わが国における言語聴覚療法のエビデンス—システマティックレビューによる検討—Dysarthriaに対する言語聴覚療法のエビデンス

Evidence of speech-language and hearing therapy for Dysarthria in Japan：A systematic review

【目的】本研究の目的はわが国におけるdysarthriaに対する言語聴覚療法のエビデンスをシステマティックレビューによりまとめることである．Research question（以下，RQ）は「言語聴覚療法を主体としたリハビリテーションはDysarthria患者の心身機能・活動・参加レベルにどのようなアウトカムをもたらすか」とした．

【方法】RQを基にdysarthriaに対する言語聴覚療法の介入研究を，適格基準と情報源を明確にして検索し1次・2次スクリーニングを実施した．次いで採択した論文についてバイアスリスクなどを評価し結果を定性的に統合した．

【結果】213文献中1次・2次スクリーニング後に21文献を採択した．包括的介入および発話速度の調節で肯定的な結果が多かった．PLP（palatal lift prosthesis）に関しては効果に個人差があり，適応基準が課題であった．統計学的検定を実施した研究は少数で，バイアスリスクに課題のある研究が存在した．

【考察】今後，対照群を設定した群研究，よくデザインされた実験的な単一事例研究の増加が望まれる．また，アウトカム測定の標準的方法の確立が必要と考える．

　Objective：The aim of this study is to compile evidence for speech-language therapy for dysarthria in Japan through a systematic review. The research question (RQ) is：“What outcomes does speech-language therapy produce in terms of improving body functions, activities and participation for individuals with dysarthria?”

　Methods：Based on the RQ, intervention studies on speech-language therapy for dysarthria were searched for those with clearly defined eligibility criteria and sources. Primary and secondary screenings were conducted. Subsequently, the selected studies were assessed for bias risk and their results were integrated.

　Results：In the primary screening, 102 out of 213 studies were selected, of which 21 studies were further selected in the secondary screening. Positive results were observed in comprehensive interventions and speech rate control. However, there was a variability in the effectiveness of palatal lift prosthesis (PLP), and it was challenging to define the criteria for adaptation. Six studies conducted statistical tests, but some studies had issues with bias risk.

　Discussion：Future research should include studies with control groups, well-designed experimental single-case studies, and investigations into intervention techniques other than speech rate control. Also, there is a need to develop quantitative assessments and standardize outcome assessment in evaluating intervention effects.