A recent discussion with a parent
and a speech and language therapist about how best to measure whether therapy
has had an effect made me choose this article for this month’s blog post.
I am not telling you anything new
when I say that speech therapy can have a positive impact on a person’s
communication and wellbeing. However, services are under increasing pressure to
prove that their therapies are effective – from a clinical as well as cost-effective
point of view. According to Pamela Enderby, one of the leading researchers on speech
and language therapy and health interventions in the UK, outcome measures are
important for evaluating and improving clinical services as they can measure communication
changes in individuals, but also allow for comparison across services.
Outcomes measures try to establish
whether an individual has benefitted from therapy. There are several reasons
why this is this difficult to find out for an area such speech and language
therapy: 1) there are a wide range of therapy options for a child with
dysarthria depending on the communication problem; 2) it is one thing to
measure improvement in speech e.g. intelligibility, but how do you measure wellbeing,
improved coping skills or increased confidence, which can all contribute to
improved communication?
According to Enderby, Therapy
Outcomes Measures or TOM (Enderby et al., 2006) can capture these more holistic
aspects of therapy. TOM allows clinicians to describe the abilities of a child for
impairment, communication activity, participation and wellbeing before and
after therapy. The four features are rated on an 11 point scale (0 – severe to
5 – normal for age and sex) using the usual assessment procedures. I see TOMs
strengths in the fact that they are a set of scales which are based on the
International Classification of Functioning, Disability and Health framework
(WHO). It is a quick tool that has proved reliable for a range studies, and can
be applied irrespective of the various assessment procedures that exist in
services.
On the other hand, I think that in
some cases a qualitative analysis of the data would be helpful to better understand
results. For instance, no change in the rating could be considered a positive outcome
in cases where the dysarthria is due to progressive disorders. Also, training
may be needed to ensure consistency in the use of the scale. Being a member of
review panels, I know how differently the same work can be viewed, with some
judges, for instance, never exhausting the full scoring range available to them.
After all, judging is the act or process of forming an opinion or making a decision
after careful thought, i.e. it has a subjective element to it. This, however, should
not stop us in our endeavour to improve the quality of the services we offer.
Enderby, P. (2014). Use of extended therapy outcome measure
for children with dysarthria. International
Journal of Speech-Language Pathology, 16(4), 436-444.
