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P Enderby

Publications and source records attributed to P Enderby.

At least 19 recordsLinked to original sources
PubMed2003

A 12-month follow-up of preschool children investigating the natural history of speech and language delay.

AIM: The aim of this paper is to examine the natural history of early speech and language delay in preschool children over a 12-month period. METHODS: The study reports data on 69 children under the age of 3.5 years who were referred for speech and language therapy because of early speech and language delay. The children were monitored over a 12-month period but received no direct intervention during that time. Assessment of their comprehension, expressive language and their phonology took place at baseline and again at 6 and 12 months after baseline. RESULTS: The results show a general picture of improvement, although there was considerable individual variation. By the end of the 12 months, two-thirds of the children were still eligible on the study intake criteria. Therapist's rating of a child's functional communication at the outset was a significant predictor of the child's outcome at the end of the 12-month period. DISCUSSION: The paper discusses the appropriateness of a 'monitoring' approach to the management of early language delay and highlights the need to consider the social issues and views of parents as well as the severity of a child's difficulties.

Articulation Disorders↗
PubMed2001

Pharmacological treatment for aphasia following stroke.

BACKGROUND: Aphasia describes language impairment associated with a brain lesion. OBJECTIVES: The objective of this review was to assess the effects of drugs on language abilities when given to people with aphasia following stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Register (last searched: May 2001), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. MEDLINE was searched from 1966-1998, and CINAHL from 1982-1998. We searched the International Journal of Disorders of Communication by hand (known by other names in the past), from 1969 to 1998. SELECTION CRITERIA: Randomised controlled trials comparing: ~bullet~Any drug given to improve language, versus no treatment, or versus placebo ~bullet~Any drug given to improve language versus speech and language therapy ~bullet~One drug given to improve language versus another drug given with the same aim DATA COLLECTION AND ANALYSIS: The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description. We sought missing data from authors, or where appropriate, a drug company. MAIN RESULTS: We considered fifty two studies in detail, from which we identified ten trials suitable for the review. In most cases the methodological quality was unassessable, and only one trial reported sufficient detail for us to complete a description and analysis. This study did lose a large number of patients during its course. Drugs used in the trials identified were piracetam, bifemalane, piribedil, bromocriptine, idebenone, and Dextran 40. We found weak evidence that patients were more likely to have improved on any language measure at the end of the trial if they had received treatment with piracetam (odds ratio 0.46, 95% confidence interval 0.3 to 0.7). The evidence is considered weak because of the large numbers of drop outs from the trials identified, who were lost to follow up. Patients who were treated with piracetam were no more likely (considering statistical significance) than those who took a placebo to experience unwanted effects, including death (odds ratio 1.29, 95% confidence interval for difference 0.9 to 1.7). However, the differences in death rates between the two groups, even though not not statistically significant, do give rise to some concerns that there may be an increased risk of death from taking piracetam. We could not determine if drug treatment is more effective than speech and language therapy. We could not determine whether one drug is more effective than another. REVIEWER'S CONCLUSIONS: The main conclusion of this review is that drug treatment with piracetam may be effective in the treatment of aphasia after stroke. Further research is needed to explore the effects of drugs for aphasia, in particular piracetam. If a trial is done, this must be large enough to have adequate statistical power. The safety of the drug should be of primary interest. Researchers should examine the long term effects of this treatment, and whether it is more effective than speech and language therapy.

Aphasia↗
PubMed2001

Community rehabilitation in the United Kingdom.

