Herd Clare P, Tomlinson Claire L, Deane Katherine H O, Brady Marian C, Smith Christina H, Sackley Catherine M, Clarke Carl E
School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, Birmingham, UK.
Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD002812. doi: 10.1002/14651858.CD002812.pub2.
Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and language therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids.
To compare the efficacy of speech and language therapy versus placebo or no intervention for speech and voice problems in patients with Parkinson's disease.
Relevant trials were identified by electronic searches of numerous literature databases including MEDLINE, EMBASE, and CINAHL, as well as handsearching of relevant conference abstracts and examination of reference lists in identified studies and other reviews. The literature search included trials published prior to 11(th) April 2011.
Only randomised controlled trials (RCT) of speech and language therapy versus placebo or no intervention were included.
Data were abstracted independently by CH and CT and differences settled by discussion.
Three randomised controlled trials with a total of 63 participants were found comparing SLT with placebo for speech disorders in Parkinson's disease. Data were available from 41 participants in two trials. Vocal loudness for reading a passage increased by 6.3 dB (P = 0.0007) in one trial, and 11.0 dB (P = 0.0002) in another trial. An increase was also seen in both of these trials for monologue speaking of 5.4 dB (P = 0.002) and 11.0 dB (P = 0.0002), respectively. It is likely that these are clinically significant improvements. After six months, patients from the first trial were still showing a statistically significant increase of 4.5 dB (P = 0.0007) for reading and 3.5 dB for monologue speaking. Some measures of speech monotoni city and articulation were investigated; however, all these results were non-significant.
AUTHORS' CONCLUSIONS: Although improvements in speech impairments were noted in these studies, due to the small number of patients examined, methodological flaws, and the possibility of publication bias, there is insufficient evidence to conclusively support or refute the efficacy of SLT for speech problems in Parkinson's disease. A large well designed placebo-controlled RCT is needed to demonstrate SLT's effectiveness in Parkinson's disease. The trial should conform to CONSORT guidelines. Outcome measures with particular relevance to patients with Parkinson's disease should be chosen and patients followed for at least six months to determine the duration of any improvement.
帕金森病患者常伴有言语和发声问题，包括构音障碍、音量降低和清晰度丧失。这些症状会随着疾病进展而在频率和强度上增加。言语和语言治疗（SLT）旨在通过行为治疗技术或辅助工具提高言语清晰度。
比较言语和语言治疗与安慰剂或无干预措施对帕金森病患者言语和嗓音问题的疗效。
通过对多个文献数据库进行电子检索来识别相关试验，这些数据库包括MEDLINE、EMBASE和CINAHL，同时还手动检索了相关会议摘要，并查阅了已识别研究及其他综述中的参考文献列表。文献检索涵盖了2011年4月11日前发表的试验。
仅纳入言语和语言治疗与安慰剂或无干预措施对比的随机对照试验（RCT）。
数据由CH和CT独立提取，差异通过讨论解决。
共发现三项随机对照试验，总计63名参与者，比较了帕金森病言语障碍患者接受SLT与安慰剂治疗的情况。两项试验中有41名参与者的数据可供分析。在一项试验中，朗读文章时的嗓音响度增加了6.3 dB（P = 0.0007），在另一项试验中增加了11.0 dB（P = 0.0002）。在这两项试验中，独白时嗓音响度也分别增加了5.4 dB（P = 0.002）和11.0 dB（P = 0.0002）。这些很可能是具有临床意义的改善。六个月后，第一项试验中的患者朗读时嗓音响度仍有统计学显著增加，为4.5 dB（P = 0.0007），独白时增加了3.5 dB。还对一些言语单调性和清晰度的指标进行了研究；然而，所有这些结果均无统计学意义。
尽管这些研究中注意到言语障碍有所改善，但由于所研究的患者数量较少、存在方法学缺陷以及可能存在发表偏倚，目前尚无足够证据确凿支持或反驳SLT对帕金森病言语问题的疗效。需要开展一项设计良好的大规模安慰剂对照RCT来证明SLT在帕金森病中的有效性。该试验应符合CONSORT指南。应选择与帕金森病患者特别相关的结局指标，并对患者随访至少六个月以确定任何改善的持续时间。
