Major trial looks at most effective speech therapy for people with Parkinson’s disease

A major clinical trial involving researchers at Glasgow Caledonian University has shown that the Lee Silverman Voice Treatment (LSVT LOUD®) is more effective than general speech and language therapy provided by the NHS, when treating patients with Parkinson’s disease (PD).

The results of the trial, which has just been published in the British Medical Journal (BMJ),showed that LSVT LOUD® was more effective at reducing the participants’ reported impact of voice problems than the NHS delivered speech and language therapy.

LSVT LOUD® is an effective speech treatment for people with PD and other neurological conditions.  The treatment trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Patients are also given voice exercises to practice at home.

The usual NHS treatment approach is chosen to address individuals’ specific symptoms, is also delivered by a therapist but is less intensive. It is delivered over six to eight sessions rather than the LSVT LOUD® which is delivered in 16 sessions over four weeks.

The trial was led by experts from the Universities of Nottingham, in collaboration with Glasgow Caledonian University, Sandwell and Dudley Hospital Trust, University of Birmingham, University College London, King’s College London, the University of Bangor and Canterbury Christ Church University.

It was carried out by NHS Speech and Language Therapy services across the UK and co-ordinated and analysed by the team at the Birmingham Clinical Trials Unit (BCTU) at the University of Birmingham.

Professor Marian Brady, in Glasgow Caledonian’s School of Health and Life Sciences’ Research Centre for Health (ReaCH), was the lead speech and language therapy clinical expert in the trial. She had specific responsibility for Scottish recruitment and the process evaluation relating to the two active treatments.

Professor Brady said: “This successful trial of an intensive approach to speech and language therapy for people with Parkinson’s-related speech and voice problems is a wonderful example of a clinical-academic endeavour.

“Together with therapists across Scotland and the UK, the trial team addressed an important patient and clinical question using the highest quality research. The results of this rigorous trial have advanced the evidence-base for intensive rehabilitation for people with Parkinson’s.

“I look forward to seeing the results of many more trials that explore the effectiveness of other NHS-delivered interventions for people with Parkinson’s-related speech problems, delivered at a similar intensity.”

ReaCH Research Fellow Syliva Dickson, Dr Pauline Campbell and and former colleague Avril Nicol, were also involved in the research.

Professor Catherine Sackley, from the School of Health Sciences and the NIHR Nottingham Biomedical Research Centre, led the study.

Professor Sackley said: “The impact of speech and communication problems in people with PD can cause them to feel stigmatised. It can stop them going out, socialising, and doing day-to-day tasks such as shopping, which can have a detrimental impact on their quality of life.

“This is the largest study of its kind to look at the most effective treatment options. The results clearly show that, delivered in this way, the LSVT LOUD® method is both effective and it can be cost effective. The NHS method, as it is currently delivered, is not effective. Now we have this data, we need to look at other factors and whether, if different therapies are delivered in different ways, this would further impact the results.”

Adrian Wrigley, who has Parkinson's, said: “Speech and language therapy research is very important to me personally, as I've seen first-hand how the loss or reduction of our main communication tool leads to higher levels of frustration and anxiety, not only for those of us with Parkinson's, but our partners and friends, so the development of a treatment that works is very important for the Parkinson's community.”

The study was funded by the National Institute for Health Research (NIHR), Health Technology Assessment Programme and the pilot trial was funded by the Dunhill Medical Trust, UK.

Read the BMJ article here - ‘Lee Silverman voice treatment versus NHS speech and language therapy versus control for dysarthria in people with Parkinson’s disease (PD COMM): pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial’.