READING ALOUD PROTOCOLxALOUD,PRO… · range of different groups of people including people with...
Transcript of READING ALOUD PROTOCOLxALOUD,PRO… · range of different groups of people including people with...
Reading aloud as a therapeutic intervention Protocol
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Completed May 2012
What is the evidence for reading aloud and group reading as a therapeutic intervention to improve the health and well-being of patients with neurological disorders in clinical and long-term care settings?
PROTOCOL
Reading aloud as a therapeutic intervention Protocol
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Contents 1 REVIEW TEAM .............................................................................................................. 3
2 PLAIN ENGLISH SUMMARY ....................................................................................... 4
3 BACKGROUND AND RATIONALE ............................................................................. 4
3.1 Aims and objectives .......................................................................................................... 4
3.2 Background ....................................................................................................................... 4
3.3 Importance of the proposed research ................................................................................ 6
4 METHODS FOR SYNTHESISING EVIDENCE ............................................................ 6
4.1 Search strategy .................................................................................................................. 6
4.2 Study selection .................................................................................................................. 6
4.3 Data extraction strategy .................................................................................................... 8
4.4 Quality assessment strategy .............................................................................................. 8
4.5 Methods of analysis/synthesis .......................................................................................... 8
5 PROJECT MILESTONES ................................................................................................ 8
6 JUSTIFICATION OF SUPPORT REQUIRED ............................................................... 8
7 DISSEMINATION ........................................................................................................... 9
8 REFERENCES ................................................................................................................. 9
9 APPENDICES ................................................................................................................ 10
Reading aloud as a therapeutic intervention Protocol
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1 REVIEW TEAM Julie Latchem1
Dr Janette Greenhalgh2
Dr Rumona Dickson3
1Physiotherapy Team Leader – General and Old Age Medicine, Gloucestershire Royal Hospital, Gloucestershire NHS Foundation Trust.
2Liverpool Reviews and Implementation Group (LRiG), University of Liverpool
3 Liverpool Reviews and Implementation Group (LRiG), University of Liverpool
Correspondence to:
Julie Latchem
Physiotherapy Team Leader
Gloucestershire NHS Foundation Trust
Gloucestershire Royal Hospital
Great Western Road
Gloucester
GL1 3NN
Tel: +44 (0) 8454 228527
Email: [email protected]
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2 PLAIN ENGLISH SUMMARY The Reader Organisation’s ‘Get into Reading’ model of shared reading has to date been used with a
range of different groups of people including people with dementia, depression, single mothers,
women in prisons and is currently being utilised with people with chronic pain. Whilst research into
the health benefits of this model of shared reading, is in its infancy, the research to date has been
encouraging. To date little research has been carried out considering the utilising of this model with
people with neurological conditions. Anecdotally reading groups of varying nature have been seen to
have positive effects of residents with neurological conditions in long-term settings. The aim of this
review is to establish the strength of the current evidence for use of this type of intervention (reading
aloud, group and individual or ‘lone’ reading) on improving the health and well-being of those with
neurological conditions.
3 BACKGROUND AND RATIONALE
3.1 Aims and objectives The objectives of the review are:
• To systematically review and summarise relevant evidence, identifying the breadth of research already conducted around the area of individual or ‘lone’ reading, reading aloud and group reading with people with neurological disease or insult and produce a descriptive map.
• To synthesise the evidence of the outcomes of individual or ‘lone’ reading, reading aloud and group reading interventions to map the potential benefits of the interventions for people with neurological conditions.
• To identify gaps in the literature to inform future research development in this area.
3.2 Background Get into Reading (GiR) is a reading model developed by The Reader Organisation (TRO), a national
charity which has an extensive social inclusion programme based on shared reading (Billington et al,
2010). The GiR Model is a standardised model of group reading. The principal features of the model
is the reading aloud of classic English literature in the session itself and open-ended discussion
encouraged by the facilitator. Each group session follows a standard structure - an initial period of
reflection on the previous session, the reading of a short poem to open and conclude the session and
the shared reading and discussion of a section of a novel. Each session lasts between an hour to an
hour and a half (Billington et al, 2010).
TRO’s intervention is distinguished from other reading therapies (which rely on ‘self-help’ books) in
emphasising the importance of serious, ‘classic’ literature and its role in mediating experience and
offering a model of human thinking and feeling (Davis, 2009). GiR has been nationally lauded:
finalist in 2007 NHS Health and Social Awards (Billington et al, 2010); and identified in the
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Department of Health’s recent New Horizons consultation document as a non-
pharmacological/medical intervention that can help improve quality of life (DoH, 2009).
