远程提供言语治疗对帕金森病患者的有效性——一项随机对照试验。

Effectiveness of remotely delivered speech therapy in persons with Parkinson's disease - a randomised controlled trial.

作者信息

Maas Janna J L, de Vries Nienke M, IntHout Joanna, Bloem Bastiaan R, Kalf Johanna G

机构信息

Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.

Radboud University Medical Center, IQ Health; Nijmegen, the Netherlands.

出版信息

EClinicalMedicine. 2024 Sep 11;76:102823. doi: 10.1016/j.eclinm.2024.102823. eCollection 2024 Oct.

DOI:10.1016/j.eclinm.2024.102823

PMID:39309726

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11415969/

Abstract

BACKGROUND

Increasing evidence supports the merits of speech therapy in Parkinson's disease, but the current practice of multiple in-house treatments is demanding for patients. We therefore assessed the effectiveness of remotely delivered and personalised speech therapy on improving quality of life and speech quality in persons with Parkinson's disease.

METHODS

We performed a single blinded randomised controlled trial (the PERSPECTIVE study), comparing 8 weeks of personalised remote speech therapy to no intervention (waiting list design). Patients with reduced speech intelligibility were included, regardless of disease stage or dysarthria severity. Patients were assigned randomly (1:1) to the intervention or control group. Measurements took place at baseline and after 8 weeks (both groups), and after 32 weeks (intervention group only). Patients were treated remotely by 20 experienced speech therapists. The primary outcome was disease-related quality of life at 8 weeks, assessed with the Parkinson's Disease Questionnaire 39 (PDQ-39). Data were analysed using analysis of covariance based on the intention-to-treat principle. This trial is registered in ClinicalTrials.gov, NCT03963388.

FINDINGS

Between March 1, 2019, and March 27, 2021, 214 patients were enrolled in the intervention group (n = 109) or control group (n = 105). At the primary timepoint, the adjusted mean difference in PDQ-39 was -2.0 in favour of the intervention group (95% CI -4.0 to 0.1); p = 0.056). The intervention group scored better on the communication index score of the PDQ-39 (post hoc analysis), with an adjusted mean difference of -5.3 (95% CI -9.4 to -1.2; p = 0.011). We found no between-group differences on any other PDQ-39 domain. Follow-up measurements showed a significant reduction of the PDQ-39 compared to the primary timepoint with a difference of 2.40 (95% CI 0.77-4.02; p = 0.004).

INTERPRETATION

Personalised remote speech therapy improved communication-related quality of life, but not overall quality of life.

FUNDING

Michael J. Fox Foundation, Gatsby Foundation, and Health∼Holland.

摘要

背景

越来越多的证据支持言语治疗对帕金森病的益处，但目前多种院内治疗方式对患者来说要求较高。因此，我们评估了远程提供的个性化言语治疗对改善帕金森病患者生活质量和言语质量的有效性。

方法

我们进行了一项单盲随机对照试验（PERSPECTIVE研究），将8周的个性化远程言语治疗与无干预措施（等待列表设计）进行比较。纳入言语清晰度降低的患者，无论疾病阶段或构音障碍严重程度如何。患者被随机（1:1）分配到干预组或对照组。在基线时、8周后（两组）以及32周后（仅干预组）进行测量。由20名经验丰富的言语治疗师对患者进行远程治疗。主要结局是8周时与疾病相关的生活质量，采用帕金森病问卷39（PDQ-39）进行评估。数据采用基于意向性分析原则的协方差分析进行分析。该试验已在ClinicalTrials.gov注册，注册号为NCT03963388。

结果

在2019年3月1日至2021年3月27日期间，214名患者被纳入干预组（n = 109）或对照组（n = 105）。在主要时间点，PDQ-39的调整后平均差异为-2.0，有利于干预组（95%CI -4.0至0.1；p = 0.056）。干预组在PDQ-39的沟通指数评分上得分更高（事后分析），调整后平均差异为-5.3（95%CI -9.4至-1.2；p = 0.011）。我们发现两组在PDQ-39的任何其他领域均无差异。随访测量显示，与主要时间点相比，PDQ-39显著降低，差异为2.40（95%CI 0.77 - 4.02；p = 0.004）。