Trial looks at most effective speech therapy for people with Parkinson's

 A major clinical trial, led by researchers at the University of Nottingham, has shown the Lee Silverman Voice Treatment (LSVT LOUD) is more effective than the current speech and language therapy provided by the NHS, when treating patients with Parkinson's disease (PD).

The results of the trial, which are published today in The BMJ, showed that LSVT LOUD was more effective at reducing the participant's reported impact of voice problems than no speech and language therapy, as well as the NHS delivered speech and language therapy.

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

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

Professor Catherine Sackley, from the School of Health Sciences and the NIHR Nottingham Biomedical Research Centre, led the study. She says, "The impact of speech and communication problems in people with PD can cause them to feel stigmatized. It can stop them going out, stop them socializing, and stop them doing day-to-day tasks such as shopping, which can have a detrimental impact on their quality of life.

"This is the first 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."

Building on a pilot study, participants were recruited from 40 NHS sites across the UK and were randomized into three groups. One group received the LSVT LOUD, one received the current NHS speech and language treatment, and the third didn't receive any 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 level while speaking at home, at work, or in the community. Patients are given voice exercises to do this.

The NHS treatment is a personalized program delivered by a therapist and 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.

Between September 2016 and March 2020, 388 people with PD and dysarthria (difficulty speaking) took part in the trial. Of these, 130 were allocated to the LSVT LOUD group, 129 to the NHS therapy group and 129 to neither.

LSVT LOUD consisted of four face-to-face or remote 50-minute sessions, each week delivered over four weeks, with additional home-based practice. The NHS speech and language therapy was determined by the local therapist in response to a participant's individual needs, and an average of one session every other week was delivered over 11 weeks.

The findings of the trial showed that LSVT LOUD was more effective at reducing the impact of dysarthria than no speech and language therapy and the NHS version. The NHS therapy showed no evidence of benefit compared to no speech and language therapy.

Adrian Wrigley, who has Parkinson's said, "Speech and language therapy research is very important to me personally, as I've seen firsthand 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."

More information: What is the clinical effectiveness of Lee Silverman Voice Treatment (LSVT LOUD), NHS speech and language therapy (SLT), versus no speech and language therapy for dysarthria in people with Parkinson's disease?, The BMJ (2024). DOI: 10.1136/bmj-2023-078341

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