Is High-Intensity Speech Intervention Better? A Comparison of High-Intensity Intervention Versus Low-Intensity Intervention in Children With a Cleft Palate

2021 ◽  
pp. 1-18
Author(s):  
Cassandra Alighieri ◽  
Kristiane Van Lierde ◽  
Anne-Sophie De Caesemaeker ◽  
Kris Demuynck ◽  
Laura Bruneel ◽  
...  
Keyword(s):  
Cleft Palate ◽  
High Intensity ◽  
Controlled Trial ◽  
Velopharyngeal Insufficiency ◽  
Dose Frequency ◽  
Baseline Design ◽  
Low Intensity ◽  
Session Duration ◽  
Speech Intervention ◽  
Over Time

Purpose The purpose of this study was to compare the effect of speech intervention provided with a low intensity with speech intervention provided with a high intensity on the speech and health-related quality of life (HRQoL) in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years. Method A longitudinal, prospective, randomized controlled trial with a multiple baseline design was used. Twelve children with a CP ± L ( M age = 8.0 years, SD = 1.54) were divided into two groups using block randomization stratified by age and gender: One group received low-intensity speech intervention (LISI; n = 6) and one group received high-intensity speech intervention (HISI; n = 6). Children in the LISI group received intervention with a session duration of 1 hr, a dose frequency of 1 session per week, and a total intervention duration of 10 weeks. Children in the HISI group received intervention with a session duration of 1 hr, a dose frequency of 5 sessions per week, and a total intervention duration of 2 weeks. The cumulative intervention intensity was kept constant. Both groups received identical therapy programs provided by the same experienced speech therapist. Perceptual speech assessments were performed on baseline and posttreatment data points. Changes in HRQoL were assessed using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) questionnaire. Both groups were compared over time using (generalized) linear mixed models. Results No significant Time × Group interactions were observed for the percentage of correctly produced consonants at the word and sentence levels, indicating no differences in evolution over time among the two groups. The variables speech understandability, speech acceptability, and the total VELO scores significantly improved following HISI, but not following LISI. Conclusions Children in the HISI group made equal and, for some variables, even superior progress in only 2 weeks of therapy compared to children in the LISI group who received 10 weeks of therapy. HISI is a promising strategy to improve speech outcomes and HRQoL in a shorter time period.

Naturalistic Comparison of Models of Programmatic Interventions for Combat-Related Post-Traumatic Stress Disorder

2008 ◽  
Vol 42 (12) ◽  
pp. 1051-1059 ◽  
Author(s):  
David Forbes ◽  
Virginia Lewis ◽  
Ruth Parslow ◽  
Graeme Hawthorne ◽  
Mark Creamer
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
High Intensity ◽  
Stress Disorder ◽  
Moderate Intensity ◽  
Post Traumatic Stress ◽  
Low Intensity ◽  
Post Traumatic ◽  
Over Time ◽  
Ptsd Severity

Objectives: Post-traumatic stress disorder (PTSD) is a difficult-to-treat sequel of combat. Data on effectiveness of alternate treatment structures are important for planning veterans’ psychiatric services. The present study compared clinical presentations and treatment outcomes for Australian veterans with PTSD who participated in a range of models of group-based treatment. Method: Participants consisted of 4339 veterans with combat-related PTSD who participated in one of five types of group-based cognitive behavioural programmes of different intensities and settings. Data were gathered at baseline (intake), as well as at 3 and 9 month follow up, on measures of PTSD, anxiety, depression and alcohol misuse. Analyses of variance and effect size analyses were used to investigate differences at intake and over time by programme type. Results: Small baseline differences by programme intensity were identified. Although significant improvements in symptoms were evident over time for each programme type, no significant differences in outcome were evident between programmes. When PTSD severity was considered, veterans with severe PTSD performed less well in the low-intensity programmes than in the moderate- or high-intensity programmes. Veterans with mild PTSD improved less in high-intensity programmes than in moderate- or low-intensity programmes. Conclusion: Comparable outcomes are evident across programme types. Outcomes may be maximized when veterans participate in programme intensity types that match their level of PTSD severity. When such matching is not feasible, moderate-intensity programmes appear to offer the most consistent outcomes. For regionally based veterans, delivering treatment in their local environment does not detract from, and may even enhance, outcomes. These findings have implications for the planning and purchasing of mental health services for sufferers of PTSD, particularly for veterans of more recent combat or peacekeeping deployments.

