Therapy Outcome Measures Research Articles

The effect of tDCS on functional connectivity in primary progressive aphasia.

Transcranial direct current stimulation (tDCS) is an innovative technique recently shown to improve language outcomes even in neurodegenerative conditions such as primary progressive aphasia (PPA), but the underlying brain mechanisms are not known. The present study tested whether the additional language gains with repetitive tDCS (over sham) in PPA are caused by changes in functional connectivity between the stimulated area (the left inferior frontal gyrus (IFG)) and the rest of the language network.We scanned 24 PPA participants (11 female) before and after language intervention (written naming/spelling) with a resting-state fMRI sequence and compared changes before and after three weeks of tDCS or sham coupled with language therapy. We correlated changes in the language network as well as in the default mode network (DMN) with language therapy outcome measures (letter accuracy in written naming).Significant tDCS effects in functional connectivity were observed between the stimulated area and other language network areas and between the language network and the DMN. TDCS over the left IFG lowered the connectivity between the above pairs. Changes in functional connectivity correlated with improvement in language scores (letter accuracy as a proxy for written naming) evaluated before and after therapy.These results suggest that one mechanism for anodal tDCS over the left IFG in PPA is a decrease in functional connectivity (compared to sham) between the stimulated site and other posterior areas of the language network. These results are in line with similar decreases in connectivity observed after tDCS over the left IFG in aging and other neurodegenerative conditions.

A feasibility randomized controlled trial of ReaDySpeech for people with dysarthria after stroke

Objective: To evaluate the feasibility of a multicentre randomized controlled trial of ReaDySpeech, an online speech therapy programme for people with dysarthria. Design: Feasibility randomized controlled trial, 2:1 minimization procedure. Setting: Four UK NHS services across hospital and community. Participants: Forty participants with dysarthria at least one week post-stroke. Interventions/comparator: ReaDySpeech with usual care (n = 26) versus usual care only (n = 14). Main outcomes: Feasibility measures included the following: recruitment and retention rate, time taken to carry out assessments, success of outcome assessor blinding, fidelity and adherence. Participant baseline and outcome measures collected before and after 8–10 weeks of intervention were the Frenchay Dysarthria Assessment II, Therapy Outcome Measure, Communication Outcomes After Stroke Scale, EQ-5D-5L and Dysarthria Impact Profile. Results: Recruited 40 participants out of 74 eligible people, 1–13 weeks post stroke and mean age 69 years (37–99). Retention was very high (92%). Assessor blinding was not achieved with intervention allocation correctly guessed for 70% of participants (26/37). Time to carry out assessments was acceptable to participants. ReaDySpeech was delivered to 16 of 26 allocated participants, who completed 55% of prescribed activities, but both interventions were delivered at low intensity (mean 6.6 face-to-face sessions of 40-minute duration). Conclusion: Recruitment and retention in this randomized controlled trial of computerized therapy for dysarthria is feasible for acute stroke. However, further feasibility work is needed to evaluate whether it is possible to recruit chronic stroke; increase intervention delivery, intensity and adherence; achieve outcome assessor blinding by video-recording and to determine sample size for a larger trial of effectiveness.

Living with incurable cancer: what are the rehabilitation needs in a palliative setting?

Background: Increasing numbers of people are living with incurable cancers. Symptoms, side effects, and treatment burdens impact on physical functioning, yet little is known about the impact on people’s lives and how best to provide rehabilitation.Materials and methods: A qualitative study employing a phenomenological approach explored the lived experience of incurable cancer. A purposive sample of six people participated in semi-structured interviews. The data were analysed thematically at a semantic level to identify the functional difficulties experienced by people living with incurable cancer, the meanings of those difficulties, and participants perceived rehabilitation needs.Results: People living with incurable cancer described cancer-related issues spanning all five domains of the International Classification of Functioning, Disability and Health (ICF). Although highly valued amongst study participants, rehabilitation services were difficult to access, poorly utilised, and referrals were sporadic and consequential; indicative of poor awareness of rehabilitation for people with incurable cancer amongst potential referrers.Discussion: Participants valued a change in terminology away from “palliative” towards more positive language in line with enhanced supportive care movements. Validated tools such as the Palliative Care Therapy Outcome Measure, which align with the ICF, would allow rehabilitation professionals to demonstrate maintenance or improvement in participation and wellbeing.Implications for RehabilitationIncurable cancer leads to a fluctuating multifactorial disability.People living with incurable cancer can benefit from rehabilitation input throughout their illness.Offering flexible and varied rehabilitation options for people living with incurable cancer will increase physical and emotional well-being, function, and coping.Allied health professionals should take and create opportunities to promote rehabilitation for people living with incurable cancer and their services to other potentially referring healthcare professionals to increase understanding of benefits and utilisation of available services for people living with incurable cancer.

Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem - A proof of concept study

Background & aimsStroke involving the brainstem (SBS) causes severe oropharyngeal dysphagia (OD). Research on the therapeutic efficacy of vagus nerve modulation (VNM) by using repetitive transcranial magnetic stimulation (rTMS) in SBS patients with OD has been limited thus far. We aimed to assess the effect of VNM by using rTMS in improving swallowing function after SBS. MethodWe conducted a sham-controlled, double-blinded, parallel pilot study in 28 SBS patients with OD randomly allocated to a real rTMS group (n = 13; TMSreal) or a sham group (n = 15; TMSsham). For VNM, 5-Hz rTMS was applied to the left mastoid in 10 sessions. We evaluated all patients for swallowing function before and after rTMS conditioning, assessed on the 8-point Penetration–Aspiration Scale (PAS) through videofluoroscopy and the Australian Therapy Outcome Measures–Swallowing scale (AusTOMs). We measured the amplitude and latency of cricopharyngeal motor evoked potentials (CP-MEPs) as the neurophysiological parameters. ResultsTMSreal exhibited significant improvement in all swallowing outcomes—neurophysiological, radiological, and functional—compared with TMSsham: We noted higher CP-MEP amplitude (p = 0.004), shorter CP-MEP latency (p = 0.004), a lower PAS score (p = 0.001), and a higher AusTOMs score (p < 0.001) following rTMS in TMSreal. Moreover, the neurophysiological improvements were significantly correlated with the functional outcomes (p < 0.05). ConclusionsOur results encourage the application of VNM by using rTMS for improving swallowing function after SBS. The immediate therapeutic effects suggest that this novel intervention can be an effective complementary therapy to traditional oropharyngeal rehabilitation. Clinical trial registrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02893033.

Implementing routine outcome monitoring in public mental health services in Israel: Shared and unique challenges.

This study aimed to assess the feasibility, benefits, and challenges of routine outcome monitoring (ROM) in a public mental health centre in Israel. This is the first initiation of ROM implementation in a setting of a large psychiatric hospital, affiliated with the largest health maintenance organization in Israel, Clalit Health Services. Four ambulatory units were invited to participate in the implementation of ROM. Prior to initiation of recruitment, staff meetings were held and broad descriptions of current knowledge regarding benefits and challenges were discussed. Upon initiation of recruitment, patients completed outcome and process questionnaires during each session, and reports of patients' progress were sent to therapists soon after sessions ended. One hundred sixty-three patients were invited to participate in measurement and feedback of therapy outcomes. Overall, 101 patients and 32 therapists agreed and actively participated in the implementation phase of ROM, producing 535 evaluated measurements and reports. Clinical, methodological, legal, administrative, and ethical aspects of the implementation were encountered and documented throughout the implementation process. Medical confidentiality issues, as well as the multidisciplinary nature of hospital staff work, serve as central and unique challenges for incorporating ROM in a public psychiatric hospital. Other challenges that were previously reported in other implementation studies were also encountered and included therapist overload and objections, attrition, and the need for organizational support. Recommendations for future pioneering efforts for ROM implementation in large psychiatric facilities are discussed.

P.339 - Generation of a new, inducible model of FSHD that develops overt myopathic phenotypes

Autosomal dominant Facioscapulohumeral muscular dystrophy (FSHD) is among the most prevalent muscular dystrophies, estimated to affect as many as 1 in 8,333 individuals worldwide. FSHD was classified as a major form of muscular dystrophy in 1954, but the pathogenic events leading to the disease have only recently started coming into focus. Several studies now support an FSHD pathogenesis model involving aberrant expression of the DUX4 gene, which encodes a myotoxic transcription factor. The emergence of DUX4 represented a momentum shift in the FSHD field as we are no longer solely focused on understanding FSHD pathogenesis, and can now turn an eye toward translational research. Mouse models are important tools for translational research, but there are currently no published DUX4-expressing germline models that develop myopathic phenotypes useful as outcome measures, largely due to the extreme toxicity of DUX4 making it difficult to generate such animals. The absence of valid FSHD mice is a hurdle to testing therapies, thereby making development of FSHD mouse models a critical need in the field. Our goal was to generate an FSHD mouse model that develops to adulthood, contains a heritable transgene, and shows myopathic phenotypes that can be used as outcome measures for DUX4-targeted therapies. We created a novel FSHD mouse model in which DUX4 can be expressed in skeletal muscle using Tamoxifen-inducible CRE recombinase (called iDUX4 mice). We have generated the first FSHD mouse model that expresses a heritable DUX4 transgene and displays myopathic phenotypes useful as outcome measures for therapy development, including molecular, histopathological, and functional deficits. Our iDUX4 mice display Tamoxifen and DUX4 dose-dependent molecular, histopathological, and functional deficits associated with muscular dystrophy and will be used for testing therapeutic strategies targeting DUX4.

