Comparing face-to-face and online LSVT®LOUD speech training using LSVT®Coach in patients with Parkinson's disease: a pilot randomised controlled trial.

Abstract

Background: LSVT®LOUD is an intensive speech therapy targeting voice amplitude, incorporating proprioceptive feedback and auditory-vocal self-monitoring, delivered through 16 one-hour sessions over a month with a high-effort approach. This study aimed to investigate preliminary effects of LSVT®LOUD teletherapy (LSVT®LOUD-tele) in comparison to traditional face-to-face LSVT®LOUD therapy (LSVT®LOUD-FTF) in people with PD and hypokinetic dysarthria, and to assess the usability of the LSVT®LOUD-tele software and the feasibility of a full-scale randomised controlled trial (RCT).

Methods: Using a pilot RCT, 20 people with PD and hypokinetic dysarthria were assigned to either LSVT®LOUD-tele or LSVT®LOUD-FTF, receiving 60-min sessions 4x/week for 4 weeks, along with home-based practice maintaining the same intensity and frequency in both conditions. Primary outcome was voice loudness (sound pressure levels [SPL]). Secondary outcomes included voice handicap, dysarthria-related QoL, HRQoL, and depression, assessed at baseline and post-intervention. The feasibility of conducting a full-scale RCT based on predetermined criteria (33% recruitment rate, 85% retention rate, 75% adherence rate, and high intervention safety) and the usability of the LSVT®LOUD-tele software were assessed post-intervention.

Results: Nineteen participants completed the study (10 women). The LSVT®LOUD-FTF group showed improvements in vowel 'Ah' and 'high-pitched A' SPLs (Hedge's g = 1.416 and 0.826), while both groups showed increases in 'low-pitched A' and good quality loud voice SPLs (g = 0.148; g = 0.211). No changes were observed in everyday phrases SPL (g = 0.167) for either intervention, and both groups showed improvements in text reading (g = 0.436) and conversation SPLs (g = 0.345). Subjective voice handicap improved in both groups (eta squared [η²] = 0.259), while only LSVT®LOUD brought improvement to total dysarthria-related QoL (η² = 0.747). HRQoL improvements were noted in activities of daily living, cognition, and bodily discomfort domains after LSVT®LOUD-FTF, and in communication after LSVT®LOUD-tele (η² = 0.054-0.386). LSVT®LOUD-FTF led to small improvements in depression, with no significant differences noted between groups. Good-to-excellent usability of LSVT®LOUD-tele was observed, and the feasibility of a full-scale RCT was supported by high overall recruitment, retention, and adherence rates, with no adverse events reported.

Conclusions: Both LSVT®LOUD-tele and LSVT®LOUD-FTF appear effective for people with PD and hypokinetic dysarthria, and the feasibility of a full-scale RCT was confirmed. Larger studies are needed to validate these findings.

Trial registration: German Clinical Trials Register, DRKS00027825 . Registered on 13.01.2022.