Department of Clinical Speech & Language Studies, School of Linguistic Speech and Communication Sciences, Trinity College Dublin, Ireland.
Mater Misericordiae University Hospital, Dublin, Ireland.
Int J Lang Commun Disord. 2019 Nov;54(6):875-893. doi: 10.1111/1460-6984.12494. Epub 2019 Jul 19.
There is a growing body of evidence that speech and language therapy (SLT) intervention is effective in improving communication ability for individuals with non-progressive acquired apraxia of speech (AOS). However, there is no universally agreed diagnostic standard for AOS, and diverging opinions on its diagnostic features. This has led to claims that diverse diagnostic criteria may be used to select participants for AOS research studies. These claims raise concerns for evidence-based practice in AOS but have yet to be systematically investigated.
To determine the presence, nature and extent of diversity in the diagnostic criteria for non-progressive AOS used in both published studies and clinical practice internationally.
METHODS & PROCEDURES: The study used a scoping review methodology that followed the 2005 framework of Arksey and O'Malley and included a consultation exercise in the form of an online survey of international SLTs. The scoping review included 157 studies involving participants with acquired AOS, published between 1997 and 2017. There were 264 respondents to the online survey of SLTs, with a completion rate of 72%. Respondents came from 15 countries and had varying levels of clinical experience.
This study found that no common set of diagnostic criteria for AOS was used universally across research and practice. Although the diagnostic criteria used to select participants with AOS were reported explicitly in most studies, they varied from study to study. Some studies used directly conflicting criteria. Use of specific diagnostic criteria in studies was influenced by year of publication but not by location. There was a trend towards increasing consistency in diagnostic criteria in recent years. Compared with the research, the survey revealed relatively greater consistency among SLTs on the speech features considered indicative of AOS, although the SLTs who responded to the survey showed variation in how diagnostic criteria were combined into sets. Use of specific diagnostic criteria was not associated with SLTs' location or experience. There were differences between the diagnostic criteria for AOS used most commonly in research studies and those selected most commonly by SLTs in the survey. These findings have implications for the generalizability of AOS research to clinical practice, as well as implications for effective research synthesis.
CONCLUSIONS & IMPLICATIONS: The claim that research and practice in the field of AOS is characterized by the use of diverse diagnostic criteria is supported by this scoping review. The findings support the need to develop a universal consensus standard for AOS diagnosis to ensure consistency across research and clinical practice.
越来越多的证据表明，言语和语言治疗（SLT）干预措施对于改善非进行性获得性构音障碍（AOS）患者的沟通能力是有效的。然而，对于 AOS 并没有普遍认可的诊断标准，对于其诊断特征也存在不同意见。这导致了人们认为可能使用不同的诊断标准来选择 AOS 研究的参与者。这些说法引起了对 AOS 循证实践的关注，但尚未得到系统调查。
确定在国际上发表的研究和临床实践中，用于非进行性 AOS 的诊断标准在存在、性质和程度上的多样性。
本研究采用了 2005 年 Arksey 和 O'Malley 框架的范围综述方法，并以在线调查形式对国际 SLT 进行了咨询。该范围综述包括了 1997 年至 2017 年间涉及获得性 AOS 参与者的 157 项研究。对 SLT 的在线调查有 264 名受访者，完成率为 72%。受访者来自 15 个国家，具有不同的临床经验。
本研究发现，在研究和实践中没有普遍使用一套共同的 AOS 诊断标准。尽管大多数研究都明确报告了用于选择 AOS 参与者的诊断标准，但它们在研究之间有所不同。一些研究使用了直接冲突的标准。研究中使用特定的诊断标准受到发表年份的影响，但不受地点的影响。近年来，诊断标准的一致性呈上升趋势。与研究相比，调查显示，在认为表明 AOS 的语音特征方面，SLT 之间相对更为一致，尽管对调查做出回应的 SLT 在如何将诊断标准组合成集合方面存在差异。特定诊断标准的使用与 SLT 的位置或经验无关。在研究中最常使用的 AOS 诊断标准和调查中最常选择的诊断标准之间存在差异。这些发现对 AOS 研究向临床实践的推广具有影响，对有效的研究综合也具有影响。
本范围综述支持这样一种说法，即 AOS 领域的研究和实践的特点是使用多种诊断标准。研究结果支持制定 AOS 诊断的通用共识标准的必要性，以确保研究和临床实践的一致性。