scholarly journals A Three-Arm Randomised Controlled Trial of High- and Low-Intensity Implementation Strategies to Support Centre-Based Childcare Service Implementation of Nutrition Guidelines: 12-Month Follow-Up

2020 ◽  
Vol 17 (13) ◽  
pp. 4664
Author(s):  
Alice Grady ◽  
Kirsty Seward ◽  
Meghan Finch ◽  
Luke Wolfenden ◽  
Rebecca Wyse ◽  
...  
Keyword(s):  
High Intensity ◽  
Controlled Trial ◽  
Implementation Strategies ◽  
Food Group ◽  
Audit And Feedback ◽  
Face To Face ◽  
Low Intensity ◽  
Nutrition Guidelines ◽  
Randomised Controlled

The study aimed to compare the effectiveness of a suite of implementation strategies of varying intensities on centre-based childcare service implementation of nutrition guideline recommendations at 12-month follow-up. A six-month three-arm parallel group randomised controlled trial was undertaken with 69 services, randomised to one of three arms: high-intensity strategies (executive support; group face-to-face training; provision of resources; multiple rounds of audit and feedback; ongoing face-to-face and phone support); low-intensity strategies (group face-to-face training; provision of resources; single round of audit and feedback); or usual care control. Across all study arms, only three high-intensity services were compliant with overall nutrition guidelines. A significant group interaction was found between the three arms for compliance with individual food groups. Relative to control, a significantly greater proportion of low-intensity services were compliant with dairy, and a significantly greater proportion of high-intensity services were compliant with fruit, vegetables, dairy, breads and cereals, and discretionary foods. No significant differences between the high- and low-intensity for individual food group compliance were found. High-intensity implementation strategies may be effective in supporting childcare service implementation of individual food group recommendations. Further research is warranted to identify strategies effective in increasing overall nutrition compliance.

scholarly journals Early High-Intensity Versus Low-Intensity Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial

2017 ◽  
Vol 69 (9) ◽  
pp. 1360-1368 ◽  
Author(s):  
Michael J. Bade ◽  
Tamara Struessel ◽  
Michael Dayton ◽  
Jared Foran ◽  
Raymond H. Kim ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
High Intensity ◽  
Controlled Trial ◽  
Low Intensity ◽  
Randomized Controlled ◽  
Total Knee

Perspectives and Determinants for Training-Intensity Distribution in Elite Endurance Athletes

2019 ◽  
Vol 14 (8) ◽  
pp. 1151-1156
Author(s):  
Jan G. Bourgois ◽  
Gil Bourgois ◽  
Jan Boone
Keyword(s):  
Intensity Distribution ◽  
High Intensity ◽  
Ventilatory Threshold ◽  
Important Determinant ◽  
Endurance Athletes ◽  
Training Intensity ◽  
High Intensity Training ◽  
Low Intensity ◽  
Intensity Training ◽  
Over Time

Training-intensity distribution (TID), or the intensity of training and its distribution over time, has been considered an important determinant of the outcome of a training program in elite endurance athletes. The polarized and pyramidal TID, both characterized by a high amount of low-intensity training (below the first lactate or ventilatory threshold), but with different contributions of threshold training (between the first and second lactate or ventilatory threshold) and high-intensity training (above the second lactate or ventilatory threshold), have been reported most frequently in elite endurance athletes. However, the choice between these 2 TIDs is not straightforward. This article describes the historical, evolutionary, and physiological perspectives of the success of the polarized and pyramidal TID and proposes determinants that should be taken into account when choosing the most appropriate TID.

scholarly journals Effects of a large-scale social media advertising campaign on holiday travel and COVID-19 infections: a cluster randomized controlled trial

2021 ◽  
Vol 27 (9) ◽  
pp. 1622-1628
Author(s):  
Emily Breza ◽  
Fatima Cody Stanford ◽  
Marcella Alsan ◽  
Burak Alsan ◽  
Abhijit Banerjee ◽  
...  
Keyword(s):  
Social Media ◽  
Randomized Controlled Trial ◽  
Health Professionals ◽  
High Intensity ◽  
Controlled Trial ◽  
The United States ◽  
Advertising Campaign ◽  
Low Intensity ◽  
Randomized Controlled ◽  
Link Type

