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
Authors: Sackley Catherine M , Rick Caroline , Brady Marian C , Woolley Rebecca , Burton Christopher , Patel Smitaa , Masterson-Algar Patricia , Nicoll Avril , Smith Christina H , Jowett Sue , Ives Natalie , Beaton Gillian , Dickson Sylvia , Ottridge Ryan , Sharp Leslie , Nankervis Helen , Clarke Carl E 
Published: July 2024

Abstract

Objectives
To assess the clinical effectiveness of two speech and language therapy approaches versus no speech and language therapy for dysarthria in people with Parkinson’s disease.

Design
Pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial.

Setting
The speech and language therapy interventions were delivered in outpatient or home settings between 26 September 2016 and 16 March 2020.

Participants
388 people with Parkinson’s disease and dysarthria.

Interventions
Participants were randomly assigned to one of three groups (1:1:1): 130 to Lee Silverman voice treatment (LSVT LOUD), 129 to NHS speech and language therapy, and 129 to no speech and language therapy. LSVT LOUD consisted of four, face-to-face or remote, 50 min sessions each week delivered over four weeks. Home based practice activities were set for up to 5-10 mins daily on treatment days and 15 mins twice daily on non-treatment days. Dosage for the NHS speech and language therapy was determined by the local therapist in response to the participants’ needs (estimated from prior research that NHS speech and language therapy participants would receive an average of one session per week over six to eight weeks). Local practices for NHS speech and language therapy were accepted, except for those within the LSVT LOUD protocol. Analyses were based on the intention to treat principle.

Main outcome measures
The primary outcome was total score at three months of self-reported voice handicap index.

Results
People who received LSVT LOUD reported lower voice handicap index scores at three months after randomisation than those who did not receive speech and language therapy (−8.0 points (99% confidence interval −13.3 to −2.6); P<0.001). No evidence suggests a difference in voice handicap index scores between NHS speech and language therapy and no speech and language therapy (1.7 points (−3.8 to 7.1); P=0.43). Patients in the LSVT LOUD group also reported lower voice handicap index scores than did those randomised to NHS speech and language therapy (−9.6 points (−14.9 to −4.4); P<0.001). 93 adverse events (predominately vocal strain) were reported in the LSVT LOUD group, 46 in the NHS speech and language therapy group, and none in the no speech and language therapy group. No serious adverse events were recorded.

Conclusions
LSVT LOUD was more effective at reducing the participant reported impact of voice problems than was no speech and language therapy and NHS speech and language therapy. NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy.

Trial registration

ISRCTN registry
ISRCTN12421382
.