The PD COMM Process Evaluation: Describing Interventions and Implementation in a UK Pragmatic Randomised Controlled Trial of Speech and Language Therapy for People with Parkinson's-Related Dysarthria
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| Title: | The PD COMM Process Evaluation: Describing Interventions and Implementation in a UK Pragmatic Randomised Controlled Trial of Speech and Language Therapy for People with Parkinson's-Related Dysarthria |
|---|---|
| Language: | English |
| Authors: | Avril Nicoll (ORCID |
| Source: | International Journal of Language & Communication Disorders. 2025 60(4). |
| Availability: | Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us |
| Peer Reviewed: | Y |
| Page Count: | 16 |
| Publication Date: | 2025 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Foreign Countries, Neurological Impairments, Intervention, Program Implementation, Speech Language Pathology, Speech Therapy, Speech Impairments, Outcomes of Treatment, Randomized Controlled Trials |
| Geographic Terms: | United Kingdom |
| DOI: | 10.1111/1460-6984.70084 |
| ISSN: | 1368-2822 1460-6984 |
| Abstract: | Background: As people with Parkinson's experience progressive communication changes, effective, implementable speech and language therapy (SLT) interventions are needed. Process evaluations alongside pragmatic randomised controlled trials (RCTs) are of clinical value if they describe, compare and understand the implementation of trial interventions. This paper reports the PD COMM process evaluation. PD COMM was a large, UK multi-centre phase III pragmatic RCT of SLT in the National Health Service (NHS). It recruited 388 people with Parkinson's who were randomised to Lee Silverman Voice Treatment (LSVT), Standard NHS SLT, or no dysarthria intervention. Aims: To describe and compare the content and service delivery components of the PD COMM SLT interventions; understand experiences of implementing LSVT; explain trial outcomes; and reflect on implications for practice and research. Methods and Procedures: We took a pragmatic, mixed methods approach. The intervention description team used a sub-sample of routine therapy notes and trial record forms, the Template for Intervention Description and Replication (TIDieR) and simple descriptive statistics to compare Individual Participant Therapy Data (LSVT n = 51; Standard NHS SLT n = 54). In parallel, informed by Normalisation Process Theory (NPT), the implementation team conducted qualitative interviews with a sub-sample of therapists (n = 20) and participants (n = 24) to understand the additional work of implementing LSVT. The core process evaluation team met to integrate the findings in relation to the trial outcomes. Outcomes and Results: LSVT was largely delivered per protocol, tailored to participants' interests and interactions. Dosage was a key difference between the two interventions, commonly achieved by two or more therapists delivering LSVT. Effective mechanisms were LSVT's structured design, repetitive and social nature, practise requirements and focus on volume. Standard NHS SLT was eclectic, reflecting a range of clinical approaches at a lower intensity, including some techniques and activities in common with LSVT. Although focused on impairment therapy, including specific voice therapy techniques, it also featured cognitive-linguistic and psychosocial targets and low technology augmentative and alternative communication (AAC). The trial design may have limited opportunities for group intervention. Conclusions and Implications: Any LSVT roll-out needs service support and coordination, and should take an inclusive approach. Future research of Standard NHS SLT should explore a rationale for dosage and more explicit tailoring to individuals and their families. There is also a pressing need to deliver the benefits of LSVT in a cost-effective manner and to develop a range of evidence-based, implementable alternatives as people's communication support needs change. |
| Abstractor: | As Provided |
| Entry Date: | 2025 |
| Accession Number: | EJ1478172 |
| Database: | ERIC |
| FullText | Text: Availability: 0 |
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| Header | DbId: eric DbLabel: ERIC An: EJ1478172 AccessLevel: 3 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: The PD COMM Process Evaluation: Describing Interventions and Implementation in a UK Pragmatic Randomised Controlled Trial of Speech and Language Therapy for People with Parkinson's-Related Dysarthria – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Avril+Nicoll%22">Avril Nicoll</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9677-4817">0000-0001-9677-4817</externalLink>)<br /><searchLink fieldCode="AR" term="%22Marian+C%2E+Brady%22">Marian C. Brady</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4589-7021">0000-0002-4589-7021</externalLink>)<br /><searchLink fieldCode="AR" term="%22Patricia+Masterson-Algar%22">Patricia Masterson-Algar</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6344-1346">0000-0001-6344-1346</externalLink>)<br /><searchLink fieldCode="AR" term="%22Christopher+Burton%22">Christopher Burton</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1159-1494">0000-0003-1159-1494</externalLink>)<br /><searchLink fieldCode="AR" term="%22Gillian+Beaton%22">Gillian Beaton</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8539-9318">0000-0002-8539-9318</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sylvia+Dickson%22">Sylvia Dickson</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4137-5752">0000-0002-4137-5752</externalLink>)<br /><searchLink fieldCode="AR" term="%22Maria+Caulfield%22">Maria Caulfield</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0006-8933-8076">0009-0006-8933-8076</externalLink>)<br /><searchLink fieldCode="AR" term="%22Christina+H%2E+Smith%22">Christina H. Smith</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7803-9616">0000-0001-7803-9616</externalLink>)<br /><searchLink fieldCode="AR" term="%22Carl+E%2E+Clarke%22">Carl E. Clarke</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2478-3436">0000-0003-2478-3436</externalLink>)<br /><searchLink fieldCode="AR" term="%22Natalie+Ives%22">Natalie Ives</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1664-7541">0000-0002-1664-7541</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sue+Jowett%22">Sue Jowett</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8936-3745">0000-0001-8936-3745</externalLink>)<br /><searchLink fieldCode="AR" term="%22Caroline+Rick%22">Caroline Rick</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7713-9834">0000-0001-7713-9834</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rebecca+Woolley%22">Rebecca Woolley</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5119-1431">0000-0001-5119-1431</externalLink>)<br /><searchLink fieldCode="AR" term="%22Catherine+M%2E+Sackley%22">Catherine M. Sackley</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8580-6622">0000-0002-8580-6622</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Language+%26+Communication+Disorders%22"><i>International Journal of Language & Communication Disorders</i></searchLink>. 