AbstractDuring the Coronavirus Disease 2019 (COVID-19) epidemic, many health professionals used social media to promote preventative health behaviors. We conducted a randomized controlled trial of the effect of a Facebook advertising campaign consisting of short videos recorded by doctors and nurses to encourage users to stay at home for the Thanksgiving and Christmas holidays (NCT04644328 and AEARCTR-0006821). We randomly assigned counties to high intensity (n = 410 (386) at Thanksgiving (Christmas)) or low intensity (n = 410 (381)). The intervention was delivered to a large fraction of Facebook subscribers in 75% and 25% of randomly assigned zip codes in high- and low-intensity counties, respectively. In total, 6,998 (6,716) zip codes were included, and 11,954,109 (23,302,290) users were reached at Thanksgiving (Christmas). The first two primary outcomes were holiday travel and fraction leaving home, both measured using mobile phone location data of Facebook users. Average distance traveled in high-intensity counties decreased by −0.993 percentage points (95% confidence interval (CI): –1.616, −0.371; P = 0.002) for the 3 days before each holiday compared to low-intensity counties. The fraction of people who left home on the holiday was not significantly affected (adjusted difference: 0.030; 95% CI: −0.361, 0.420; P = 0.881). The third primary outcome was COVID-19 infections recorded at the zip code level in the 2-week period starting 5 days after the holiday. Infections declined by 3.5% (adjusted 95% CI: −6.2%, −0.7%; P = 0.013) in intervention compared to control zip codes. Social media messages recorded by health professionals before the winter holidays in the United States led to a significant reduction in holiday travel and subsequent COVID-19 infections.

scholarly journals Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive–compulsive disorder: the Obsessive–Compulsive Treatment Efficacy randomised controlled Trial (OCTET)

2017 ◽  
Vol 21 (37) ◽  
pp. 1-132 ◽  
Author(s):  
Karina Lovell ◽  
Peter Bower ◽  
Judith Gellatly ◽  
Sarah Byford ◽  
Penny Bee ◽  
...  
Keyword(s):  
High Intensity ◽  
Controlled Trial ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Waiting List ◽  
Obsessive Compulsive ◽  
Low Intensity ◽  
Self Help ◽  
Randomised Controlled

BackgroundThe Obsessive–Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive–compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive–behavioural therapy (CBT) treatment intensity formats.ObjectivesTo determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive–behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions.DesignA three-arm, multicentre, randomised controlled trial.SettingImproving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts.ParticipantsPatients aged ≥ 18 years meetingDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale–Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English.InterventionsParticipants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT.Main outcome measuresThe primary outcome was OCD symptoms using the Yale–Brown Obsessive Compulsive Scale – Observer Rated.ResultsPatients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data were analysed for 473 patients. In the short term, prior to accessing high-intensity CBT, guided self-help demonstrated statistically significant benefits over waiting list, but these benefits did not meet the prespecified criterion for clinical significance [adjusted mean difference –1.91, 95% confidence interval (CI) –3.27 to –0.55;p = 0.006]. Supported cCBT did not demonstrate any significant benefit (adjusted mean difference –0.71, 95% CI –2.12 to 0.70). In the longer term, access to guided self-help and supported cCBT, prior to high-intensity CBT, did not lead to differences in outcomes compared with access to high-intensity CBT alone. Access to guided self-help and supported cCBT led to significant reductions in the uptake of high-intensity CBT; this did not seem to compromise patient outcomes at 12 months. Taking a decision-making approach, which focuses on which decision has a higher probability of being cost-effective, rather than the statistical significance of the results, there was little evidence that supported cCBT and guided self-help are cost-effective at the 3-month follow-up compared with a waiting list. However, by the 12-month follow-up, data suggested a greater probability of guided self-help being cost-effective than a waiting list from the health- and social-care perspective (60%) and the societal perspective (80%), and of supported cCBT being cost-effective compared with a waiting list from both perspectives (70%). Qualitative interviews found that guided self-help was more acceptable to patients than supported cCBT. Professionals acknowledged the advantages of low intensity interventions at a population level. No adverse events occurred during the trial that were deemed to be suspected or unexpected serious events.LimitationsA significant issue in the interpretation of the results concerns the high level of access to high-intensity CBT during the waiting list period.ConclusionsAlthough low-intensity interventions are not associated with clinically significant improvements in OCD symptoms, economic analysis over 12 months suggests that low-intensity interventions are cost-effective and may have an important role in OCD care pathways. Further research to enhance the clinical effectiveness of these interventions may be warranted, alongside research on how best to incorporate them into care pathways.Trial registrationCurrent Controlled Trials ISRCTN73535163.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 37. See the NIHR Journals Library website for further project information.