Analysing and interpreting outcomes data to support evidence-based practice using the example of AusTOMs-OT

Statement of context Occupational therapists working with clients who have neurological impairments routinely collect outcomes data. However, data cannot inform practice unless it is routinely reviewed. The aim of this paper was to show how outcomes data collected on the Australian Therapy Outcome Measures – Occupational Therapy scale were analysed and interpreted. Although the example pertains to clients with neurological problems, the approach can be applied to all areas of practice. Critical reflection on practice When outcomes data are routinely analysed and findings reviewed, occupational therapists have an increased understanding of practice strengths and limitations. Implications for practice Incorporating analysis and interpretation of outcomes data for clients with neurological problems into practice contributes evidence to support therapy and ensures clinicians retain control of their data.

Strategies for inhibiting quorum sensing.

The ability of bacterial cells to synchronize their behaviour through quorum sensing (QS) regulatory networks enables bacterial populations to mount co-operative responses against competing micro-organisms and host immune defences and to adapt to environmental challenges. Since QS controls the ability of many pathogenic bacteria to cause disease, it is an attractive target for novel antibacterial agents that control infection through inhibition of virulence and by rendering biofilms more susceptible to conventional antibiotics and host clearance pathways. QS systems provide multiple druggable molecular targets for inhibitors (QSIs) that include the enzymes involved in QS signal molecule biosynthesis and the receptors involved in signal transduction. Considerable advances in our understanding of the chemical biology of QS systems and their inhibition have been made, some promising QS targets structurally characterized, QSI screens devised and inhibitors identified. However, much more work is required before any QSI 'hits' with the appropriate pharmacological and pharmacokinetic properties can enter human clinical trials. Indeed, the relative efficacy of QSIs alone or as prophylactics or therapeutics or as adjuvants in combination with conventional antibiotics still needs to be extensively evaluated in vivo. Particular attention must be given to the measurement of successful QSI therapy outcomes with respect to bacterial clearance, immune response and pathophysiology. Currently, our understanding of the potential of QS as a promising antibacterial target suggests that it is likely to be of value with respect to a limited number of major pathogens.

Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review.

Primary hyperhidrosis is a condition characterized by excessive sweating. Patients are treated off-license with oral anticholinergic medications and report adverse events associated with systemic anticholinergic interactions. This review assesses clinical evidence of efficacy, impact on quality of life and adverse events associated with oral anticholinergic therapy for primary hyperhidrosis. PRISMA guidelines were implemented to complete a systematic review (PROSPERO:CRD42016036326). MEDLINE, EMBASE and PubMed were searched from 1946 to 2015. Inclusion criteria included observational and experimental studies, anticholinergic medication use in primary hyperhidrosis, oral therapy and clear diagnostic and outcome measures. Twenty-three articles relevant to the inclusion criteria were analysed. Oxybutynin therapy improved symptoms in an average of 76.2% (range 60-97%) patients and improved QOL in 75.6% (range 57.6-100%) of patients. Methantheline bromide therapy was associated with a 41% reduction in axillary sweating, 16.4% reduction in palmar sweating, 25% decrease in HDSS score and 40.9% increase in DLQI score. Outcome measures of glycopyrrolate therapy were too variable to collate. Dry mouth was reported in 73.4% (range 43.3-100%) of participants taking oxybutynin 10 mg/day, 38.6% (range 27.8-63.2%) of patients taking glycopyrrolate and 68.8% of patients taking methantheline bromide. Nine studies reported that patients stopped therapy due to adverse events. In eight of these studies, a mean of 10.9% of total participants ceased treatment due to dry mouth. Evidence of oral anticholinergic therapy for hyperhidrosis is limited. However, its use is associated with improvement in quality of life and clinical symptoms but at the cost of considerable adverse events.

