Evaluating a Speech-Specific and a Computerized Step-Training-Specific Rhythmic Intervention in Parkinson's Disease: A Cross-Over, Multi-Arms Parallel Study

Background:Recent studies suggest movements of speech and gait in patients with Parkinson's Disease (PD) are impaired by a common underlying rhythmic dysfunction. If this being the case, motor deficits in speech and gait should equally benefit from rhythmic interventions regardless of whether it is a speech-specific or step-training-specific approach.Objective:In this intervention trial, we studied the effects of two rhythmic interventions on speech and gait. These rhythmic intervention programs are similar in terms of intensity and frequency (i.e., 3x per week, 45 min-long sessions for 4 weeks in total), but differ regarding therapeutic approach (rhythmic speech vs. rhythmic balance-mobility training).Methods:This study is a cross-over, parallel multi-arms, single blind intervention trial, in which PD patients treated with rhythmic speech-language therapy (rSLT; N = 16), rhythmic balance-mobility training (rBMT; N = 10), or no therapy (NT; N = 18) were compared to healthy controls (HC; N = 17; matched by age, sex, and education: p > 0.82). Velocity and cadence in speech and gait were evaluated at baseline (BL), 4 weeks (4W-T1), and 6 months (6M-T2) and correlated.Results:Parameters in speech and gait (i.e., speaking and walking velocity, as well as speech rhythm with gait cadence) were positively correlated across groups (p < 0.01). Statistical analyses involved repeated measures ANOVA across groups and time, as well as independent and one-samples t-tests for within groups analyses. Statistical analyses were amplified using Reliable Change (RC) and Reliable Change Indexes (RCI) to calculate true clinically significant changes due to the treatment on a patient individual level. Rhythmic intervention groups improved across variables and time (total Mean Difference: 3.07 [SD 1.8]; 95% CI 0.2–11.36]) compared to the NT group, whose performance declined significantly at 6 months (p < 0.01). HC outperformed rBMT and NT groups across variables and time (p < 0.001); the rSLT performed similarly to HC at 4 weeks and 6 months in speech rhythm and respiration.Conclusions:Speech and gait deficits in PD may share a common mechanism in the underlying cortical circuits. Further, rSLT was more beneficial to dysrhythmic PD patients than rBMT, likely because of the nature of the rhythmic cue.

When (Not) to Rely on the Reliable Change Index

The reliable change index (RCI) is a widely used statistical tool designed to account for measurement error when evaluating difference scores. Because of its conceptual simplicity and computational ease, it persists in research and applied psychology. However, researchers have repeatedly demonstrated ways that the RCI is insufficient or invalid for various applications. This is a problem in research and clinical psychology since this common tool is potentially problematic. The aims of this manuscript are to non-technically describe the formulation and assumptions of the RCI, to offer guidance as to when the RCI is (and is not) appropriate, and to identify what is needed for proper calculation of the RCI when it is used. Several criteria are identified to help determine whether the RCI is appropriate for a specific use. It is apparent that the RCI is the best available method only in a small number of situations, is frequently miscalculated, and produces incorrect inferences more often than simple alternatives, largely because it is highly insensitive to real changes. Specific alternatives are offered which may better operationalize common inferential tasks, including when more than two observations are available and when false negatives are equally costly to false positives.

Univariate and Multivariate Base Rates of Score Elevations, Reliable Change, and Inter-Rater Discrepancies in the BRIEF-A Standardization Samples

The Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A) is a standardized rating scale of subjective executive functioning. We provide univariate and multivariate base rates (BRs) for scale/index scores in the clinical range ( T scores ≥65), reliable change, and inter-rater information not included in the Professional Manual. Participants were adults (ages = 18–90 years) from the BRIEF-A self-report ( N = 1,050) and informant report ( N = 1,200) standardization samples, as well as test–retest ( n = 50 for self, n = 44 for informant) and inter-rater ( n = 180) samples. Univariate BRs of elevated T scores were low (self-report = 3.3%–15.4%, informant report = 4.5%–16.3%). Multivariate BRs revealed the common occurrence of obtaining at least one elevated T-score across scales (self-report = 26.5%–37.3%, informant report = 22.7%–30.3%), whereas virtually none had elevated scores on all scales. Test–retest scores were highly correlated (self = .82–.94; informant = .91–.96). Inter-rater correlations ranged from .44 to .68. Significant ( p < .05) test–retest T-score differences ranged from 7 to 12 for self-report, from 6 to 8 for informant report, and from 16 to 21 points for inter-rater T-score differences. Applications of these findings are discussed.

Traditional-versus Online videoconferencing with smartphone application support Cognitive Behavioral Therapy for Depression: A retrospective cohort study (Preprint)

BACKGROUND Background: The prevalence of major depression is very high and it is considered one of the most hindering disorders, associated with a strong social- and financial impact. Despite the effectiveness of traditional cognitive behavioral therapy (CBT), response, improvement, remission and recovery rates are low and relapse percentages are considerably high. This study is the first to investigate the effectiveness of online videoconferencing CBT with smartphone app support in patients with major depression. With this ‘modern’ way of online CBT, we aim to enhance the effectiveness of CBT OBJECTIVE Objective: The objective is to assess the results of online videoconferencing CBT with app-support compared to TAU in patients with depression. To enhance therapy outcome and patient satisfaction for the treatment of depression. METHODS Methods: A retrospective cohort study was conducted in an outpatient treatment center (PsyQ-Parnassia, the Netherlands). Routine Outcome Monitoring (ROM) data was collected from September 2018 to March 2020, at pre- and post-treatment. Seven hundred and seventy patients were included; 40 for psyQ-online and 730 for psyQ-TAU. The primary outcome measure is the symptoms of depression measured with the Quick Inventory of Depressive Symptomatology (QIDS-SR-16; Trivedi et al., 2004). To assess ‘significant change’ in depressive symptoms we compared pre-and post-treatment scores for PsyQ-online group compared with the PsyQ-TAU group. Clinical significant change or remission was defined as ‘going from above the clinical cut-off score at pre-treatment to below the cut-off score’ which equals ‘normalcy’ or ‘no depression’ (in this case below 6) at post-treatment. ‘Reliable change’ was defined as ‘whether people changed sufficiently that the change is unlikely to be due to simple measurement unreliability’. Reliable changes were grouped in four categories: (1) Recovered = reliable and clinical significant change in QIDS-SR-16, (2) Improved = reliable change, without clinical significant change, (3) No change = no reliable change and no clinical significant change, and (4) Deteriorated = negative reliable change in the QIDS-SR-16 (Jakobsen et al., 2017). To investigate patients satisfaction for online psychotherapy when compared to the patients in the PsyQ-TAU group, we used KLANT scores (Huijbrechts et al., 2009). RESULTS Results: The psyQ-online patients showed significantly higher improvement, remission and recovery percentages compared to the psyQ-TAU patients. Online patients were more satisfied with their therapy compared to TAU patients. CONCLUSIONS Conclusion: ‘Significant reduction’ in depressive symptoms and high percentages of ‘improvement’, ‘remission’ and ‘recovery’, can be obtained when performing online cbt with smartphone-application-support for depression. This even enhances CBT-outcome in highly satisfied patients. CLINICALTRIAL n/a

Test–Retest Reliability and Reliable Change Estimates for Four Mobile Cognitive Tests Administered Virtually in Community-Dwelling Adults

Objective: Remote mobile cognitive testing (MCT) is an expanding area of research, but psychometric data supporting these measures are limited. We provide preliminary data on test–retest reliability and reliable change estimates in four MCTs from SWAY Medical, Inc.Methods: Fifty-five adults from the U.S. Midwest completed the MCTs remotely on their personal mobile devices once per week for 3 consecutive weeks, while being supervised with a video-based virtual connection. The cognitive assessment measured simple reaction time (“Reaction Time”), go/no-go response inhibition (“Impulse Control”), timed visual processing (“Inspection Time”), and working memory (“Working Memory”). For each cognitive test except Working Memory, we analyzed both millisecond (ms) responses and an overall SWAY composite score.Results: The mean age of the sample was 26.69years (SD=9.89; range=18–58). Of the 55 adults, 38 (69.1%) were women and 49 (89.1%) used an iPhone. Friedman’s ANOVAs examining differences across testing sessions were nonsignificant (ps&gt;0.31). Intraclass correlations for Weeks 1–3 were: Reaction Time (ms): 0.83, Reaction Time (SWAY): 0.83, Impulse Control (ms): 0.68, Impulse Control (SWAY): 0.80, Inspection Time (ms): 0.75, Inspection Time (SWAY): 0.75, and Working Memory (SWAY): 0.88. Intraclass correlations for Weeks 1–2 were: Reaction Time (ms): 0.75, Reaction Time (SWAY): 0.74, Impulse Control (ms): 0.60, Impulse Control (SWAY): 0.76, Inspection Time (ms): 0.79, Inspection Time (SWAY): 0.79, and Working Memory (SWAY): 0.83. Natural distributions of difference scores were calculated and reliable change estimates are presented for 70, 80, and 90% CIs.Conclusion: Test–retest reliability was adequate or better for the MCTs in this virtual remote testing study. Reliable change estimates allow for the determination of whether a particular level of improvement or decline in performance is within the range of probable measurement error. Additional reliability and validity data are needed in other age groups.

Nostalgic conversations: The co-production of an intervention package for people living with dementia and their spouse

Objectives Nostalgic memories are more social than other forms of autobiographical recall, often refer to atypical events, express more positive affect and reflect life as meaningful. Recalling a nostalgic (compared to ordinary) memory increases self-esteem, self-growth, meaning in life and social connectedness for people living with dementia. We set two objectives: to work with people living with dementia to develop an intervention based on nostalgia, and to assess whether couples could engage in nostalgic conversations. Method Our research fell into three phases. Initially, we consulted with people living with dementia and with carers to identify the parameters for a nostalgic intervention. From this, we drafted a workbook that contained triggers for nostalgic conversations, which we then took back to the public contributors for refinement. Finally, we trialled the workbook over 5 weeks with six couples, each of which included a person living with dementia. We assessed pre- and post-intervention self-esteem, self-growth, meaning in life and social connectedness for participants with dementia and social connectedness for carers. We then calculated Reliable Change Index scores and established levels of clinically significant change. We also interviewed couples at the end of the intervention to explore its implementation and acceptability. Results All six couples could identify nostalgic memories, with five couples successfully integrating the nostalgic conversations into their day-to-day lives. A sixth couple found it difficult to engage fully with the intervention, but still considered it useful. All six couples manifested a reliable change in at least one outcome, with one couple showing reliable change across three outcomes. Conclusion The psychological benefits of nostalgia have been robustly demonstrated in laboratory-based studies. This co-production of an intervention that sets nostalgic recall into the context of a conversation has clinical potential but requires further investigation through a larger study.

Interpreting change on the Symbol Digit Modalities Test in people with relapsing multiple sclerosis using the reliable change methodology

Background: The Symbol Digit Modalities Test (SDMT) is increasingly utilized in clinical trials. A SDMT score change of 4 points is considered clinically important, based on association with employment anchors. Optimal thresholds for statistically reliable SDMT changes, accounting for test reliability and measurement error, are yet to be applied to individual cases. Objective: The aim of this study was to derive a statistically reliable marker of individual change on the SDMT. Methods: This prospective, case–control study enrolled 166 patients with multiple sclerosis (MS). SDMT scores at baseline, relapse, and 3-month follow-up were compared between relapsing and stable patient groups. Using data from the stable group and three previously published studies, candidate thresholds for reliable decline were calculated and validated against other tests and a clinically meaningful anchor—cognitive relapse. Results: Candidate thresholds for reliable decline at the 80% confidence level varied between 6 and 11 points. An SDMT change of 8 or more raw score points was deemed to offer the best balance of discriminatory power and external validity for estimating cognitive decline. Conclusion: This study illustrates the feasibility and usefulness of reliable change methodology for identifying statistically meaningful cognitive decline that could be implemented to identify change in individual patients, for both clinical management and clinical trial outcomes.