Reviews on assistive technology for communication and information


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AAATE conference 2011 Anttila Heidi presentation

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Reviews on assistive technology for communication and information

  1. 1. What do we know from systematic reviews about the effectiveness of assistive products for communication and information used by people with disability? Heidi Anttila, Kersti Samuelsson, Anna-Liisa Salminen, and Åse BrandtSept 2011 Heidi Anttila 1
  2. 2. Outline• To describe a systematic approach to identify and evaluate research evidence• To summarize the available evidence• To inspire clinicians to use the available evidence• To point out potential pitfalls and inspire researchers in doing better research in this fieldSept 2011 Heidi Anttila 2
  3. 3. Definition of the review question• Populations: persons with disabilities• Interventions: AT for communication and information (ISO 9999:2007 classes: 22 09, 22 12, 22 21, 22 33, 22 36 and 22 39)• Comparisons: no AT or other AT, or no comparison• Outcomes: all studied and reported outcomes• Study types: systematic reviews that aimed to evaluate effectiveness or harms of AT Sept 2011 Heidi Anttila 3
  4. 4. MethodsA subsample of 5 reviews from a larger overview of systematic reviews:• Search from 12 databases 01/2000-04/2010, 2210 citations, selected 175 full text articles, included 44 systematic reviews (Anttila et al. Technol Disabil, 2011. In press)• Process: Two authors independently• Data extraction: Study types, sample sizes, types of disabilities, settings, AT, outcome measures, outcomes.• Methodological quality of the reviews: internal validity by AMSTAR checklist (Shea BJ, BMC Medical Research Methodology 2007, 7:10) and 2 questions on external validity• Overall quality of evidence: principles from the GRADE system. (GRADE Working group. BMJ 328, 2004:1490-4)Sept 2011 Heidi Anttila 4
  5. 5. Quality of evidence ”Grading of Recommendations Assessment, Development, and Evaluation”(BMJ 2004, 328: 1490-4) High-quality One or more updated, high-quality systematic reviews that evidence are based on at least 2 high-quality primary studies with consistent resultsModerate- One or more updated systematic reviews of high orquality moderate qualityevidence • Based on at least 1 high-quality primary study • Based on at least 2 primary studies with methodological limitations with consistent resultsLow-quality One or more systematic reviews of variable qualityevidence • Based on primary studies of moderate quality • Based on observational studies with control groups • Based on inconsistent results in the reviews • Based on inconsistent results in primary studiesUnclear Not possible to assess based on the information from the review • Quality of the included studies was not assessed • Reporting was inadequateSept 2011 Heidi Anttila 5
  6. 6. Results• The 5 reviews included: – 1 review on AT for reading and writing – 4 reviews on augmented and alternative communication (AAC)• 3 reviews had only minor methodolocical limitations, 1 moderate and 1 major limitations.• 3 reviews described the participants’ functional limitations and 1 study contexts• Overall quality of evidence remained unclear or low (as derived from the primary studies, their design, consistency and directness)Sept 2011 Heidi Anttila 6
  7. 7. Effectiveness of AT for reading andwriting• 1 review with moderate methodological limitations: – effectiveness of AT for reading and writing for students with reading, learning or mild cognitive disability (MacArthur et al. 2001)• Computer-assisted speech-feedback when reading: improved phonological awareness, decoding skills and word identification Quality of evidence: unclear• Electronic text when reading: inconsistent effects on text comprehension Quality of evidence: Unclear• Word processing when writing: little effect on quality of writing, slower text composition rate Quality of evidence: UnclearSept 2011 Heidi Anttila 7
  8. 8. Effectiveness of AT for augmented andalternative communication• 4 reviews for children with autism or developmental disorders evaluated: – picture exchange communication systems (PECS) – speech generating devices (SGD)• PECS or SGD: gains in speech production, but small and vary across individuals. Quality of evidence: LOW (2 high-quality reviews by Schlosser & Wendt 2008, Millar et al. 2006)• PECS increases initiations, but less eye contact and challenging behaviour Quality of evidence: LOW (1 Low-quality review by Schlosser & Sigafoos 2006)• SGD increases spelling skills and spontaneous speech, not effective in increasing vocalisations Quality of evidence: LOW (1 High-quality review by Wendt 2007)Sept 2011 Heidi Anttila 8
  9. 9. Limitations• Possible publication bias, e.g. unpublished reviews?• Rapidly accumulating reserach literature!• Question of what evidence is enough?Sept 2011 Heidi Anttila 9
  10. 10. Clinical implications• A few high-quality systematic reviews are available!• Use this synthesis as a core evidence resource for clinical decision-making• Do not use as a practice recommendation as such,• Consider also: clinical experiences, costs, and your local AT provision system and constraints.Sept 2011 Heidi Anttila 10
  11. 11. Research implications• Resources are needed for regular updating• Methodological development needed for grading small primary studies• Only narrative conclusions on effectiveness, so the effect sizes and their confidence intervals remain unknown• Need for participation or quality-of-life outcomes• Methodological limitations and small sizes of primary studies: an urgent need for further and better quality research.Sept 2011 Heidi Anttila 11
  12. 12. Conclusion• This overview identified and summarized results of 5 reviews• Three reviews were methodologically robust• Despite low or unclear quality of evidence, potential benefits of the reviewed AT were found and summarizedSept 2011 Heidi Anttila 12
  13. 13. Acknowledgements• Special thanks to information specialists Jukka Lindeman, THL, Finland and Silva Rintanen, Social Insurance Institution, Finland• The authors declare no conflicts of interests.• This study was fully financed by the authors institutions: – National institute for Health and Welfare (THL), Finland; – Linköping University Hospital, Clinical Department Rehabilitation Medicine, Sweden – Social Insurance Institution (Kela), Helsinki, Finland – Danish Centre for Assistive Technology, DenmarkSept 2011 13
  14. 14. Contact informationAnttila, H., Samuelsson K., Salminen A.-L. and Brandt Å. Effectiveness of assistive technology interventions for people with disability: an overview of systematic reviews. Technol Disabil, 2011. In press. heidi.anttila@thl.fiSept 2011 Heidi Anttila 14