Development and psychometric properties of the Psychological Therapies Outcome Scale - Intellectual Disabilities (PTOS-ID).

There are few valid and reliable psychological therapy outcome measures available for use with people with intellectual disabilities (ID). The current study involved the development of a new scale; the Psychological Therapies Outcome Scale - Intellectual Disabilities (PTOS-ID), and the examination of its validity and internal consistency. The PTOS-ID was administered to 175 people who have ID accessing specialist ID services. The construct validity of the scale was investigated through exploratory factor analysis, concurrent validity through comparison with the Brief Symptom Inventory and internal reliability through internal consistency analysis. Three factors emerged from the principal components analysis with high levels of internal consistency: (1) anger and mood (α=0.82); (2) positive well-being (α=0.81); and (3) anxiety (α=0.76). Factors (1) and (2) were combined to measure psychological distress (α=0.85), which correlated strongly with the Global Severity Index of the Brief Symptom Inventory (r=0.85). This preliminary study suggests that the PTOS-ID is a psychometrically robust measure of psychological distress and psychological well-being that can be used with people with ID. Further research is required to assess its reliability and ability to detect change.

Music in Dementia Assessment Scales (MiDAS): clinical relevance, cultural adaptation and its contribution to psychosocial research in dementia

Background: Music in Dementia Assessment Scales (MiDAS) is a validated outcome measure for music therapy with people with dementia. In preparation for multi-centre studies, there was a need to develop a systematic procedure for translating and adapting music therapy outcome measures. Investigation of the clinical relevance of MiDAS and its value and limitations in the wider context of psychosocial research in dementia was also necessary.Methods: Cultural adaptation and translation procedures were developed through literature review, expert and peer consultations and field-testing. Feedback from music therapists in Denmark, Norway and the UK was obtained. Expert opinions on MiDAS were sought from INTERDEM researchers involved in recommendation of outcome measures for dementia psychosocial research across Europe.Results: Danish and Norwegian MiDAS were produced. A guideline on translation and adaptation procedures for music therapy outcome measures was published.Conclusions: MiDAS is a reliable tool to eval...

Quantifying Visual Dysfunction and the Response to Surgery in Macular Pucker

To measure the effects of macular pucker (MP) on macular structure and quantify function by measuring visual acuity (VA), contrast sensitivity (CS), and distortions. The effects of surgery were quantitatively evaluated using these measures. Prospective, comparative case series. Fifty-three patients with unilateral MP and normal fellow eyes: 24 operated MP subjects, 17 unoperated controls, and 12 reproducibility subjects. Posterior vitreous detachment was diagnosed by ultrasound and ellipsoid zone disruption (EZD) was determined by OCT, which also measured macular thickness and volume. Vision was assessed, bymeasuring VA (logMAR) and CS (Freiburg acuity contrast testing: Weber index, %W). A visual distortions index (%DI) was calculated using 3-dimensional threshold Amsler grid testing. Comparisons to controls were performed before surgery and at 1, 3, 6, and 12 months after vitrectomy/membrane peel without chromodissection. Posterior vitreous detachment (ultrasound), EZD (OCT), macular thickness and volume (OCT), VA (logMAR), CS (%W), distortions (%DI). Posterior vitreous detachment was present in 90% of MP eyes, but only 50% of fellow eyes (P< 0.001). All structural and functional indices were worse (28% to 5-fold) in the 24 operated MP eyes than the 17 unoperated MP eyes (P < 0.001). Before surgery, EZD was present in 33% of operated MP eyes but none of the unoperated MP eyes (P < 0.02). The macula was thicker (514±85 μm vs. 257±59 μm; P < 0.001) with greater volume (3.22±0.56 μl vs. 2.14±0.22 μl; P < 0.001) in operated MP eyes than normal fellow eyes. Before surgery, MP eyes had VA = 0.53 logMAR (Snellen equivalent, 20/67) vs. controls = 0.21 (20/32); P < 0.001; CS was 8.61±5.36 %W vs. controls = 3.71±1.47 %W (P < 0.001); and distortions were 7.61±12.6 %DI vs. controls = 0.13±0.61 %DI (P < 0.001). EZD was associated with worse VA (P < 0.01) and CS (P < 0.03) before and after surgery. Each outcome measure improved progressively at 1, 3, 6, and 12 months after surgery, but only %DI and macular volume normalized. These quantitative measures characterize the impact of MP on macular structure and function. All indices improved after surgery, but only distortions and macular volume normalized. Contrast sensitivity measurements and quantification of distortions can objectively assess visual dysfunction in MP and may be useful outcome measures of therapy.

