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JCPSLP
Volume 19, Number 2 2017
Journal of Clinical Practice in Speech-Language Pathology
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
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
Table 3: Critical appraisal of systematic review
Does this review address a clear question?
1 Did the review address a clearly focused
issue?
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.
2 Did the authors look for the appropriate
sort of papers?
4
All peer reviewed studies were included with appropriate inclusion and exclusion criteria
related to the PICO question.
Are the results of the review valid?
3 Do you think the important, relevant
studies were included?
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 Unpublished studies were also excluded.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 Did the review’s authors do enough to
assess the quality of the included studies?
4
Yes, studies were rated using the PEDRO scale which has a maximum score
of 10.
5 If the results of the review have been
combined, was it reasonable to do so?
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.
What are the results?
6 What is the overall result of the review?
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.
7 How precise are the results?
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.
Will the results help locally?
8 Can the results be applied to the local
population?
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.
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.