OBJECTIVE: To investigate the extent and nature of community rehabilitation services within the United Kingdom. DESIGN: A postal survey starting with the Community Rehabilitation Network and extending to any other teams identified or making contact. SETTING: The National Health Service within the UK. SUBJECTS: Any team who identified themselves as a community rehabilitation service that worked 'primarily with adults with physical disability' within the UK. INTERVENTION: A questionnaire was sent to each team identified with follow-up telephone contact to clarify answers and/or to encourage replies. RESULTS: One hundred and fifty-two organizations were sent questionnaires and 145 replied, but 47 were excluded for various reasons leaving 98 valid replies. Four types of team were identified: community rehabilitation teams, young disabled community teams, community teams for older adults, and specific client group teams. There were huge variations in management arrangements, team composition, goals of the services and likely lifespan of the service. CONCLUSIONS: Community rehabilitation in the UK is currently characterized by small, often short-term teams with poor identity and the term has no clear or consistent meaning.

Adolescent↗
PubMed2001

Benchmarking can facilitate the sharing of information on outcomes of care.

Recent restructuring in the national health service (NHS) aimed to effect cultural and organisation changes that would ensure fair and equal access for service users to effective and efficient services. Clinical governance has been introduced as a means of delivering quality improvement. One element of this is the use of benchmarking to assess current process and outcome and to use comparative information to inform about current and best practice. The use of the Therapy Outcome Measure (TOM) (Enderby and John 1997) was investigated as an indicator to benchmark the outcomes of treatment for different client-groups and compare patterns of outcomes from different speech and language therapy (SLT) services. The study recruited eight SLT trust sites and ran for eighteen months. The TOM data was analysed to note similarities and differences in cases entering treatment, in the direction of change resulting from treatment, and on completing treatment. Variation was found on these points between cases with different disorders and across the trusts. TOM data could be used to provide a benchmark for a disorder against which services could make comparisons. However, for benchmarking to succeed there is a need for support and commitment from every level of an organisation.

Benchmarking↗
PubMed2001

Informing educational change to improve clinical competence.

The factors that have influenced the current approaches to speech and language therapy education in Great Britain are discussed. A project is presented which will provide data on how educational approaches can more clearly reflect professional practice.

Clinical Competence↗
PubMed2001

Day in, day out: the everyday therapy of community clinics.

This paper describes the timing and nature of therapy provided within a recent randomised controlled trial (RCT) of preschool speech and language therapy services. There is literature that describes and evaluates speech and language therapy but there is little indication of how this is translated into everyday practice. The study collected data from 21 speech and language therapists (SLTs) in 16 community clinics. The areas targeted, goals, approaches used, the frequency and timing of contact for the 68 children who received treatment were documented. The data show that several aspects of therapy were frequently targeted simultaneously, that approaches were combined and that the frequency of therapy did not vary with severity. The discussion will consider the gap between published programmes and everyday practice and the implications for effectiveness.

Child, Preschool↗
PubMed2001

Who's afraid of the randomised controlled trial? Parents' views of an SLT research study.

Evidence-based health care is now a reality within the national health service (NHS) and the randomised controlled trial (RCT) is the linchpin of this movement. In modern health care, there has also been a shift towards understanding client perspectives. With regard to clients' participation in research, much consideration has been given to ethical issues and barriers to participation. However, less attention has been paid to the participants' views of clinical trials and understanding how they construe the research. This paper reports a study of the attitudes of parents whose children took part in an RCT. Data were collected from the parents of 20 children, using qualitative in-depth interviews. Parents talked about the meaning of their participation, their motivation for taking part and their understanding of the nature of the trial. The implications of the findings for future research will be considered.

Attitude↗
PubMed2000

Randomised controlled trial of community based speech and language therapy in preschool children.

