Authors' objectives:

"This trial aimed to address the following research questions.

How do direct individual therapy [speech and language therapist (SLT) working individually with a child], indirect individual therapy [speech and language therapy assistant (SLTA) working individually with a child], direct group therapy (SLT working with a small group of children) and indirect group therapy (SLTA working with a small group of children) compare with regard to the language outcomes for primary school-age children with persistent primary receptive and/or expressive language impairment relative to a comparison group receiving current models and levels of SLT service?

What is the evidence for long-term benefits for such children from their therapy at 12 months' follow-up?

How do the four intervention approaches compare in terms of cost? "

(from executive summary)

Authors' results and conclusions: There was no evidence that the five modes involved in the project were different at the onset in terms of primary outcome measures, although there were significant gender differences. The results from both the intention-to-treat analyses of the outcomes from the 161 children randomised who met the eligibility criteria and the protocol analyses of the outcomes from the 152 children for whom postbaseline data were available revealed that there were no significant postintervention differences between direct and indirect modes of therapy on the one hand, or between individual and group modes on the other on any of the primary language outcome measures, after adjustment for the effects of severity of language impairment at pretest. However, there was evidence of some benefits from direct therapy from an SLT in secondary outcome measures. Parents and teachers were positive about the childrens progress and their experience of the project. All four intervention modes were acceptable to parents and schools. Intervention delivered three times a week for 30;40 minutes over a 15-week period also yielded significant improvements in age-corrected standardised scores for expressive language, although not for receptive language, relative to those receiving community-based SLT services. Children with specific expressive language delay were more likely to show improvement than those with mixed receptive;expressive difficulties, and non-verbal IQ was not a significant moderating variable. The within-trial economic evaluation identified indirect therapy, particularly indirect group therapy, as the least costly of the modes investigated in the study, with direct individual therapy as the most costly option. This is unsurprising given the differences in the ratio of trained professional staff to children and in the cost of labour between different staff grades. However, these cost differences should not be overinterpreted as these estimates were based on the pattern of resource use inherent in the trial design with allowance for how the different modes of therapy could be delivered in practical settings.

Authors' recommendations: Implications for healthcare Well-trained, well-supported and well-motivated SLTAs can act as effective surrogates for SLTs in the delivery of services within primary schools to children with PLI who do not to require the specialist skills of an SLT. Generalising the central estimates of the relative cost of different therapy modes to other educational/health systems is possible, but the precise differences reported in resource use need to be qualified by the level of programme intensity and other characteristic features of education and therapy services that may differ from those observed in this trial.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1232

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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