No systemancally-established benchmarks on these measures to show change. Creates challenges for clinicians and researchers alike

Transcription

1 A systema)c review of outcome measures u)lized in aphasia treatment research, including meta-analysis Natalie Gilmore, Michaela Dwyer, Swathi Kiran Boston University Aphasia Research Laboratory Wide variety of outcome measures used in aphasia treatment research (Brady, Kelly, Godwin, Enderby, Campbell, 2016; Wallace, Worrall, Rose & Le Dorze, 2014; Xiong, Bunning, Horton & Hartley, 2011) No systemancally-established benchmarks on these measures to show change Creates challenges for clinicians and researchers alike

2 Useful frameworks for classifying aphasia assessments and interven)ons World Health OrganizaNon (WHO) ICF model (WHO, 2002) A-FROM (Kagan et al., 2008)

3 Group Use Ac)on Many different treatment approaches Body Structure/Func)on Ac)vity/Par)cipa)on Quality of Life Loca)on Associa)on Proper)es Boyle & Coehlo, 1995 Aten, Caligiuri, Holland, 1982 Elman, 2016 Many different assessment measures Body Structure/Func)on Ac)vity/Par)cipa)on Quality of Life Kertesz, 2006 Holland, Fra\ali, & Fromm, 1999 Hilari, Byng, Lamping & Smith, 2003

4 Showing change from interven)on is essen)al Inconsistency in measurement use Clinicians (Hesketh & Hopcu\, 1997; Worrall & Egan, 2001; Simmons-Mackie, Threats & Kagan, 2004) Researchers (Brady et al., 2016, Wallace et al., 2014) Steps to manage this challenge Improving Research Outcome Measurement in Aphasia (ROMA) & Core Outcome Set (COS)(Wallace et al., 2014) Yet, what is the average change on these measures? <- our primary aim Clinicians -> Choose appropriate tools -> Efficacy & reimbursement Researchers -> Select best measures -> Appropriately-powered studies & easier meta-analyses

5 Specific Aims of this project 1 Iden)fica)on of outcome measures used in behavioral aphasia treatment research 2 Classifica)on of interven)ons and outcome measures according to their associa)on with health and health-related domains using ICF & A-FROM 3 Calcula)on of the mean significant change reported on the most frequently-used and most relevant outcome measures

6 Methods Preferred ReporNng Items for SystemaNc Review and Meta-analysis Protocol (PRISMA-P) Registered on InternaNonal ProspecNve Register of SystemaNc Reviews (PROSPERO) Comprehensive literature search Screening, data extracnon and ranng of quality of evidence 2 independent reviewers

7 Literature Search 12 databases: PubMed CINAHL PsychInfo SpeechBite EMBASE SCOPUS Web of Science PLoS Worldcat NARIC GoogleScholar LinguisNc & Language Behavior Abstracts (LLBA) Sample Search Strategy : aphasia AND treatment OR therapy OR intervennon OR rehabilitanon OR outcome OR training OR educanon AND adult NOT primary progressive aphasia OR demenna OR deglunnon disorders OR transcranial magnenc snmulanon OR transcranial direct current snmulanon NOT pharmaceuncal preparanons

8 Eligibility Criteria Included: Behavioral aphasia treatment studies Used standardized outcome measure to measure change Randomized-controlled trials, quasi-experimental studies, single-subject designs and case reports (i.e., N of 3) Excluded: Diagnoses of primary progressive aphasia, demenna, traumanc brain injury (TBI), voice impairment, dysarthria and apraxia of speech (AOS) Drug treatments or neuro-modulanon (e.g., repennve transcranial magnenc snmulanon (rtms)) QualitaNve research designs Studies evaluanng the validity of an assessment tool

9 Iden)fica)on Records iden)fied through database searching (n = 15,809) Addi)onal records iden)fied through other sources (n = 151) Screening Titles and abstracts screened (n =9285) Records a[er duplicates removed (n = 9285) Excluded (n = 8428) Eligibility Full-text ar)cles assessed for eligibility (n = 858) Excluded with reasons (n=548) Wrong popula)on = 60 Not behavioral treatment = 3 Not treatment study = 80 N of 1 = 3 N of 2 = 7 Non-English = 11 Not peer-reviewed = 9 Duplicate = 9 Other = 2 No standardized measure =330 Duplicate data set = 29 Ongoing study = 5 Included Studies included in qualita)ve synthesis (n = 310) Studies included in quan)ta)ve synthesis TBD ajer IARC 2016 Moher D, LiberaN A, Tetzlaff J, Altman DG, The PRISMA Group (2009) PRISMA Flow Diagram

10 Next steps Select measures from each ICF domain for meta-analysis Likely opnons: Revised Western Aphasia Ba\ery (WAB) (Kertesz, 2006) CommunicaNve EffecNveness Index (CETI) (Lomas et al., 1989) Conduct meta-analyses for select set of measures THANK YOU FOR YOUR ATTENTION! Natalie Gilmore, Michaela Dwyer & Swathi Kiran Boston University Aphasia Research Laboratory Please forward ques)ons to