Lass Norman J, Pannbacker Mary
West Virginia University, Morgantown, WV 26506-6122, USA.
Lang Speech Hear Serv Sch. 2008 Jul;39(3):408-21. doi: 10.1044/0161-1461(2008/038).
The purpose of this article is to help speech-language pathologists (SLPs) apply the principles of evidence-based practice (EBP) to nonspeech oral motor treatments (NSOMTs) in order to make valid, evidence-based decisions about NSOMTs and thus determine if they are viable treatment approaches for the management of communication disorders.
A detailed description of EBP is provided, including levels of evidence for rating the quality of evidence. NSOMTs are described and a survey of the literature on NSOMTs is provided along with a determination of the level of evidence of each study reported. A systematic literature search was conducted using the electronic databases of MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) within an unrestricted time period. In addition, reference lists from identified articles were also reviewed. Ethical and fiscal issues related to EBP and NSOMTs, as well as clinical implications of EBP for the use of NSOMTs, are discussed.
A total of 45 articles/reports were published between 1981 and 2006 in peer-reviewed and non-peer-reviewed journals. Most of the sources (25) relied on weak anecdotal evidence and opinions. Moreover, studies that employed stronger designs reported negative results for NSOMTs (i.e., evidence against the use of NSOMTs for modifying speech).
Despite their use for many years and their popularity among some SLPs for the treatment of a wide variety of speech problems in children and adults, NSOMTs are controversial because sufficient evidence does not exist to support their effectiveness in improving speech. Moreover, limited evidence exists for the use of NSOMTs to facilitate nonspeech activities. Therefore, the available evidence does not support the continued use of NSOMTs as a standard treatment and they should be excluded from use as a mainstream treatment until there are further data. SLPs should consider the principles of EBP in making decisions about NSOMTs.
本文旨在帮助言语语言病理学家（SLP）将循证实践（EBP）原则应用于非言语口腔运动治疗（NSOMT），以便就NSOMT做出有效的、基于证据的决策，从而确定它们是否是管理沟通障碍的可行治疗方法。
提供了EBP的详细描述，包括用于评估证据质量的证据级别。描述了NSOMT，并提供了关于NSOMT的文献综述以及对所报告的每项研究的证据级别判定。在不受限制的时间段内，使用MEDLINE和CINAHL（护理及相关健康文献累积索引）电子数据库进行了系统的文献检索。此外，还查阅了已识别文章的参考文献列表。讨论了与EBP和NSOMT相关的伦理和财务问题，以及EBP对NSOMT使用的临床意义。
1981年至2006年期间，共有45篇文章/报告发表在同行评审和非同行评审期刊上。大多数资料来源（25个）依赖于薄弱的轶事证据和观点。此外，采用更强设计的研究报告了NSOMT的负面结果（即反对使用NSOMT来改善言语的证据）。
尽管NSOMT已使用多年且在一些SLP中很受欢迎，用于治疗儿童和成人的各种言语问题，但NSOMT存在争议，因为没有足够的证据支持其在改善言语方面的有效性。此外，关于使用NSOMT促进非言语活动的证据有限。因此，现有证据不支持继续将NSOMT作为标准治疗方法使用，在有更多数据之前，应将其排除在主流治疗方法之外。SLP在就NSOMT做出决策时应考虑EBP原则。