2025 60(4). – Name: Avail Label: Availability Group: Avail Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 16 – Name: DatePubCY Label: Publication Date Group: Date Data: 2025 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Neurological+Impairments%22">Neurological Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Implementation%22">Program Implementation</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+Language+Pathology%22">Speech Language Pathology</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+Therapy%22">Speech Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+Impairments%22">Speech Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Randomized+Controlled+Trials%22">Randomized Controlled Trials</searchLink> – Name: Subject Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22United+Kingdom%22">United Kingdom</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1111/1460-6984.70084 – Name: ISSN Label: ISSN Group: ISSN Data: 1368-2822<br />1460-6984 – Name: Abstract Label: Abstract Group: Ab Data: Background: As people with Parkinson's experience progressive communication changes, effective, implementable speech and language therapy (SLT) interventions are needed. Process evaluations alongside pragmatic randomised controlled trials (RCTs) are of clinical value if they describe, compare and understand the implementation of trial interventions. This paper reports the PD COMM process evaluation. PD COMM was a large, UK multi-centre phase III pragmatic RCT of SLT in the National Health Service (NHS). It recruited 388 people with Parkinson's who were randomised to Lee Silverman Voice Treatment (LSVT), Standard NHS SLT, or no dysarthria intervention. Aims: To describe and compare the content and service delivery components of the PD COMM SLT interventions; understand experiences of implementing LSVT; explain trial outcomes; and reflect on implications for practice and research. Methods and Procedures: We took a pragmatic, mixed methods approach. The intervention description team used a sub-sample of routine therapy notes and trial record forms, the Template for Intervention Description and Replication (TIDieR) and simple descriptive statistics to compare Individual Participant Therapy Data (LSVT n = 51; Standard NHS SLT n = 54). In parallel, informed by Normalisation Process Theory (NPT), the implementation team conducted qualitative interviews with a sub-sample of therapists (n = 20) and participants (n = 24) to understand the additional work of implementing LSVT. The core process evaluation team met to integrate the findings in relation to the trial outcomes. Outcomes and Results: LSVT was largely delivered per protocol, tailored to participants' interests and interactions. Dosage was a key difference between the two interventions, commonly achieved by two or more therapists delivering LSVT. Effective mechanisms were LSVT's structured design, repetitive and social nature, practise requirements and focus on volume. Standard NHS SLT was eclectic, reflecting a range of clinical approaches at a lower intensity, including some techniques and activities in common with LSVT. Although focused on impairment therapy, including specific voice therapy techniques, it also featured cognitive-linguistic and psychosocial targets and low technology augmentative and alternative communication (AAC). The trial design may have limited opportunities for group intervention. Conclusions and Implications: Any LSVT roll-out needs service support and coordination, and should take an inclusive approach. Future research of Standard NHS SLT should explore a rationale for dosage and more explicit tailoring to individuals and their families. There is also a pressing need to deliver the benefits of LSVT in a cost-effective manner and to develop a range of evidence-based, implementable alternatives as people's communication support needs change. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2025 – Name: AN Label: Accession Number Group: ID Data: EJ1478172 |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1478172 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/1460-6984.70084 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 16 Subjects: – SubjectFull: Foreign Countries Type: general – SubjectFull: Neurological Impairments Type: general – SubjectFull: Intervention Type: general – SubjectFull: Program Implementation Type: general – SubjectFull: Speech Language Pathology Type: general – SubjectFull: Speech Therapy Type: general – SubjectFull: Speech Impairments Type: general – SubjectFull: Outcomes of Treatment Type: general – SubjectFull: Randomized Controlled Trials Type: general – SubjectFull: United Kingdom Type: general Titles: – TitleFull: The PD COMM Process Evaluation: Describing Interventions and Implementation in a UK Pragmatic Randomised Controlled Trial of Speech and Language Therapy for People with Parkinson's-Related Dysarthria Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Avril Nicoll – PersonEntity: Name: NameFull: Marian C. Brady – PersonEntity: Name: NameFull: Patricia Masterson-Algar – PersonEntity: Name: NameFull: Christopher Burton – PersonEntity: Name: NameFull: Gillian Beaton – PersonEntity: Name: NameFull: Sylvia Dickson – PersonEntity: Name: NameFull: Maria Caulfield – PersonEntity: Name: NameFull: Christina H. Smith – PersonEntity: Name: NameFull: Carl E. Clarke – PersonEntity: Name: NameFull: Natalie Ives – PersonEntity: Name: NameFull: Sue Jowett – PersonEntity: Name: NameFull: Caroline Rick – PersonEntity: Name: NameFull: Rebecca Woolley – PersonEntity: Name: NameFull: Catherine M. Sackley IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 07 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 1368-2822 – Type: issn-electronic Value: 1460-6984 Numbering: – Type: volume Value: 60 – Type: issue Value: 4 Titles: – TitleFull: International Journal of Language & Communication Disorders Type: main |
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