JCPSLP Vol 18 No. 1Mar 2016

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JCPSLP Volume 18, Number 1 2016 10
disagree responses receive a score of 5 and strongly agree
responses receive a score of 1. The DIP was completed
once prior to, and again post-treatment. The DIP total
score was calculated from the sum of the scores from each
section.
Speech treatment
The participants were treated by certified clinicians using
the LSVT® LOUD program of 16 one-hour sessions, four
days a week, for four weeks (Trail et al., 2005). Homework
and carry-over tasks were tailored to facilitate each
participants’motivation, engagement and to continue to
drive the neuroplasticity changes activated by the treatment
(Fox et al., 2012).
Data analysis
Data analysis was conducted using IBM SPSS Statistics
Version 22. Comparison of treatment outcomes (dB level in
monologue and DIP total score) between the three groups
using a linear mixed model indicated that there was no
significant differences between the groups with respect to
group-time interaction on these measures (Monologue: F =
0.234; p = .791; DIP total score: F = 0.089; p = .915). This
finding allowed for the pooling of all group data for
subsequent data analyses.
Paired t-tests were completed on the pooled data (n =
49), and were used to establish any change to dB level in
monologue, from baseline to the completion of treatment.
A paired t-test was also used to compare the mean of the
DIP total score, pre- and post-treatment.
To examine the relationship between mean expectancy
and average credibility with the differences in dB level in
monologue and the DIP total scores from pre- to post-
intervention, nonparametric Spearman rank correlations
were performed. Secondary analyses were conducted
using Spearman rank correlation to examine the relationship
between credibility and expectancy with the participant
variables age, time post onset of PD, severity of dysarthria
and stage of PD. For this analysis, it was necessary to
include two participants with a severe dysarthria in the
moderate group as the analysis could not be completed on
a group of two. Significance for correlation coefficients was
set at p < .05. The following criteria were used to interpret
the magnitude of correlation coefficients: coefficients of
.25 were considered low, coefficients of .26 to .50 were
considered fair, coefficients of .51 to .75 were considered
good, and coefficients of >.75 were considered excellent
(Portney &Watkins, 2000).
treatment itself. The current study will report on the results
of patient expectations and treatment credibility data, with
reference to the primary clinical outcome measure
(difference in dB level in monologue), and one quality-of-life
measure (Dysarthria Impact Profile [DIP] total score
difference).
In order to determine patient expectations of the
intervention and treatment credibility, an expectation
and credibility questionnaire was administered prior to
treatment. The participants completed this questionnaire
independently after having read the participant information
sheet, which outlined the intervention but also indicated
that they may not directly benefit from the intervention.
The questionnaire was adapted from the Credibility and
Expectations Questionnaire (CEQ; Devilly & Borkovek,
2000) and comprised of two sets of questions. Adaptation
to the questionnaire involved the substitution of the
phrase ‘trauma symptoms’ with ‘speech difficulties’ in
two questions. Questions 1–3 from set I and question 1
from set II assessed the perception of treatment credibility
on a 9-point scale, with 0 representing not at all/logical/
useful/confident, and 9 representing very much/logical/
useful/confident. The mean treatment credibility score for
the group was derived from the average score of these
four questions. Question 4 from set I and question 2 from
set II related to patients’ expectations of the treatment.
These questions were rated on a 0–100% scale. The mean
expectation score for the group was derived from the
average score of these two questions.
The primary outcome measure of the effectiveness of
the speech treatment was determined by having each
participant talk about a familiar topic for a minute and a half.
This monologue was recorded and the average dB level
of the participant’s speech was measured using calibrated
software. This outcome measure is a standard measure of
vocal volume in numerous studies relating to LSVT®LOUD
(Howell, Tripoliti, & Pring, 2009; Ramig et al., 1995). This
assessment was administered twice prior to and after
treatment, with a 2-day interval between assessments.
The DIP explores the psychosocial impact of acquired
dysarthria from the speaker’s perspective. The DIP consists
of four sections with a total of 48 statements (Walshe,
Peach, & Miller, 2009). The person with dysarthria rates
each statement on a 5-point scale from strongly agree to
strongly disagree. There are positively worded statements
where strongly agree responses receive a score of 5
and strongly disagree responses receive a score of 1.
Negatively worded statements are the reverse. Strongly
Table 1. Descriptive characteristics for participants who received the LSVT® LOUD
Group according tomode
of delivery of LSVT®LOUD
Gender Mean age
(years) (SD)
Meantimepostonset
of PD (years) (SD)
Dysarthriaseverity
rating
Mean stage of PD
(SD)
Face-to-facemetro(n=15) Male = 10
Female = 5
71.23 (9.43) 3.91 (2.94) Mild = 12
Moderate = 2
Severe = 1
2 (.95)
Telerehabilitation Metro
(n = 14)
Male = 10
Female = 4
71.76 (8.05) 4.36 (3.88) Mild = 11
Moderate = 2
Severe = 1
1.57 (.39)
Telerehabilitation Rural
(n =20)
Male = 14
Female = 6
69.19 (8.82) 4.7 (3.03) Mild = 15
Moderate = 5
Severe = 0
2.2 (1.11)
Note. SD = Standard deviation