Health technology assessment : HTA
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Health Technol Assess · Jul 2007
Randomized Controlled Trial Multicenter Study Comparative StudyA randomised controlled trial and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment.
To compare language outcomes following 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) 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. ⋯ SLTAs can act as effective surrogates for SLTs in the delivery of services within primary schools to children with primary language impairment 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. Further research is needed into effective interventions for receptive language problems and also investigations of the efficacy of the relationship between dose and treatment effect in both expressive and receptive language. Research is also needed into models of integrative service delivery, cluster models of delivery via integrated community schools, and the involvement of class teachers, classroom assistants and parents/carers. There is also a need for studies to identify the characteristics of children who are most likely to succeed with indirect intervention approaches, and also to evaluate alternative methods of working with those who may benefit from different modes. Finally, research to refine the therapy manual would also be helpful.
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Health Technol Assess · Jul 2007
Randomized Controlled Trial Multicenter StudyThe clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis.
To investigate if repetitive transcranial magnetic stimulation (rTMS) was as effective as electroconvulsive therapy (ECT) in treating major depressive episodes and to perform a cost-effectiveness analysis. ⋯ ECT is a more effective and potentially cost-effective antidepressant treatment than 3 weeks of rTMS as administered in this study. Optimal treatment parameters for rTMS need to be established for treating depression. More research is required to refine further the administration of ECT in order to reduce associated cognitive side-effects while maintaining its effectiveness. There is a need for large-scale, adequately powered RCTs comparing different forms of ECT. The next generation of randomised trials of rTMS should also seek to compare treatment variables such as stimulus intensity, number of stimuli administered and duration of treatment, with a view to quantifying an effect size for antidepressant action.