OBJECTIVE: To compare routine speech and language therapy in preschool children with delayed speech and language against 12 months of "watchful waiting." DESIGN: Pragmatic randomised controlled trial. SETTING: 16 community clinics in Bristol. PARTICIPANTS: 159 preschool children with appreciable speech or language difficulties who fulfilled criteria for admission to speech and language therapy. MAIN OUTCOME MEASURES: Four quantitative measures of speech and language, assessed at 6 and 12 months; a binary variable indicating improvement, by 12 months, on the trial entry criterion. RESULTS: Improvement in auditory comprehension was significant in favour of therapy (adjusted difference in means 4.1, 95% confidence interval 0.5 to 7.6; P=0.025). No significant differences were observed for expressive language (1.4, -2.1 to 4.8; P=0.44); phonology error rate (-4.4, -12.0 to 3.3; P=0.26); language development (0.1, -0.4 to 0.6; P=0.73); or improvement on entry criterion (odds ratio 1.3, 0.67 to 2.4; P=0.46). At the end of the trial, 70% of all children still had substantial speech and language deficits. CONCLUSIONS: This study provides little evidence for the effectiveness of speech and language therapy compared with watchful waiting over 12 months. Providers of speech and language therapy should reconsider the appropriateness, timing, nature, and intensity of such therapy in preschool children. Continued research into more specific provision to subgroups of children is also needed to identify better treatment methods. The lack of resolution of difficulties for most of the children suggests that further research is needed to identify effective ways of helping this population of children.

Analysis of Variance↗
PubMed2000

Speech and language therapy for aphasia following stroke.

BACKGROUND: Aphasia describes language impairment associated with a brain lesion. OBJECTIVES: The objective of this review was to assess the effects of formal speech and language therapy and non-professional types of support from untrained providers for people with aphasia after stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched: March 1999), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. We searched The International Journal of Disorders of Communication by hand (known by other names in the past), from 1969 to 1998. Date of most recent searches: January 1999. SELECTION CRITERIA: Randomised controlled trials comparing: 1. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus no treatment. 2. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus any type of informal support for aphasia, given by speech and language therapists or volunteers, whether these were trained or untrained. 3. One type of speech and language therapy versus another type. Outcome measures included measures of any type of communication, other measures of functioning, numbers of drop-outs, and other non-clinical outcomes. DATA COLLECTION AND ANALYSIS: The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description. MAIN RESULTS: We considered sixty studies in detail, from which we identified twelve trials suitable for the review. Most of these trials were relatively old with poor or unassessable methodological quality. None of the trials was detailed enough for us to complete description and analysis. We could not determine whether formal speech and language therapy is more effective than informal support. REVIEWER'S CONCLUSIONS: The main conclusion of this review is that speech and language therapy treatment for people with aphasia after a stroke has not been shown either to be clearly effective or clearly ineffective within a RCT. Decisions about the management of patients must therefore be based on other forms of evidence. Further research is required to find out if effectiveness of speech and language therapy for aphasic patients is effective. If researchers choose to do a trial, this must be large enough to have adequate statistical power, and be clearly reported.

Aphasia↗
PubMed2000

Benchmarking in rehabilitation: comparing physiotherapy services.

This report presents outcome data from 3,176 consecutive prospective patients referred to physiotherapy for the treatment of soft tissue injuries. The results detailed here are part of a larger study collecting data from different NHS trusts in a benchmarking study. The Therapy Outcome Measure was used to collect data on each patient in four domains: Impairment, Disability/activity, Handicap/participation, and Distress/wellbeing on the entry and the exit from physiotherapy. The study concludes that patients do not have equal opportunity of accessing therapy for their specific condition according to their abilities and needs. Therapy provided in the Trusts did not produce similar changes in the patients' abilities and some dimensions appeared to improve more significantly in some locations. Furthermore this study would suggest that there are no common criteria for discharge of patients with similar conditions from physiotherapy across the Trusts as measured by the Therapy Outcome Measure.

Age Factors↗
PubMed1999

Issues to consider in the evaluation of speech and language therapy for preschool children.

This paper reviews some of the methodological issues involved in the design of a randomized controlled trial currently underway in Bristol. The trial compares the progress of preschool children randomly allocated to a 'watching-waiting' control group with the experimental group who have immediate access to therapy. This paper reviews a number of relevant studies, which have either followed up preschool children with early language delays or have investigated the effects of therapy with this age group. The basic design of the trial is outlined along with a discussion of the sample, the measurements used and the therapy given.

Child, Preschool↗
PubMed1998

Changes in referral to speech and language therapy.