Impact of voice and communication deficits for individuals with cervical spinal cord injury living in the community.

Post-spinal cord injury (SCI), individuals may exhibit mild to moderate impairments in aspects of speech influenced by impaired respiratory support. However, limited research has been conducted into the impact of these impairments on activity and participation when living in the community. To examine the nature and extent of voice and communication function in a group of individuals with cervical SCI living in the community, and to explore participant perceptions of the impact of these deficits on levels of activity and participation. Participants included 14 individuals who had sustained a SCI above C8 level and had returned to living in the community. All completed a series of speech and voice assessments, the Voice Handicap Index, the Australian Therapy Outcome Measures Voice scale, four voice perception questions, and the General Short Form of the Communicative Participation Item Bank. As a group, participants were found to have reduced vocal intensity and phonatory duration. Vocal quality was mildly altered in 93% and pitch control, breath support for speech, speech rate and phrase length impacted in one-quarter or more of the group. All reported impacts, though three individuals reported that their impairments had more extensive impact on communication in daily life. Individuals post-SCI experience mild speech and voice deficits that can have negative impacts on functional communication. The monitoring of communication function may help to identify those individuals who could benefit from additional support and intervention on return to community life.

Methodological issues in the design and evaluation of supported communication for aphasia training: a cluster-controlled feasibility study

ObjectiveTo assess the feasibility and acceptability of training stroke service staff to provide supported communication for people with moderate–severe aphasia in the acute phase; assess the suitability of outcome measures;...

Suicide Ideation Is Related to Therapeutic Alliance in a Brief Therapy for Attempted Suicide

The objective of this study was to investigate the role of therapeutic alliance on suicide ideation as outcome measure in a brief therapy for patients who attempted suicide. Sixty patients received the 3-session therapy supplemented by follow-up contact through regular letters. Therapeutic alliance was measured with the Helping Alliance Questionnaire (HAQ). Outcome at 6 and 12 months was measured with the Beck Scale for Suicide Ideation (BSS). Therapeutic alliance increased from session 1 to session 3. Higher alliance measures correlated with lower suicidal ideation at 12 months follow-up. A history of previous attempts and depression had a negative affect on therapeutic alliance. The results suggest that in the treatment of suicidal patients therapeutic alliance may be a moderating factor for reducing suicide ideation.

Multiple phonetically trained-listener comparisons of speech before and after articulatory intervention in two children with repaired submucous cleft palate

ABSTRACTCleft Palate (CP) assessments based on phonetic transcription are the “gold standard” therapy outcome measure, despite reliability difficulties. Here we propose a novel perceptual evaluation, applied to ultrasound-visual biofeedback (U-VBF) therapy and therapy using visual articulatory models (VAMs) for two children with repaired submucous CP.Three comparisons were made: post VAM, post U-VBF and overall pre- and post-therapy. Twenty-two phonetically-trained listeners were asked to determine whether pre- or post-therapy recordings sounded “closer to the English target”, using their own implicit phonological knowledge (prompted via orthographic representation). Results are compared with segment-oriented percent target consonant correct (PTCC) derived from phonetic transcriptions.Listener judgements and PTCC suggest that both children made improvements using both VAM and U-VBF. Statistical analysis showed listener agreement in each comparison, though agreement was weak. However, perceptual evaluation offers a straightforward method of evaluating the effectiveness of interventions and can be used by phonetically trained or lay listeners.

In the Groove: An Evaluation to Explore a Joint Music Therapy and Occupational Therapy Intervention for Children with Acquired Brain Injury

An acquired brain injury in children disrupts brain development and neural pathways, which may have serious implications on occupational role performance. Assessment and management of children with neurological disorders is complex and treatment requires the engagement of a multidisciplinary team. Increasing evidence indicates that both occupational therapists and music therapists work effectively towards similar goals with children with acquired brain injury. This evaluation investigated the effectiveness of a joint music therapy and occupational therapy group in promoting the development of self-regulation skills in children with an acquired brain injury or neurological condition, as part of a pilot project at a regional paediatric hospital in Australia. Six participants, aged five and half to ten years, were recruited through the acquired brain injury and neurology outpatient service at a regional paediatric hospital. Children underwent occupational therapy assessment and were identified to have sensory processing difficulties that negatively impacted on the child’s occupational roles of "friend" and "student." The intervention group, In the Groove, received seven, weekly, one-hour sessions, held for one hour on a weekly basis. Each session involved a variety of joint music therapy and occupational therapy activities, specifically planned to achieve intervention goals. A range of standardised occupational therapy and music therapy outcome measures were used, as well as non-standardised measures. All children received positive outcomes following intervention for at least one outcome measure. The findings indicate that joint music therapy and occupational therapy intervention may provide children with acquired brain injury and neurological impairment opportunities to develop self-regulation skills.

