A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson’s disease: a study protocol for a randomised controlled trial

C.M. Sackley, C. Rick*, P. Au, M..C. Brady, G. Beaton, C. Burton, M. Caulfield, S. Dickson, F. Dowling, M. Hughes, N. Ives, S. Jowett, P. Masterson-Algar, A. Nicoll, S. Patel, C.H. Smith, R. Woolley, C.E. Clarke

*Corresponding author for this work

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Abstract

Background: Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. Methods/design: PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. Primary outcome: Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. Discussion: The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. 

Original languageEnglish
Article number436
Pages (from-to)436
Number of pages13
JournalTrials
Volume21
Issue number1
DOIs
Publication statusPublished - 27 May 2020

Bibliographical note

This study is funded by the NIHR HTA programme (HTA: 10/135/02). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study design, collection, management, analysis and interpretation of the data, publishing the data is the responsibility of the chief investigator, and the Collaborative Group. The funder does not have any role in the above.

Keywords

  • Dysarthria
  • Idiopathic Parkinson's disease
  • Lee Silverman voice treatment
  • Randomised controlled trial
  • Speech and language therapy
  • TREATMENT LSVT(R)
  • INTELLIGIBILITY
  • VALIDATION
  • PEOPLE
  • LOUDNESS
  • SPEAKERS
  • COMMUNICATION
  • LIFE

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  • Sackley_etal_Trials_Multicentre_VOR

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