Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet and Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden.
J Commun Disord. 2021 Jan-Feb;89:106076. doi: 10.1016/j.jcomdis.2020.106076. Epub 2021 Jan 6.
There is a recognized need for a reliable assessment instrument for apraxia of speech (AOS) diagnosis for post stroke patients. In 2014, Strand and colleagues reported high to excellent intra- and interjudge reliability of the Apraxia of Speech Rating Scale (ASRS) in neurodegenerative speech and language disorders. Excellent interjudge reliability of the ASRS total score has also recently been reported in another study of individuals with chronic AOS after stroke, where the ratings were carried out by two experienced researchers not involved in the development of the instrument. However, it is still not fully determined whether the ASRS is a reliable instrument in assessment of patients in an early phase after stroke, where severe AOS is not uncommon. It is also not determined whether ASRS ratings can be performed reliably by practicing speech-language pathologists (SLPs) without long common experience and joint training. This study therefore addresses these questions.
The ASRS was administered to thirty-six individuals in the first six months after stroke. The assessment procedures were video recorded. Ten of the recordings were selected for the reliability study, representative of patients typically seen at the actual inpatient ward with varying degrees of AOS severity. Five SLPs from different hospital departments participated as raters. The raters viewed each video and independently rated the presence and severity of AOS using the ASRS. To study intrajudge reliability, a rescoring was performed after a minimum of three weeks. Reliability was calculated using the intraclass correlation coefficient (ICC).
Intrajudge agreement for the ASRS total score varied from moderate to excellent (mean ICC = 0.69, 95 % CI [0.60, 0.77]) with most of the mean item level agreements within the categories 'moderate' or 'good. Interjudge reliability was poor for the ASRS total score (ICC = 0.42, 95 % CI [0.35, 0.50]). The item level results varied between moderate and poor, with lack of agreement on several items.
For clinicians without expert knowledge of AOS and limited training using the ASRS, intra- and interjudge reliability of the ASRS is not satisfactory. Also, since some items in the protocol require a certain level of speech production to target the diagnostic marker, findings indicate that the ASRS in its present design has limitations in assessment of severe AOS. As suggested by Strand and colleagues, video examples that illustrate the ASRS characteristics could be one helpful alternative to support clinician training. A minor revision of response definitions of the scale may improve the applicability of the ASRS in severe AOS.
需要一种可靠的评估工具来诊断脑卒中后患者的言语失用症(AOS)。2014 年，Strand 及其同事报告了在神经退行性言语和语言障碍中，言语失用症评估量表(ASRS)的高至极好的内部和外部评估者之间的可靠性。最近的另一项研究也报道了脑卒中后慢性 AOS 患者的 ASRS 总分具有极好的外部评估者之间的可靠性，这些评分由两名不参与该仪器开发的经验丰富的研究人员进行。然而，仍不完全确定 ASRS 是否是评估脑卒中后早期患者的可靠工具，在该阶段，严重的 AOS 并不罕见。也不确定没有长期共同经验和联合培训的言语语言病理学家(SLPs)是否可以可靠地进行 ASRS 评分。本研究旨在解决这些问题。
在脑卒中后 6 个月内对 36 名患者进行了 ASRS 评估。评估过程被视频记录下来。选择了 10 个录像进行可靠性研究，这些录像代表了在实际住院病房中常见的不同严重程度的 AOS 患者。来自不同医院科室的 5 名 SLP 作为评估者参与了研究。评估者观看了每个视频，并使用 ASRS 独立评估 AOS 的存在和严重程度。为了研究内部评估者的可靠性，在至少 3 周后进行了重新评分。使用组内相关系数(ICC)来计算可靠性。
ASRS 总分的内部评估者之间的一致性从中度到极好(平均 ICC=0.69,95%置信区间[0.60,0.77])，大多数平均项目水平的一致性处于“中度”或“良好”类别。ASRS 总分的外部评估者之间的可靠性较差(ICC=0.42,95%置信区间[0.35,0.50])。项目水平的结果在中度和较差之间变化，在一些项目上存在不一致。
对于没有 AOS 专业知识和使用 ASRS 进行有限培训的临床医生来说，ASRS 的内部和外部评估者之间的可靠性并不令人满意。此外，由于该方案中的某些项目需要一定水平的言语产生来针对诊断标记，研究结果表明，在目前的设计中，ASRS 在评估严重的 AOS 方面存在局限性。正如 Strand 及其同事所建议的，视频示例可以说明 ASRS 的特征，这可能是支持临床医生培训的一种有用方法。对量表的反应定义进行微小修改可能会提高 ASRS 在严重 AOS 中的适用性。
