JCPSLP Vol 18 No. 1Mar 2016

Table 1. Descriptive characteristics for participants who received the LSVT ® LOUD Group according tomode of delivery of LSVT ® LOUD Gender Mean age (years) (SD) Meantimepostonset of PD (years) (SD)

Dysarthriaseverity rating

Mean stage of PD (SD)

2 (.95)

Face-to-facemetro(n=15) Male = 10 Female = 5

71.23 (9.43)

3.91 (2.94)

Mild = 12 Moderate = 2 Severe = 1 Mild = 11 Moderate = 2 Severe = 1 Mild = 15 Moderate = 5 Severe = 0

1.57 (.39)

Telerehabilitation Metro (n = 14)

Male = 10 Female = 4

71.76 (8.05)

4.36 (3.88)

2.2 (1.11)

Telerehabilitation Rural (n =20)

Male = 14 Female = 6

69.19 (8.82)

4.7 (3.03)

Note. SD = Standard deviation

disagree responses receive a score of 5 and strongly agree responses receive a score of 1. The DIP was completed once prior to, and again post-treatment. The DIP total score was calculated from the sum of the scores from each section. Speech treatment The participants were treated by certified clinicians using the LSVT ® LOUD program of 16 one-hour sessions, four days a week, for four weeks (Trail et al., 2005). Homework and carry-over tasks were tailored to facilitate each participants’motivation, engagement and to continue to drive the neuroplasticity changes activated by the treatment (Fox et al., 2012). Data analysis Data analysis was conducted using IBM SPSS Statistics Version 22. Comparison of treatment outcomes (dB level in monologue and DIP total score) between the three groups using a linear mixed model indicated that there was no significant differences between the groups with respect to group-time interaction on these measures (Monologue: F = 0.234; p = .791; DIP total score: F = 0.089; p = .915). This finding allowed for the pooling of all group data for subsequent data analyses. Paired t-tests were completed on the pooled data (n = 49), and were used to establish any change to dB level in monologue, from baseline to the completion of treatment. A paired t-test was also used to compare the mean of the DIP total score, pre- and post-treatment. To examine the relationship between mean expectancy and average credibility with the differences in dB level in monologue and the DIP total scores from pre- to post- intervention, nonparametric Spearman rank correlations were performed. Secondary analyses were conducted using Spearman rank correlation to examine the relationship between credibility and expectancy with the participant variables age, time post onset of PD, severity of dysarthria and stage of PD. For this analysis, it was necessary to include two participants with a severe dysarthria in the moderate group as the analysis could not be completed on a group of two. Significance for correlation coefficients was set at p < .05. The following criteria were used to interpret the magnitude of correlation coefficients: coefficients of .25 were considered low, coefficients of .26 to .50 were considered fair, coefficients of .51 to .75 were considered good, and coefficients of >.75 were considered excellent (Portney &Watkins, 2000).

treatment itself. The current study will report on the results of patient expectations and treatment credibility data, with reference to the primary clinical outcome measure (difference in dB level in monologue), and one quality-of-life measure (Dysarthria Impact Profile [DIP] total score difference). In order to determine patient expectations of the intervention and treatment credibility, an expectation and credibility questionnaire was administered prior to treatment. The participants completed this questionnaire independently after having read the participant information sheet, which outlined the intervention but also indicated that they may not directly benefit from the intervention. The questionnaire was adapted from the Credibility and Expectations Questionnaire (CEQ; Devilly & Borkovek, 2000) and comprised of two sets of questions. Adaptation to the questionnaire involved the substitution of the phrase ‘trauma symptoms’ with ‘speech difficulties’ in two questions. Questions 1–3 from set I and question 1 from set II assessed the perception of treatment credibility on a 9-point scale, with 0 representing not at all/logical/ useful/confident, and 9 representing very much/logical/ useful/confident. The mean treatment credibility score for the group was derived from the average score of these four questions. Question 4 from set I and question 2 from set II related to patients’ expectations of the treatment. These questions were rated on a 0–100% scale. The mean expectation score for the group was derived from the average score of these two questions. The primary outcome measure of the effectiveness of the speech treatment was determined by having each participant talk about a familiar topic for a minute and a half. This monologue was recorded and the average dB level of the participant’s speech was measured using calibrated software. This outcome measure is a standard measure of vocal volume in numerous studies relating to LSVT®LOUD (Howell, Tripoliti, & Pring, 2009; Ramig et al., 1995). This assessment was administered twice prior to and after treatment, with a 2-day interval between assessments. The DIP explores the psychosocial impact of acquired dysarthria from the speaker’s perspective. The DIP consists of four sections with a total of 48 statements (Walshe, Peach, & Miller, 2009). The person with dysarthria rates each statement on a 5-point scale from strongly agree to strongly disagree. There are positively worded statements where strongly agree responses receive a score of 5 and strongly disagree responses receive a score of 1. Negatively worded statements are the reverse. Strongly


JCPSLP Volume 18, Number 1 2016

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