A five-phase model for clinical-outcome research

ArticleinJournal of Communication Disorders 37(5):401-11 · May 2004with163 Reads
DOI: 10.1016/j.jcomdis.2004.04.003 · Source: PubMed
Unlabelled: Through a variety of approaches, speech-language pathologists and audiologists have produced strong evidence that treatments are generally potent. However, we have largely ignored the accepted standards for clinical-outcome testing used throughout the broader research community (e.g., by other clinical disciplines, federal regulators, and third-party payers). Several clinical professions recognize a comprehensive model for organizing and scaffolding the many forms of clinical-outcome research. An adaptation of this five-phase model of clinical-outcome research is examined as a means for structuring forms of clinical research throughout audiology and speech-language pathology. Within the organizing structure, relationships become apparent between types and grades of scientific evidence and the processes underpinning evidence-based practice which ultimately lead to decisions on the status of intervention protocols. Learning outcomes: Readers will be able to distinguish the phases of clinical-outcome research in a comprehensive model. Readers will be able to identify relationships between the structure of the model and broadly recognized concepts associated with the terms 'efficacy' and 'effectiveness.' Readers will be able to identify indicators of quality for controlled clinical trials.
    • "On the other hand, the different levels of parental involvement may reflect the phase of phonology-based intervention research. As shown in the review by Baker and McLeod (2011), researchers in the field of phonology-based SSD have focused on efficacy, rather than effectiveness studies, which necessitate a greater degree of scientific control during intervention (Robey 2004 ). The inclusion of parents and home tasks introduces additional variables to determining the efficacy of an intervention; researchers may have been wary of including them in intervention protocols in order to maintain levels of control. "
    [Show abstract] [Hide abstract] ABSTRACT: Internationally, speech and language therapists (SLTs) are involving parents and providing home tasks in intervention for phonology-based speech sound disorder (SSD). To ensure that SLTs’ involvement of parents is guided by empirical research, a review of peer-reviewed published evidence is needed. To provide SLTs and researchers with a comprehensive appraisal and analysis of peer-reviewed published intervention research reporting parent involvement and the provision of home tasks in intervention studies for children with phonology-based SSD. A systematic search and review was conducted. Academic databases were searched for peer-reviewed research papers published between 1979 and 2013 reporting on phonological intervention for SSD. Of the 176 papers that met the criteria, 61 were identified that reported on the involvement of parents and/or home tasks within the intervention. These papers were analysed using a quality appraisal tool. Details regarding the involvement of parents and home tasks were extracted and analysed to provide a summary of these practices within the evidence base. Parents have been involved in intervention research for phonology-based SSD. However, most of the peer-reviewed published papers reporting this research have provided limited details regarding what this involved. This paucity of information presents challenges for SLTs wishing to integrate external evidence into their clinical services and clinical decision-making. It also raises issues regarding treatment fidelity for researchers wishing to replicate published intervention research. The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.
    Full-text · Article · Mar 2016
    • "Due to small participant numbers following partial glossectomy, current methodological standards suggest use of single case experimental design (SCED, Tate, et al., 2014; Tate, et al., 2013). For this phase I intervention study (Robey, 2004), a SCED was used with multiple baseline measures across behaviors replicated with a second participant. The study comprised three phases (A-B-A): "
    [Show abstract] [Hide abstract] ABSTRACT: Disordered speech is common following treatment for tongue cancer, however there is insufficient high quality evidence to guide clinical decision making about treatment. This study investigated use of ultrasound tongue imaging as a visual feedback tool to guide tongue placement during articulation therapy with two participants following partial glossectomy. A Phase I multiple baseline design across behaviors was used to investigate therapeutic effect of ultrasound visual feedback during speech rehabilitation. Percent consonants correct and speech intelligibility at sentence level were used to measure acquisition, generalization and maintenance of speech skills for treated and untreated related phonemes, while unrelated phonemes were tested to demonstrate experimental control. Swallowing and oromotor measures were also taken to monitor change. Sentence intelligibility was not a sensitive measure of speech change, but both participants demonstrated significant change in percent consonants correct for treated phonemes. One participant also demonstrated generalization to non-treated phonemes. Control phonemes along with swallow and oromotor measures remained stable throughout the study. This study establishes therapeutic benefit of ultrasound visual feedback in speech rehabilitation following partial glossectomy. Learning outcomes: Readers will be able to explain why and how tongue cancer surgery impacts on articulation precision. Readers will also be able to explain the acquisition, generalization and maintenance effects in the study. (C) 2016 Published by Elsevier Inc.
    Full-text · Article · Mar 2016
    • "The pain and concept of pleasure acceptance of others, self-motivation and taking responsibility have been adopted by the participants. The present study was in agreement with the earlier studies [27][28][29][30]indicating the changes in locus of control have also been reported as predicting the maintenance of therapeutic gains or the relapse in stuttering therapy. These findings also collaborate with Blomgren et al. [31], who carried out similar study in 29 participants and examined the treatment outcome of stuttering. "
    Article · Jan 2016 · Journal of Communication Disorders
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