Robust research into the patient benefits of the model is in its infancy. Observed and reported
outcomes for participants have included: being ‘taken out of the themselves’ via the stimulation of the
book or poem; feeling ‘good’, ‘better’, ‘more positive about things’ after taking part in the group;
valuing an opportunity and space to reflect on life experience, via memories or emotions evoked by
the story or poem, in a convivial and supportive environment; improved powers of concentration; a
sense of common purpose and of a shared ‘journey’; increased confidence and self-esteem; sense of
pride and achievement; valued regular social contact and decreased sense of isolation; improved
communication skills including introduction to new forms of verbal expression. (Robinson, 2008)
These preliminary findings resonate with other innovative research into reading and health, which
suggested that the act of reading together a literary text not only harnesses the power of reading as a
cognitive process: it acts as a powerful socially coalescing presence, allowing readers a sense of
subjective and shared experience at the same time. (Hodge et al, 2007) Related research suggests that
the inner neural processing of language when a mind reads a complex line of poetry or prose syntax
has the potential to galvanise existing brain pathways and to influence emotion networks and memory
function (Thierry et al, 2008; Davis, 2008). The possibility that shared reading can help make those
micro-happenings last longer and bite deeper - both at the point of delivery and in its effects over time
- is a key area requiring dedicated research.
Alongside the benefits highlighted above and the reference to neurological pathways as susceptible to
influence in private or individual reading, anecdotally reading together in groups has been observed to
be beneficial for those with neurological conditions with minor and severe disabilities and
impairments, including observations of reduced challenging behaviour (during the intervention) in
those with severe neurological insult and the engagement of mixed groups of neurological patients
(those with only mild physical impairment with those with severe disabilities and sensory and
cognitive impairments) contributing to a sense of community and connectedness in long-term care
settings. The importance of such an intervention is underlined by evidence that residents with
neurological disorders and their families living in long-term care facilities report that stimulation, a
feeling of connectedness and a sense of community is extremely important to them. (Latchem and
Kitzinger 2012)
The proposed literature review aims to provide a useful precursor into the investigation of the
potential benefit of individual reading and the GiR model of shared reading as an intervention to
improve the health and well-being of people with neurological disorders (i.e. acquired brain injury,
multiple sclerosis, huntingtons disease, stroke).
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3.3 Importance of the proposed research Neurological injury and disease progression manifests in an extensive range of symptoms and
subsequent sensory, motor and cognitive impairments. For those with neurological injury or disease
their symptoms and disabilities not only have a physical impact but a psychological and social one
too, having a potentially devastating effect on their lives. Modern medicine and therapies whilst
heavily assisting those with neurological conditions to manage their symptoms, retain or regain
independence and function for as long as possible are unable to meet all the needs of this population.
The GiR model has the potential to encourage individual self-expression, provide a platform for the
accessing and development of abstract and creative thinking, has the potential to improve divided
attention, elements of language and speech production, social skills, reduce anxiety and dis-inhibition
and provide an opportunity for social interaction, a sense of connectedness and community for those
with neurological conditions.
4 METHODS FOR SYNTHESISING EVIDENCE This research proposal is an evidence synthesis. Data will be extracted from existing papers and will
not require contact with patients, their relatives or staff.
4.1 Search strategy Seven key major electronic databases - AMED (Allied and complementary medicine), BNI (British
Nursing Index), CINAHL (Nursing and allied health), MEDLINE (General medical), PsycINFO
(Psychiatry, psychology and social sciences), Web of Knowledge (Social Sciences, Arts and
Humanities), ERIC (Education) will be searched for relevant published literature. (Please see
Appendix A) for key search terms) These databases have been selected as they cover a wide range of
health, social science, arts and education disciplines.
Systematic searching of the electronic databases, hand searching of key journals, internet searching,
‘snowballing’ technique from references of relevant research studies and consultation with experts in
the field will be conducted. A database of published literature will be assembled and held in the
EndNote X5 software package.
4.2 Study selection The citations identified by the search strategy will be assessed for inclusion in two stages by two
reviewers. Firstly all relevant titles and abstracts identified via electronic searching will be screened to
identify potentially relevant studies for inclusion in the review. Secondly, full text copies of these
potentially relevant studies will be obtained and assessed using the inclusion/exclusion criteria as
outlined in Table 1Error! Reference source not found.. The criteria specified in Table 1 will be
applied to all studies after screening.
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Table 1: Inclusion/Exclusion Criteria Inclusion Exclusion Justification
Population Adults and paediatrics
with any neurological
disease or insult,
progressive or
traumatic.
Those with
developmental or
learning difficulties
or those with a
purely mental
health diagnosis.
Clinical presentations and needs between these
groups whilst having similarities are also extremely
different. Although reading and shared reading
aloud for the excluded groups may have implication
for the focus of the review - adult and paediatric
traumatic or progressive neurology is to be included
only.
Intervention Individual reading;
reading aloud;
reading in groups.
Any form of reading
used either as a
therapeutic
intervention or as an
activity to identify
therapeutic benefit
and/or improve
health or well-being.
Narratives/life
history,
reminiscence
therapy.
Reading for
‘normal’
development of
language or
numeracy skills
development.
fMRI studies using
reading to identify
impairment.
The underpinning focus of this review is to
contribute to establishing if reading and shared
reading – specifically The Reader Organisations ‘GiR’
model - has potential implementation for those with
neurological disorders. Central to this model is
reading aloud, especially reading together in groups
and a continuation of lone reading once the group
has finished.
