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):CD002814. doi: 10.1002/14651858.CD002814.pub2.
Patients with Parkinson's disease commonly suffer from speech and voice difficulties such as impaired articulation and reduced loudness. Speech and language therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids.
To compare the efficacy and effectiveness of novel SLT techniques versus a standard SLT approach to treat Parkinsonian speech problems.
We identified relevant, published prior to 11(th) April 2011, by electronic searches of numerous literature databases including CENTRAL, MEDLINE and CINAHL, as well as handsearching relevant conference abstracts and examining reference lists in identified studies and other reviews.
Only randomised controlled trials (RCT) of one type of speech and language therapy versus another were included.
Two review authors independently extracted data and resolved differences by discussion.
Six trials involving 159 patients satisfied the inclusion criteria. Data could not be analysed from one trial due to changes in patient numbers and from a second because the data provided were not in a usable format. All trials reported intelligibility measures but a statistically significant result was only reported for the diagnostic rhyme test used in the study of Lee Silverman Voice Treatment -LOUD (LSVT-LOUD) versus a modified version of this therapy (LSVT-ARTIC). In this case a difference of 12.5 points (95% confidence interval (CI) -22.2 to -2.8; P = 0.01) between the mean changes in favour of the LSVT-LOUD group was reported for a speech sample overlaid with Babble noise; this difference was not reproduced for the two additional noise conditions under which the speech samples were assessed. LSVT-LOUD also outperformed LSVT-ARTIC and Respiration therapy (RT) in improving loudness, with a difference in reading a sample text of 5.0 dB (95%CI -8.3 to -1.7; P = 0.003) and 5.5 dB (95% CI 3.4 to 7.7; P < 0.00001) respectively, and a difference in monologue speech of 2.9 dB (95% CI 0.6 to 5.2; P = 0.01) versus RT.
AUTHORS' CONCLUSIONS: Considering the small patient numbers in these trials, there is insufficient evidence to support or refute the efficacy of any form of SLT over another to treat speech problems in patients with Parkinson's disease.
帕金森病患者常伴有言语和嗓音问题，如发音障碍和音量降低。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。
比较新型SLT技术与标准SLT方法治疗帕金森病言语问题的疗效和效果。
我们通过对多个文献数据库（包括CENTRAL、MEDLINE和CINAHL）进行电子检索，以及手工检索相关会议摘要并查阅已确定研究和其他综述中的参考文献列表，找出2011年4月11日前发表的相关文献。
仅纳入一种言语和语言治疗与另一种治疗进行对比的随机对照试验（RCT）。
两位综述作者独立提取数据，并通过讨论解决分歧。
六项涉及159名患者的试验符合纳入标准。一项试验因患者数量变化无法进行数据分析，另一项试验因提供的数据格式不可用也无法分析。所有试验均报告了言语清晰度测量结果，但仅在李·西尔弗曼嗓音治疗-大声（LSVT-LOUD）研究中使用的诊断性押韵测试与该疗法的改良版（LSVT-ARTIC）对比时报告了具有统计学意义的结果。在此案例中，对于叠加有嘈杂声的言语样本，报告显示LSVT-LOUD组平均变化比LSVT-ARTIC组有利12.5分（95%置信区间（CI）-22.2至-2.8；P = 0.01）；在评估言语样本的另外两种噪声条件下，该差异未重现。在提高音量方面，LSVT-LOUD也优于LSVT-ARTIC和呼吸疗法（RT），在朗读样本文本时差异分别为5.0 dB（95%CI -8.3至-1.7；P = 0.003）和5.5 dB（95%CI 3.4至7.7；P < 0.00001），在独白言语方面与RT的差异为2.9 dB（95%CI 0.6至5.2；P = 0.01）。
鉴于这些试验中的患者数量较少，尚无足够证据支持或反驳任何形式的SLT在治疗帕金森病患者言语问题方面比另一种更有效。
