TY - JOUR

T1 - Lee Silverman voice treatment versus NHS speech and language therapy versus control for dysarthria in people with Parkinson's disease (PD COMM)

T2 - pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial

AU - Sackley, Catherine M

AU - Rick, Caroline

AU - Brady, Marian C

AU - Woolley, Rebecca

AU - Burton, Christopher

AU - Patel, Smitaa

AU - Masterson-Algar, Patricia

AU - Nicoll, Avril

AU - Smith, Christina H

AU - Jowett, Sue

AU - Ives, Natalie

AU - Beaton, Gillian

AU - Dickson, Sylvia

AU - Ottridge, Ryan

AU - Sharp, Leslie

AU - Nankervis, Helen

AU - Clarke, Carl E

AU - PD COMM collaborative group, null

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2024/7/10

Y1 - 2024/7/10

N2 - OBJECTIVES: To assess the clinical effectiveness of two speech and language therapy approaches versus no speech and language therapy for dysarthria in people with Parkinson's disease.DESIGN: Pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial.SETTING: The speech and language therapy interventions were delivered in outpatient or home settings between 26 September 2016 and 16 March 2020.PARTICIPANTS: 388 people with Parkinson's disease and dysarthria.INTERVENTIONS: Participants were randomly assigned to one of three groups (1:1:1): 130 to Lee Silverman voice treatment (LSVT LOUD), 129 to NHS speech and language therapy, and 129 to no speech and language therapy. LSVT LOUD consisted of four, face-to-face or remote, 50 min sessions each week delivered over four weeks. Home based practice activities were set for up to 5-10 mins daily on treatment days and 15 mins twice daily on non-treatment days. Dosage for the NHS speech and language therapy was determined by the local therapist in response to the participants' needs (estimated from prior research that NHS speech and language therapy participants would receive an average of one session per week over six to eight weeks). Local practices for NHS speech and language therapy were accepted, except for those within the LSVT LOUD protocol. Analyses were based on the intention to treat principle.MAIN OUTCOME MEASURES: The primary outcome was total score at three months of self-reported voice handicap index.RESULTS: People who received LSVT LOUD reported lower voice handicap index scores at three months after randomisation than those who did not receive speech and language therapy (-8.0 points (99% confidence interval -13.3 to -2.6); P<0.001). No evidence suggests a difference in voice handicap index scores between NHS speech and language therapy and no speech and language therapy (1.7 points (-3.8 to 7.1); P=0.43). Patients in the LSVT LOUD group also reported lower voice handicap index scores than did those randomised to NHS speech and language therapy (-9.6 points (-14.9 to -4.4); P<0.001). 93 adverse events (predominately vocal strain) were reported in the LSVT LOUD group, 46 in the NHS speech and language therapy group, and none in the no speech and language therapy group. No serious adverse events were recorded.CONCLUSIONS: LSVT LOUD was more effective at reducing the participant reported impact of voice problems than was no speech and language therapy and NHS speech and language therapy. NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy.TRIAL REGISTRATION: ISRCTN registry ISRCTN12421382.

AB - OBJECTIVES: To assess the clinical effectiveness of two speech and language therapy approaches versus no speech and language therapy for dysarthria in people with Parkinson's disease.DESIGN: Pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial.SETTING: The speech and language therapy interventions were delivered in outpatient or home settings between 26 September 2016 and 16 March 2020.PARTICIPANTS: 388 people with Parkinson's disease and dysarthria.INTERVENTIONS: Participants were randomly assigned to one of three groups (1:1:1): 130 to Lee Silverman voice treatment (LSVT LOUD), 129 to NHS speech and language therapy, and 129 to no speech and language therapy. LSVT LOUD consisted of four, face-to-face or remote, 50 min sessions each week delivered over four weeks. Home based practice activities were set for up to 5-10 mins daily on treatment days and 15 mins twice daily on non-treatment days. Dosage for the NHS speech and language therapy was determined by the local therapist in response to the participants' needs (estimated from prior research that NHS speech and language therapy participants would receive an average of one session per week over six to eight weeks). Local practices for NHS speech and language therapy were accepted, except for those within the LSVT LOUD protocol. Analyses were based on the intention to treat principle.MAIN OUTCOME MEASURES: The primary outcome was total score at three months of self-reported voice handicap index.RESULTS: People who received LSVT LOUD reported lower voice handicap index scores at three months after randomisation than those who did not receive speech and language therapy (-8.0 points (99% confidence interval -13.3 to -2.6); P<0.001). No evidence suggests a difference in voice handicap index scores between NHS speech and language therapy and no speech and language therapy (1.7 points (-3.8 to 7.1); P=0.43). Patients in the LSVT LOUD group also reported lower voice handicap index scores than did those randomised to NHS speech and language therapy (-9.6 points (-14.9 to -4.4); P<0.001). 93 adverse events (predominately vocal strain) were reported in the LSVT LOUD group, 46 in the NHS speech and language therapy group, and none in the no speech and language therapy group. No serious adverse events were recorded.CONCLUSIONS: LSVT LOUD was more effective at reducing the participant reported impact of voice problems than was no speech and language therapy and NHS speech and language therapy. NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy.TRIAL REGISTRATION: ISRCTN registry ISRCTN12421382.

KW - Humans

KW - Parkinson Disease/complications

KW - Dysarthria/etiology

KW - Male

KW - Female

KW - Speech Therapy/methods

KW - Aged

KW - Language Therapy/methods

KW - United Kingdom

KW - Middle Aged

KW - Treatment Outcome

KW - Voice Training

KW - State Medicine

U2 - 10.1136/bmj-2023-078341

DO - 10.1136/bmj-2023-078341

M3 - Article

C2 - 38986549

VL - 386

SP - e078341

JO - BMJ

JF - BMJ

SN - 0959-8138

ER -