This is a retrospective study of data collected on an information system, developed specifically for the use of speech and language therapists and used by eleven health care providers since 1985. Information prior to 1987 contain the artefacts of new technology and backload logging. Thus this paper reflects data from 1987 to 1995. Information on 70,000 clients amalgamated from these trusts allow us to reflect upon the changes in speech and language therapy over that period. The annual referral rate to these eleven trusts in 1987 was 4,129. The annual referral rate for the same trusts in 1995 had risen to 11,945. The percentage referrals per head of population per year varies between 0.32% and 0.58% of the population.

Adolescent↗
PubMed1998

Running a randomised controlled trial in a service setting: a progress report.

This paper will give a progress report on a randomised controlled trial which is currently underway in the Bristol area. Some of the key influencing literature will be summarised, followed by an overview of the study design. The paper will also highlight some of the methodological and practical advantages and disadvantages afforded by the service setting of the study.

Child, Preschool↗
PubMed1998

Treatment for aphasia following stroke: evidence for effectiveness.

A systematic review of SLT for aphasia following stroke, for the Cochrane Collaboration Stroke Group. Twelve randomised controlled trials were identified, however there was no standard comparison group amongst the trials. Based on this review, it is not possible to reach a conclusion about the effectiveness of the treatments evaluated in these trials. Further research is therefore indicated, and SLTs must base decisions about treatment for aphasia on other forms of evidence.

Aphasia↗
PubMed1996

Frenchay Aphasia Screening Test: validity and comparability.

The Frenchay Aphasia Screening Test1 is a reliable test which can be used by non-specialists to discriminate between aphasia and normal language. Preliminary studies have shown good test-retest reliability, and the test itself is quick and simple to use. The present investigation examines the validity of the test by comparing the results of this test with those on more structured, detailed and frequently used assessments of aphasia -the Minnesota Test for Differential Diagnosis of Aphasia (MTDDA) and general performance in communication as reflected by the Functional Communication Profile. The results demonstrate a positive correlation between the tests, and this allows confidence in the use of this test by non-specialists as a screening instrument.

Aged↗
PubMed1996

Prevalence of speech and language disorders in a mental illness unit.

A survey was conducted to investigate the prevalence of speech and language problems in people receiving care from the Mental Health Unit of a District Health Authority. A screening assessment was devised with the aim of detecting difficulties with receptive and expressive language, voice, articulation and fluency, by use of modified standardised tests and subjective ratings. All in-patients who had been in hospital for longer than six months were screened, as were all day patients attending the Integrated Rehabilitation Workshop in the hospital grounds and a random sample of patients attending two day centres in the community. Results showed that moderate or severe difficulties in at least one aspect of speech and language was present in over two-thirds of the 138 people assessed. The most common problems occurred in the tests of comprehension and naming. A quarter of those assessed had problems with spontaneous speech. Problems with voice, articulation and fluency were less common. The limitations on the information obtained due to the nature of the population considered and the assessment procedure, and the implications of the findings for the management of patients are discussed.

Adolescent↗
PubMed1996

Management of speech and language disorders in a mental illness unit.

Few speech and language therapists work with psychiatric patients. This study investigates how the specific communication problems of this population are addressed by care staff. Following a survey to determine the prevalence of speech and language problems in a psychiatric population, subjects assessed as having moderate or severe difficulties were selected for further study in order to investigate how they were currently being managed by the people responsible for their care. Key workers or charge nurses were interviewed, and ward and department nursing care plans were examined for mentions of speech and language problems, for aims in connection with these problems and for strategies to achieve these aims. Speech and language problems were not mentioned in 40% of the nursing care plans inspected. Where speech and language problems were mentioned there were aims in connection with half of these and strategies to achieve the aims in only 10% of the sample. The reasons for failure to mention speech and language in nursing care plans and for discrepancies between the results of speech and language therapy assessment and assessments of ward and department staff are discussed.

Adolescent↗