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ACQ
Volume 13, Number 1 2011
ACQ
uiring knowledge in speech, language and hearing
You limit your search to English language papers and human
studies (in order to exclude research on drug therapies tested in
animal models). Because you have designed your search to
be exhaustive in identifying possible evidence-based treatments,
it retrieves 457 studies. Many of these, however, describe
experimental pharmacological interventions or pathological
mechanisms, rather than speech, language or communication
interventions. By listing the results by title, 100 per page, it is
possible to scroll through to identify only the speech-
language pathology interventions. You find a critical review of
all intervention studies published to mid-2007 (Croot,
Nickels, Laurence, & Manning, 2009), a review of anomia
treatment in semantic dementia (Henry, Beeson, & Rapcsak,
2008a), and 6 of the further studies in Table 2.
Next you search the SpeechBITE
TM
database that
catalogues published speech pathology interventions,
searching on the term “progressive aphasia” and scanning
articles listed for the client subgroup “Alzheimer’s and other
dementias”, which yields one additional study, not yet pre-
appraised. Search results are summarised in Table 2, and
rated for level of evidence according to the NHMRC Levels
of Evidence Hierarchy, where level I represents the highest
level of evidence and level IV the lowest (NHMRC, 2009).
but rather to identify what the evidence is for any relevant
interventions in order to decide what your service should offer.
Outcomes
The outcome (increased intelligibility, word retrieval, sentence
comprehension, social participation, etc.) would be
determined by the type of therapy, and you are keeping your
options open on the type of therapy for the time being.
Clinical question
The final clinical question you formulate is,
“What evidence is
there to include speech, language or communication inter-
ventions in the speech pathology services provided for people
referred with one of the types of progressive aphasia?”
Searching for the evidence
The first databases you search are Medline, PreMedline, and
PsychINFO and the database of Cochrane Reviews. These
are all available via the Ovid SP gateway, which means they
can be searched at the same time. Because the search
engine can remove duplicates if you select this option, this is
more efficient than searching the 4 databases serially. Table
1 outlines the keywords that were generated and searched
to find any relevant literature.
Table 1. Search terms
PICO
Search terms
Notes
Patient or problem
“progressive aphasia”
Multiple search terms were required given the different
“progressive non fluent aphasia or progressive
labels for progressive aphasia that exist in the literature.
non-fluent aphasia” and
“semantic dementia” and
“fronto-temporal dementia or frontotemporal dementia
or frontotemporal lobar degeneration”
Intervention
“intervention or treatment$ or therap$”
$ indicates that the search term is truncated. The search
engine will pick up any words starting with that letter string
(e.g. therapy, therapies, therapeutic).
Comparison intervention No search terms
You are interested in any interventions done with this
clinical population.
Outcomes
No search terms
You are interested in any treatment outcomes.
Table 2. Research articles identified
Articles identified
Purpose
Level of evidence (NHMRC, 2009)
Croot et al. (2009)
Reviews published impairment- and activity/participation-directed interventions
Reviews a mix of Level IV studies
in semantic dementia and progressive aphasia
and others
Diehl et al. (2003)
Pilot support group for spouse-carers of people with frontotemporal dementia,
Not applicable
reports survey of carers after group
Henry et al. (2008a)
Reviews anomia treatment in semantic dementia
Reviews a mix of Level IV studies
and others
Henry et al. (2008b)
Semantic treatment for anomia in progressive vs. stroke-induced aphasia
IV
Jokel et al. (2010)
Computer-based treatment for anomia in semantic dementia
IV
Newhart et al. (2009)
Spoken naming therapy using a cueing hierarchy in 2 cases, one logopenic
IV
progressive aphasia and one semantic dementia
Robinson et al. (2009)
Therapy naming, defining and using objects in 2 individuals with semantic
IV
dementia
Rogalski & Edmonds
Attentive reading and constrained summarisation (ARCS) treatment to promote
IV
(2008)
intentional language use and attentional focus to improve discourse in a man
with PPA
Taylor et al. (2009)
Reports a survey of PPA referrals to NSW speech pathologists and services
Not applicable
provided
Note.
PPA = primary progressive aphasia