JCPSLP Vol 19 No 2 2017

Table 3: Critical appraisal of systematic review

Does this review address a clear question?

4 Yes, the study asked two questions related to effectiveness of computer therapy in aphasia compared to 1) no treatment and 2) clinician-delivered treatment in improving communication outcomes. All four PICO elements were addressed with two comparators. 4 All peer reviewed studies were included with appropriate inclusion and exclusion criteria related to the PICO question. 4 Yes, the review searched four relevant databases and followed up reference lists. Although they had no language restrictions in searches, they later excluded non-English studies (although reported none being excluded for this reason). No personal contact with authors was made. Unpublished studies were also excluded. 4 Yes, studies were rated using the PEDRO scale which has a maximum score of 10. Not applicable. A meta-analysis could not be performed due to the heterogeneity of computer programs and outcome measures used. Results of individual studies are clearly tabulated. There is good evidence that computer therapy is more effective than no therapy and preliminary evidence that computer therapy may be as effective in clinician-delivered therapy in chronic aphasia. The review included a total of 7 studies, 3 of which compared computer therapy to clinician- delivered therapy. All three studies reported improvements in both clinician and computer delivered interventions. Where there were between group analyses, there were no statistically significant differences in outcomes between the two treatment groups, indicating equivalent effects of both treatments. As no meta-analyses were undertaken, confidence intervals of overall results are not included. Statistical significance of individual studies is expressed using p-values and effect sizes for within group comparisons. Generalisation to all types and severity of aphasia is limited. Most clients in included studies were young (< 65 years) with chronic non-fluent aphasia, of a moderate severity level and no concomitant communication or cognitive deficits. Computer programs investigated (e.g., ORLA, Sentactics, cueing verb treatments) may not be accessible for all SLPs. Application of findings specific to the clinical question (comparison to clinician-delivered therapy) is further limited by the small number of studies and their quality with only one RCT with a low risk of bias.

1 Did the review address a clearly focused issue?

2 Did the authors look for the appropriate sort of papers?

Are the results of the review valid?

3 Do you think the important, relevant studies were included?

4 Did the review’s authors do enough to assess the quality of the included studies? 5 If the results of the review have been combined, was it reasonable to do so?

What are the results?

6 What is the overall result of the review?

7 How precise are the results?

Will the results help locally?

8 Can the results be applied to the local population?

9 Were all important outcomes considered? The study included any outcome related to impairment, activity, functional, psychosocial or quality of life, looking at the client level outcomes. Future studies may wish to also include service outcomes such as cost effectiveness when comparing computer therapy with clinician- delivered therapy as well as clinician and client satisfaction.

10 Are the benefits worth the harms and costs?

No harms of computer therapy were reported, further evaluation regarding cost of computer therapy compared to clinician-delivered treatment and its benefit is still required.

computer therapy provided except for the mode of delivery (see Table 2). As the next step in the EBP process, you appraise the systematic review by Zheng et al., 2016 using a modified critical appraisal skills program (CASP) tool for systematic reviews as shown in Table 3. Clinical bottom line While there is good evidence to suggest that computer therapy is more effective than no therapy for people under 65 years of age with chronic non-fluent aphasia with no co-occurring cognitive or communication difficulties, there is only preliminary evidence indicating that it may be as effective as clinician-delivered therapy. Clinicians are

encouraged to consider a client’s suitability for computer therapy on an individual basis, particularly for clients in the acute and subacute phase of recovery, for different aphasia types, as well as those above 65 years of age. Discussion As well as the current research evidence base, clinicians should explore factors related to client preferences, their own experience and their local context to inform clinical decision-making. In regards to prescribing computer therapy, the clinician should explore the patient’s personal preference for computer therapy versus clinician-delivered therapy through early discussions with the client as well as

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology