Mitchell Claire, El Kouaissi Sabrina, Duncan-Zaleski Martha, Bowen Audrey, Conroy Paul, Whelan Brooke-Mai, Wallace Sarah J Jane, Cheyne Joshua, Kirkham Jamie J
Division of Psychology, Communication and Human Neuroscience, School of Health Sciences & Geoffrey Jefferson Brain Research Centre, The University of Manchester, Manchester, UK
Division of Psychology, Communication and Human Neuroscience, School of Health Sciences & Geoffrey Jefferson Brain Research Centre, The University of Manchester, Manchester, UK.
BMJ Open. 2025 May 23;15(5):e099662. doi: 10.1136/bmjopen-2025-099662.
A consensus study to establish a Core Outcome Set for dysarthria after stroke identified four key outcome domains that should be measured in research and clinical practice: (1) intelligibility of speech, (2) ability to participate in conversations, (3) living well with dysarthria and (4) communication partners skills and knowledge (where relevant). This review aimed to systematically identify corresponding measurement instruments and to examine their clinical utility and psychometric properties.
Systematic review conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
CINAHL, EMBASE, MEDLINE, PsycInfo and Cochrane Stroke Group Trials Register, CENTRAL, Linguistics and Language Behavioral Abstracts (LLBA). Major trials registers: WHO ICTRP, ISRCTN registry and ClinicalTrials.gov searched March 2024.
We included trials that developed or used measurement instruments for poststroke dysarthria. We identified studies that could be included in an update of the Cochrane systematic review of interventions for non-progressive dysarthria to identify what measurement instruments were used in therapy trials for poststroke dysarthria.
Records were screened independently by three authors. Psychometric data were extracted, by two authors, from included studies and methodological quality was evaluated using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Core Outcome Measures in Effectiveness Trials (COMET) guidance. Assessment of clinical utility followed Outcome Measures in Rheumatology (OMERACT) guidance.
Following screening, 19 publications reporting 12 measurement instruments were identified. According to COSMIN standards, all 19 publications were rated as having low, very low or unknown quality of evidence. Three measurement instruments were identified as having the most relevant clinical utility to the population, the highest quality of evidence and had the potential to measure some specific aspects from three of the four agreed domains, intelligibility, conversations and living well with dysarthria from the patient and clinician perspective. These were the Frenchay Dysarthria Assessment II, the Communication Outcomes After Stroke Scale and the Therapy Outcome Measures for Dysarthria.
This review provides a comprehensive overview and appraisal of dysarthria measurement instruments to align with a Core Outcome Set. We only included English language-based measurement instruments. Many dysarthria measurement instruments were developed for non-stroke populations, including progressive dysarthria, with limited psychometric data for stroke. Measurement instruments with uncertain quality of evidence can still be considered for inclusion with a Core Outcome Set and three have been suggested. There is a need for further psychometric testing of these and the development of new measurement instruments to cover all aspects of intelligibility, conversations, living well with dysarthria and communication partner skills.
CRD42022302998.
一项关于建立中风后构音障碍核心结局集的共识研究确定了四个关键结局领域，在研究和临床实践中均应予以测量：（1）言语可懂度；（2）参与对话的能力；（3）与构音障碍和谐共处；（4）沟通伙伴的技能和知识（如适用）。本综述旨在系统地识别相应的测量工具，并考察其临床效用和心理测量特性。
按照系统评价和Meta分析的首选报告项目指南进行系统评价。
CINAHL、EMBASE、MEDLINE、PsycInfo、Cochrane中风组试验注册库、CENTRAL、语言学与语言行为摘要数据库（LLBA）。主要试验注册库：世界卫生组织国际临床试验平台注册库、国际标准随机对照试验编号注册库和美国国立医学图书馆临床试验数据库，检索时间为2024年3月。
我们纳入了开发或使用中风后构音障碍测量工具的试验。我们确定了可纳入Cochrane关于非进行性构音障碍干预措施系统评价更新版的研究，以识别中风后构音障碍治疗试验中使用的测量工具。
由三位作者独立筛选记录。两位作者从纳入研究中提取心理测量数据，并使用基于共识的健康测量工具选择标准（COSMIN）和有效性试验核心结局测量指标（COMET）指南评估方法学质量。临床效用评估遵循风湿病学结局测量指标（OMERACT）指南。
经过筛选，共识别出19篇报告12种测量工具的出版物。根据COSMIN标准，所有19篇出版物的证据质量均被评为低、极低或未知。三种测量工具被确定为对该人群具有最相关的临床效用、最高的证据质量，并且有可能从四个商定领域中的三个领域测量一些特定方面，即从患者和临床医生的角度测量言语可懂度、对话能力以及与构音障碍和谐共处的能力。这三种测量工具分别是法国ay构音障碍评估量表第二版、中风后沟通结局量表和构音障碍治疗结局测量指标。
本综述对与核心结局集相一致的构音障碍测量工具进行了全面概述和评估。我们仅纳入了基于英语的测量工具。许多构音障碍测量工具是为非中风人群开发的，包括进行性构音障碍，针对中风的心理测量数据有限。证据质量不确定的测量工具仍可考虑纳入核心结局集，本文已推荐了三种。需要对这些工具进行进一步的心理测量测试，并开发新的测量工具，以涵盖言语可懂度、对话能力、与构音障碍和谐共处以及沟通伙伴技能的各个方面。
CRD42022302998。
