Objective: This study was designed to evaluate the implementation of an efficacious voice treatment, Lee Silverman Voice Treatment (LSVT LOUD), into scope of clinical practice in Germany, France and Japan. 404 clinicians trained in LSVT LOUD were surveyed on a range of variables including training effectiveness and treatment outcomes.

Background: Evidence-based rehabilitation without successful implementation has limited impact on patient care [1].This study will describe the implementation of LSVT LOUD, an efficacious voice treatment for Parkinson Disease (PD), with three published Randomized Control Trials (RCTs) documenting the short and long-term efficacy in the USA [2,3,4], into the clinical speech practice in Germany, France and Japan.

Method: The translation pathway recommended by CRISP was followed, with emphasis on treatment fidelity. Thus a key element in the implementation process was standardized training of speech clinicians. A fundamental goal was maintaining the fidelity of the training while respecting the culture of the country. Thirty-five LSVT LOUD Training and Certification Courses were held throughout Germany, France and Japan since 2000 resulting in more than 3,000 LSVT LOUD Certified clinicians. All training materials were translated into German, French and Japanese by native speakers and all training courses were delivered live with either simultaneous or subsequent translation. To assess implementation and treatment fidelity of LSVT LOUD, an online survey (translated into German, French and Japanese) was administered (Survey Monkey) to these LSVT LOUD Certified clinicians.

Results: Preliminary results revealed 72-90% of clinicians surveyed felt they had received effective training in LSVT LOUD and 62-72% felt they were achieving better outcomes with LSVT LOUD than previous approaches. These findings were consistent with a pilot surveys of groups of German and French clinicians [5,6].

Conclusion: LSVT LOUD is being implemented successfully into scope of clinical speech practice in Germany, France and Japan. This successful implementation of science into clinical practice model provides a road map for other countries where LSVT LOUD clinicians are trained (over 20,500 LSVT LOUD clinicians in 75 countries). Clinician feedback will impact training enhancements. These data will be presented at the World Parkinson Congress, June ,2019, Kyoto, Japan.

References: [1] CRISP (2015) Center for Research in Implementation Science and Prevention, Anschutz Medical Campus, University of Colorado. [2] Ramig, L., Sapir, S., Countryman, S., Pawlas, A., O’Brien, C., Hoehn, M., & Thompson, L. (2001a). Intensive voice treatment (LSVT) for Individuals with Parkinson disease: a two-year follow-up. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 493-498. [3] Ramig, L., Sapir, S., Fox, C., & Countryman, S. (2001b). Changes in vocal Intensity following intensive voice treatment (LSVT) in individuals with Parkinson disease: Pre post- and 6 months comparison with untreated patients and age-matched normal controls. Movement Disorders, 16, 79-83. [4] Ramig, L., Halpern, A., Spielman, J., Fox, C. and Freeman, K. (2018) Speech Treatment in Parkinson Disease: Randomized Controlled Trial (RCT). Movement Disorders. 1-15. https://doi.org/10.1002/mds.27460 [5] Brauer, T., Airiau, C., Fox, C., Ramig, L., Penner, H. & Benecke, P. (2018). Global Implementation of efficacious voice treatment for Parkinson disease: LSVT LOUD Germany and France. Presented at the American Speech Language Hearing Association Conference, Boston. [6] Brauer, T., Penner, H., Benecke, P., Fox, C. & Ramig, L. (2016). Global implementation of efficacious voice treatment for Parkinson disease: LSVT LOUD Germany. Presented at the Movement Disorders Society, 20th International Congress of Parkinson Disease and Movement Disorders, Berlin.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/global-implementation-of-efficacious-voice-treatment-for-parkinsons-disease-lsvt-loud-in-germany-france-and-japan/