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JCPSLP
Volume 18, Number 1 2016
Journal of Clinical Practice in Speech-Language Pathology
The secondary aim considered other participant variables
such as age, time post onset of PD, severity of dysarthria,
and stage of PD, and their association with both patient
expectations and treatment credibility. Participant variables
were hypothesised to be associated with treatment
credibility and patient expectations.
Method
Study design
The current study used a subset of data from a non-
inferiority randomised controlled trial involving three groups
of participants. The non-inferiority randomised controlled
trial was conducted between one group of participants who
received the LSVT
®
LOUD program face-to-face at the
University of Queensland and another group who received
the same treatment delivered via telerehabilitation in their
homes within the Brisbane City Council boundary. A third
group of participants residing outside this boundary, but
within a 2-hour drive of Brisbane, received LSVT
®
LOUD via
telerehabilitation. Ethical clearance was obtained from the
Behavioural and Social Sciences Ethical Review Committee
of The University of Queensland, Australia and all
participants provided informed consent prior to their
involvement in the study.
Participants
Forty-nine people with PD and hypokinetic dysarthria
provided data on treatment credibility and expectancy. The
average age of the participants was 70.55 years and
included 34 males (mean age 71.47 years; age range
55.92–87.58 years) and 15 females (mean age 68.48 years;
age range 50.5–84.7 years). Participants presented with
hypokinetic dysarthria of which 38 were rated as mild, 9
were rated as moderate, and 2 were rated as severe. The
level of speech severity was rated by a SLP with 20 years’
experience in the management of people with PD. Ratings
were based on the sound pressure level (SPL) of voice
during conversation prior to treatment and a perceptual
rating of speech intelligibility during a monologue task prior
to treatment (Mild = > 65dB in conversation and/or mildly
reduced speech intelligibility; Moderate = 60–65dB in
conversation and/or mild to moderate reduction in speech
intelligibility; Severe = < 65dB in conversation and moderate
to severe reduction in speech intelligibility).The mean stage
of PD according to the Hoehn and Yahr Scale (Hoehn &
Yahr, 1967) was 1.96 (range 1 to 5). The mean time post
onset of PD for the cohort was 4.36 years (range 6 months
to 15 years). See Table 1 for further participant
characteristics.
Participants were included in the study if they were
English speaking, demonstrated features of hypokinetic
dysarthria, presented with a cognitive status that was
adequate to participate in assessment tasks as judged
by the researcher, and the participants reported that they
were on a stable drug regimen. Participants were excluded
if there was a co-existing neurological disorder other than
PD, a co-existing speech disturbance other than that
associated with PD, previous participation in a LSVT
®
LOUD
program, a respiratory dysfunction unrelated to PD, a
positive history of alcohol abuse and/or dementia, and/or
poorly aided vision or hearing.
Outcome measures
The assessment battery included perceptual, acoustic, and
quality-of-life measures together with participants’
expectancy and perceived credibility ratings of the speech
explored widely in the field of psychotherapy (Constantino,
Arnkoff, Glass, Ametrano, & Smith, 2011). Although not
as extensive, there has also been research in the fields
of occupational and physical rehabilitation examining
patient expectations and treatment credibility. In the area
of pain treatment, a study by Goossens, Vlaeyen, Hidding,
Kole-Snijders, and Evers (2005) explored how patients’
initial beliefs about the success of a provided treatment
was linked to their outcomes. Findings suggested that
those who believed the treatment would assist them in
managing pain reported better pain coping and control, less
catastrophising thoughts and negative emotions, and an
overall higher health-related quality of life. Harvey, Adams,
Chu, Batty, and Barratt (2012) discussed the importance
of having similar therapist and patient expectations, in
the context of physiotherapy for spinal cord injuries.
Unreasonably high patient expectations were more likely
to be associated with depression and a lower quality of
life when their expectations were not met (Harvey et al.,
2012). Another physiotherapy study found that higher
expectations and larger changes in shoulder function were
able to significantly predict expectancy fulfilment (O’Malley,
Roddey, Gartsman, & Karon, 2004). Patient expectations
overall (across the domains of pain, physical functioning,
and social function) have been shown to positively correlate
(although with borderline significance) with improved global
functioning for patients post-surgery for spinal lumbar
stenosis (Iversen, Daltroy, Fossel, & Katz, 1998). Patients
with higher pre-operative expectations improved more than
those with moderate to low expectations. However, some
literature has been unable to establish convincing evidence
for the association between patient expectations and
treatment outcomes. This includes studies from exercise
physiology (Perkins, Waters, Baum, & Basen-Engquist,
2009) and an occupational therapy study which examined
upper-extremity motor function (Prager, Birkenmeier, &
Lang, 2011).
Treatment credibility has been found to play less of
a role in predicting outcomes (Borkovec & Costello,
1993). In a study exploring chronic back pain treatment,
the relationships between both patient expectations
and credibility of three different treatment groups were
considered (Smeets et al., 2008). It was found that only
expectations were associated with patients’ self-reported
disability and global perceived effect post-treatment.
However, relationships were found between patients’
treatment satisfaction and both patient expectations and
treatment credibility. Current research findings in this topic
area remain inconclusive with respect to how patient
perceptions of treatment credibility relate to the outcomes
of therapies.
To date, the association between patient expectations
and treatment credibility, and clinical outcomes has
not been investigated in the field of speech-language
pathology. Research into such factors has the potential
to further inform the rehabilitation process for clients with
communication disorders. The primary aim of this study
was to determine if patient expectations and treatment
credibility were associated with the outcomes of an
intensive treatment (LSVT
®
LOUD) for hypokinetic dysarthria
associated with PD. This study is of particular interest as
LSVT
®
LOUD is evidence based and well recognised for
its efficacy in the treatment of the speech disorder in PD,
and so treatment credibility and patient expectations may
be high. It was hypothesised that treatment credibility and
patient expectations would predict treatment outcomes.