopted by the SLTs and made into a meaningful part of therapy in which the clients play a significant role.
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Lamontagne ME, Routhier F, Auger C. Team Consensus Concerning Important Outcomes for Augmentative and Alternative Communication Assistive Technologies: A Pilot Study. Augment Altern Commun 2013; 29:182-9. [DOI: 10.3109/07434618.2013.784927] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Providing a quality service for people with aphasia is a primary goal of speech-language pathologists working with neurogenic communication disorders. This paper reviews what is known about the incidence and prevalence of aphasia and what services are provided for people with aphasia. On the basis of the stroke data, the incidence of aphasia in the developed world ranges between 0.02-0.06% with prevalence ranging between 0.1-0.4%. Average hours of treatment for aphasic people in the developed world ranges between 1-5 hours per week, with a great deal of variability, although recent research suggests that intense treatment of ∼9 hours per week over a relatively short period is needed in order to be effective. It is concluded that there is a significant gap between what the research suggests is the appropriate amount of treatment and actual provision throughout the English-speaking world.
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Affiliation(s)
- Chris Code
- University of Exeter–Psychology, Washington Singer Labs, Exeter, UK.
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