Predicting ReST outcomes: IPD meta-analysis (Ng et al., 2022)

Purpose: The purpose of this study is to identify predictors of treatment outcomes in Rapid Syllable Transition Treatment (ReST) for childhood apraxia of speech through an individual participant data meta-analysis.

Method: A systematic literature search identified nine ReST studies for inclusion. Individual participant data were obtained, and studies were coded for methodological design, baseline participant characteristics, service delivery factors, and treatment outcomes. Bivariate analyses were conducted to identify potential predictor variables. Multiple linear regressions were then performed to identify predictors of treatment outcomes.

Results: Data for 36 participants from seven studies were included in the statistical analyses. In multivariate modeling, better performance on treated pseudowords posttreatment was predicted by higher baseline expressive language and Goldman-Fristoe Test of Articulation scores, lower speech inconsistency and percentage of vowels correct, and higher pretreatment accuracy on pseudoword targets. Better performance on untreated real words posttreatment was predicted by higher pretreatment accuracy on real words. Gains in performance and retention of gains were not significantly predicted by any individual variable or combination of variables.

Conclusions: Baseline speech and expressive language skills and accuracy on pseudowords and real words were significant predictors of absolute posttreatment performance. Regardless of baseline characteristics, all children were statistically as likely to achieve gains during ReST and retain these gains for up to 4 weeks posttreatment. Large-scale prospective research is required to further examine the effects of dose frequency and co-occurring language impairments on treatment outcomes and the complex co-effects of percentage of vowels correct with other potential predictors.

Supplemental Material S1. Baseline variables and assessment tools.

Supplemental Material S2. Pearson’s correlation coefficients for potential predictor variables.

Supplemental Material S3. Quality ratings for included studies.

Supplemental Material S4. Suggested pretreatment assessment protocol.

Ng, W. L., McCabe, P., Heard, R., Park, V., Murray, E., & Thomas, D. (2022). Predicting treatment outcomes in rapid syllable transition treatment: An individual participant data meta-analysis. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2022_JSLHR-21-00617

研究目的：本研究旨在通过个体参与者数据元分析（individual participant data meta-analysis），明确儿童言语失用症（childhood apraxia of speech）患者接受快速音节转换治疗（Rapid Syllable Transition Treatment, ReST）的治疗结局预测因素。

研究方法：通过系统文献检索（systematic literature search）共纳入9项ReST相关研究，获取其个体参与者数据，并对研究的方法学设计、基线参与者特征、干预实施因素及治疗结局进行编码。随后开展双变量分析（bivariate analyses）以筛选潜在预测变量，再通过多元线性回归（multiple linear regressions）确定治疗结局的独立预测因素。

研究结果：最终纳入7项研究的36名参与者数据进行统计分析。多变量模型结果显示，更高的基线表达性语言（expressive language）水平、戈德曼-弗里斯特奥发音测试（Goldman-Fristoe Test of Articulation）得分，更低的言语不一致性（speech inconsistency）与元音正确百分比（percentage of vowels correct），以及更高的假词（pseudowords）靶目标治疗前准确率，可正向预测治疗后经训练的假词表现。而治疗后未训练的真实词（real words）表现，则可由更高的真实词治疗前准确率进行预测。但无论个体变量还是变量组合，均无法显著预测表现获益及获益保持率（retention of gains）。

研究结论：本研究结果表明，基线言语与表达性语言能力、假词及真实词的治疗前准确率，是治疗后绝对表现的显著预测因素。无论基线特征存在何种差异，所有受试儿童在ReST治疗期间均有同等概率获得治疗获益，并可将获益保持至治疗后4周以内。未来需开展大规模前瞻性研究，进一步考察干预频率、共病语言障碍（co-occurring language impairments）对治疗结局的影响，以及元音正确百分比与其他潜在预测因素间的复杂协同效应。

补充材料S1. 基线变量与评估工具
补充材料S2. 潜在预测变量的皮尔逊相关系数
补充材料S3. 纳入研究的质量评级
补充材料S4. 推荐的治疗前评估方案

参考文献：Ng, W. L., McCabe, P., Heard, R., Park, V., Murray, E., & Thomas, D. (2022). 预测快速音节转换治疗的治疗结局：一项个体参与者数据元分析. 《言语、语言与听力研究杂志》, 预印本在线发表. https://doi.org/10.1044/2022_JSLHR-21-00617