ACQ Vol 13 No1 2011

Table 1. Search terms PICO

Search terms

Notes

Patient or problem

“progressive aphasia”

Multiple search terms were required given the different labels for progressive aphasia that exist in the literature.

“progressive non fluent aphasia or progressive non-fluent aphasia” and “semantic dementia” and “fronto-temporal dementia or frontotemporal dementia or frontotemporal lobar degeneration”

Intervention

“intervention or treatment$ or therap$”

$ indicates that the search term is truncated. The search engine will pick up any words starting with that letter string (e.g. therapy, therapies, therapeutic). You are interested in any interventions done with this clinical population.

Comparison intervention No search terms

Outcomes

No search terms

You are interested in any treatment outcomes.

You limit your search to English language papers and human studies (in order to exclude research on drug therapies tested in animal models). Because you have designed your search to be exhaustive in identifying possible evidence-based treatments, it retrieves 457 studies. Many of these, however, describe experimental pharmacological interventions or pathological mechanisms, rather than speech, language or communication interventions. By listing the results by title, 100 per page, it is possible to scroll through to identify only the speech- language pathology interventions. You find a critical review of all intervention studies published to mid-2007 (Croot, Nickels, Laurence, & Manning, 2009), a review of anomia treatment in semantic dementia (Henry, Beeson, & Rapcsak, 2008a), and 6 of the further studies in Table 2. Next you search the SpeechBITE TM database that catalogues published speech pathology interventions, searching on the term “progressive aphasia” and scanning articles listed for the client subgroup “Alzheimer’s and other dementias”, which yields one additional study, not yet pre- appraised. Search results are summarised in Table 2, and rated for level of evidence according to the NHMRC Levels of Evidence Hierarchy, where level I represents the highest level of evidence and level IV the lowest (NHMRC, 2009).

but rather to identify what the evidence is for any relevant interventions in order to decide what your service should offer. Outcomes The outcome (increased intelligibility, word retrieval, sentence comprehension, social participation, etc.) would be determined by the type of therapy, and you are keeping your options open on the type of therapy for the time being. Clinical question The final clinical question you formulate is, “What evidence is there to include speech, language or communication inter- ventions in the speech pathology services provided for people referred with one of the types of progressive aphasia?” Searching for the evidence The first databases you search are Medline, PreMedline, and PsychINFO and the database of Cochrane Reviews. These are all available via the Ovid SP gateway, which means they can be searched at the same time. Because the search engine can remove duplicates if you select this option, this is more efficient than searching the 4 databases serially. Table 1 outlines the keywords that were generated and searched to find any relevant literature.

Table 2. Research articles identified Articles identified Purpose

Level of evidence (NHMRC, 2009)

Croot et al. (2009)

Reviews published impairment- and activity/participation-directed interventions

Reviews a mix of Level IV studies

in semantic dementia and progressive aphasia

and others

Diehl et al. (2003)

Pilot support group for spouse-carers of people with frontotemporal dementia,

Not applicable

reports survey of carers after group

Henry et al. (2008a)

Reviews anomia treatment in semantic dementia

Reviews a mix of Level IV studies and others

Henry et al. (2008b)

Semantic treatment for anomia in progressive vs. stroke-induced aphasia

IV

Jokel et al. (2010)

Computer-based treatment for anomia in semantic dementia

IV

Newhart et al. (2009)

Spoken naming therapy using a cueing hierarchy in 2 cases, one logopenic

IV

progressive aphasia and one semantic dementia

Robinson et al. (2009)

Therapy naming, defining and using objects in 2 individuals with semantic

IV

dementia

Rogalski & Edmonds

Attentive reading and constrained summarisation (ARCS) treatment to promote IV intentional language use and attentional focus to improve discourse in a man with PPA

(2008)

Taylor et al. (2009)

Reports a survey of PPA referrals to NSW speech pathologists and services

Not applicable

provided Note. PPA = primary progressive aphasia

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ACQ Volume 13, Number 1 2011

ACQ uiring knowledge in speech, language and hearing