scholarly journals The Effect of High-Intensity Power Training on Habitual, Intervention and Total Physical Activity Levels in Older Adults with Type 2 Diabetes: Secondary Outcomes of the GREAT2DO Randomized Controlled Trial

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 15
Author(s):  
Marjan Mosalman Haghighi ◽  
Yorgi Mavros ◽  
Shelley Kay ◽  
Kylie A. Simpson ◽  
Michael K. Baker ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Older Adults ◽  
High Intensity ◽  
Controlled Trial ◽  
Glycosylated Hemoglobin ◽  
Total Physical Activity ◽  
Power Training ◽  
Over Time

Background: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. Materials and Methods: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. Results: Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0–6 (p = 0.16) or 0–6–12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were significantly greater in the power training compared to the sham exercise group across timepoints (p = 0.0001). However, there were no associations between changes in any PA measures over time and changes in metabolic profile. Conclusion: Structured high-intensity power training may be an effective strategy to enhance overall PA in this high-risk cohort.

scholarly journals Effect of high-intensity versus low-intensity praziquantel treatment on HIV disease progression in HIV and Schistosoma mansoni co-infected patients: a randomised controlled trial

2019 ◽  
Vol 3 ◽  
pp. 81
Author(s):  
Andrew Abaasa ◽  
Gershim Asiki ◽  
Andrew Obuku Ekii ◽  
Josephine Wanyenze ◽  
Pietro Pala ◽  
...  
Keyword(s):  
Viral Load ◽  
High Intensity ◽  
Comparison Group ◽  
Controlled Trial ◽  
Hiv Disease ◽  
Low Intensity ◽  
Hiv Progression ◽  
Praziquantel Treatment ◽  
Randomised Controlled

Background: It has been hypothesised that Schistosoma co-infection exacerbates HIV progression, and hence anthelminthic intervention in co-infected individuals will delay it. We evaluated effects of high-intensity versus low-intensity praziquantel treatment of schistosomiasis on HIV disease progression among co-infected patients from fishing populations around Lake Victoria, Uganda. Methods: Between August 2012 and September 2015, we conducted an open-label randomised, controlled trial. Adults, antiretroviral therapy-naïve, CD4 counts ≥350 cells/μl, HIV and S. mansoni co-infected, were randomised 1:1 to praziquantel (40mg/kg) given quarterly (starting at enrolment) or annually (starting 12 weeks after enrolment; such that low-intensity participants were still untreated when sampled at 12 weeks). A non-randomised HIV-positive S. mansoni-negative comparison group was recruited. The primary outcome was mean change in plasma viral load at 12 and 60 weeks. Results: In total 363 participants (high-intensity 113, low-intensity 113, comparison group 137) were recruited; 96 (85.0%), 97 (85.8%) and 107 (78.1%) completed 60 weeks of follow up, respectively. Adjusting for baseline age and viral load, the geometric mean ratio (aGMR [95%CI]) viral load for high-intensity vs low-intensity groups at 12 weeks was 0.90 [0.65, 1.25] p=0.55 and at 60 weeks 1.88 [0.78, 4.53] p=0.16. Results in the comparison group were similar to trial arms. High-intensity, compared to low-intensity, treatment resulted in substantially lower S. mansoni prevalence at all follow up visits (p<0.05). Conclusions: In communities with a high burden of both S. mansoni and HIV infection, high-intensity treatment of S. mansoni does not delay HIV progression despite relevant benefit for parasite clearance. Trial registration: ISRCTN15371662 (17/11/2016)

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