Native T1 values identify myocardial changes and stratify disease severity in patients with Duchenne muscular dystrophy

BackgroundDuchenne muscular dystrophy (DMD) is an X-linked, inherited disorder causing dilated cardiomyopathy with variable onset and progression. Currently we lack objective markers of the effect of therapies targeted towards preventing progression of subclinical cardiac disease. Thus, our aim was to compare the ability of native T1 and extracellular volume (ECV) measurements to differentiate risk of myocardial disease in DMD and controls.MethodsTwenty boys with DMD and 16 age/gender-matched controls without history predisposing to cardiac fibrosis, but with a clinical indication for cardiovascular magnetic resonance (CMR) evaluation, underwent CMR with contrast. Data points collected include left ventricular ejection fraction (LVEF), left ventricular mass, and presence of late gadolinium enhancement (LGE). Native T1, and ECV regional mapping were obtained using both a modified Look-Locker (MOLLI) and saturation recovery single shot sequence (SASHA) on a 1.5T scanner. Using ordinal logistic regression models, controlling for age and LVEF, LGE-free septal we evaluated the ability native T1 and ECV assessments to differentiate levels of cardiomyopathy.ResultsTwenty DMD subjects aged 14.4 ± 4 years had an LVEF of 56.3 ± 7.4 %; 12/20 had LGE, all confined to the lateral wall. Sixteen controls aged 16.1 ± 2.2 years had an LVEF 60.4 ± 5.1 % and no LGE. Native T1 and ECV values were significantly higher in the DMD group (p < 0.05) with both MOLLI and SASHA imaging techniques. Native T1 demonstrated a 50 % increase in the ability to predict disease state (control, DMD without fibrosis, DMD with fibrosis). ECV demonstrated only the ability to predict presence of LGE, but could not distinguish between controls and DMD without fibrosis.ConclusionsLGE-spared regions of boys with DMD have significantly different native T1 and ECV values compared to controls. Native T1 measurements can identify early changes in DMD patients without the presence of LGE and help predict disease severity more effectively than ECV. Native T1 may be a novel outcome measure for early cardiac therapies in DMD and other cardiomyopathies.

Can the sum of pooled data from observational studies better evaluate outcome measures for therapies in coronary artery disease?

ABSTRACTRandomized control trials (RCTs) are considered the gold standard in the hierarchy of evidence based medicine. Guidelines and recommendations for clinical practice are based on the strength of evidence in this hierarchical tree. This article looks at the weakness of RCTs and variance between large pooled observational data and trial results for some of the historical trials in coronary artery disease. Observational studies can supplement data from resource intensive RCTs. Guidelines for reporting and analysis however need to be rigorous. It further discusses alternate systems of hierarchies as basis for recommendations.

The Changing Face of Hallucination Research: The International Consortium on Hallucination Research (ICHR) 2015 Meeting Report.

This article reports on the Third Biennial Meeting of the International Consortium on Hallucinations Research, held in Melbourne, Australia, in October 2015. Following a public conference in which research findings were considered in relation to subjective experience and practice, 9 multidisciplinary working groups examined key current issues in progressing the conceptualization and research of hallucinations. Work group topics included: multicenter validation of the transdiagnostic and multimodal Questionnaire for Psychotic Experiences; development of an improved outcome measure for psychological therapies; the relationship between inhibition and hallucinations across multiple levels of explanation; hallucinations in relation to sleep phenomena; emotion and hallucinations; multiple interactions between the experience of self and hallucinations; interactions between language, auditory and memory networks; resting state networks including the default mode; and analyses arising from functional magnetic resonance imaging (fMRI) data-sharing. Major themes in hallucinations research identified during the meeting included (1) progression beyond the auditory verbal modality in schizophrenia to consider hallucinations across modalities and different populations; (2) development of new measures; (3) the central role of multisite collaboration through shared data collection and data pooling; (4) study of time-based and interactive models of hallucination; and (5) the need to increase the accessibility and availability of "real-life" interventions for people with persisting and distressing hallucinations.