Abstract
BackgroundSpeech-related problems are common in Parkinson’s disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®).MethodsThe PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6–8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings.ResultsEighty-nine patients were randomised with 90% in the therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: − 12.5 points; 95% CI − 26.2, 1.2) and SLT (difference at 3 months compared with control: − 9.8 points; 95% CI − 23.2, 3.7) which needs to be confirmed in an adequately powered trial.ConclusionRandomisation to a three-arm trial of speech therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial.Trial registrationInternational Standard Randomised Controlled Trial Number Register: ISRCTN75223808. registered 22 March 2012.
Highlights
Speech-related problems are common in Parkinson’s disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®)
Cochrane reviews have summarised the evidence for the efficacy of various forms of SLT in PD, but concluded that there was insufficient evidence to support the use of one form of SLT over another and recommended a large, methodologically sound randomised controlled trial (RCT), with follow-up of at least 6 months and meaningful outcome measures. [12, 13]
6% of screened participants declined the trial which suggests that the study was acceptable to patients
Summary
Speech-related problems are common in Parkinson’s disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). [6] One technique that has been used in PD is attention to effort, where the speaker is asked to produce a loud voice and focus their effort on attaining, monitoring, and maintaining this. This technique was formalised in an evidence-based commercially available programme provided by the Lee Silverman Voice Treatment (LSVT LOUD®) organisation from the late 1980s. Cochrane reviews have summarised the evidence for the efficacy of various forms of SLT in PD, but concluded that there was insufficient evidence to support the use of one form of SLT over another and recommended a large, methodologically sound randomised controlled trial (RCT), with follow-up of at least 6 months and meaningful outcome measures. [12, 13]
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