As the aim of this review is to look at reading as a
therapeutic intervention for those with neurological
disorders studies on ‘normal’ development in
children are not to be included nor studies utilising
reading to identify impairments are not to be
included although they may be referred to as part of
a narrative map or in introduction or background
sections of the final write up. Comparators The above compared
with each other,
placebo or no
intervention
No exclusions. Due to the aim and scope of this review comparative
exclusions would be unnecessarily limiting.
Setting Hospital wards,
rehabilitation centres,
nursing and
residential homes,
respite centres and
hospices. Outpatients
and community
settings i.e GP
surgeries.
No exclusions. Whilst there are no exclusions with regards to
location - the origins of the review is underpinned by
the clinical experience of Julie Latchem in
neurological rehabilitation and long-term settings
and her observations of the positive effects group
reading has on those with complex neurological
needs in long-term care settings. A focus on long-
term care and rehabilitation settings may occur
should vast amounts of relevant literature be
uncovered.
Outcomes Any positive or
adverse health based
outcome, any
objective health
based clinical
outcome measure.
Any subjective
outcomes whether
identified through
thematic analysis or
quantitative data
collection methods.
No exclusions. The effects of reading aloud and reading in groups
for those with neurological conditions is potentially
wide ranging. Excluding any form of health outcome
would be detrimental to the main aims of the
review.
Study design All. Nil. All research methodologies have the potential to
provide a useful insight into the effect of this
intervention. Exclusions would be detrimental to the
aims of the review.
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4.3 Data extraction strategy Study details will be extracted by an initial reviewer using a standardised data extraction form and
subsequently checked by a second reviewer. Should the same data be reported in multiple
publications, the data will be extracted and reported as a single study with all other publications listed.
4.4 Quality assessment strategy The methodological quality of each included study will be assessed using a quality appraisal tool
based on appropriate criteria relevant to the study design. The quality of individual studies will be
assessed by one reviewer and a selection will be independently checked for agreement by a second
reviewer to improve the rigour of the research. Disagreements will be resolved through consensus
and, if necessary, a third reviewer will be consulted.
4.5 Methods of analysis/synthesis The results of the data extraction and quality assessment for each study will be presented in structured
tables and as a narrative summary. The possible effects of study quality on the effectiveness data and
review findings will be discussed. All summary statistics will be extracted for each outcome and
where possible, data will be pooled using a standard meta-analysis. Themes identified through
qualitative studies will also be synthesised and presented in tables.
5 PROJECT MILESTONES
Milestone Date (estimated)
Literature searches May 2012
Article screening June 2012
Data extraction July 2012
Quality assessment July 2012
Data synthesis and presentation August 2012
Final draft of report for peer review September - October 2012
Submission of final report October - November 2012
6 JUSTIFICATION OF SUPPORT REQUIRED This project is funded by LRiG from ‘Capacity building’ funds. Costs are required for time spent on
the project by Julie Latchem to backfill her clinical hours as Physiotherapy Team Leader, General and
Old Age Medicine, Gloucestershire NHS Foundation Trust and to cover travel and accommodation
expenses to allow direction and supervision of the project from key methodologists at LRiG.
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7 DISSEMINATION The review produced as a part of this project will be submitted to LRiG. We will also prepare at least
one paper for publication in an appropriate specialist journal and will propose the work for
presentation at several conferences at which to present the findings.
8 REFERENCES Billington, J. et al (2010) An investigation into the therapeutic benefits of reading in relation to depression and well-being. Liverpool Health Inequalities research institute. Coughlan et al (2007) Step by step guide to critiquing research: Part 1 quantitative research. British Journal of Nursing 16(11) pp658-663 Davis J. (2009) Groups Reading Aloud for Wellbeing, The Lancet, 373, 2009. Davis, P. (2008) ‘Syntax and Pathways’ Interdisciplinary Science Reviews, 33:4, 265-77. Department of Health (2009) New Horizons: towards a shared vision for mental health – consultation. Hodge S, Robinson J, Davis P. (2007) Reading between the lines: community reading project, Medical Humanities 33. Latchem J. and Kitzinger J. (2012) What is important to residents with neurological conditions and their relatives in rehabilitation or long-term care centres? http://www.cardiff.ac.uk/jomec/resources/Long_Term_Care.pdf Khan, K et al (2011) Systematic reviews to support evidence based medicine. Second Edition. London. Hodder and Stoughton Ltd. Robinson, J. (2008) Reading and Talking: Walton Neuro-Rehabilitation Unit & Vauxhall Health Care Centre. HaCCRU Research Reports 114 & 115/08. Ryan et al (2007) Step by step guide to critiquing research: Part 2 qualitative research. British Journal of Nursing 16(12) pp738-744 Thierry G, Martin C, Gonzalez-Diaz V et al.(2008) Event-related potential characterisation of the Shakespearean functional shift in narrative sentence structure, NeuroImage 40: 923-931.
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9 APPENDICES Appendix a) - Key search terms
Intervention Population Location Disorders
read*aloud
Reading therap*
oral reading
lone reading
shared reading
group* read*
poem*
poetry
story-telling
literature
neuro*
stroke
CVA
CVE
multiple sclerosis
huntingtons disease
parkinsons disease
motor-neurone disease
traumatic brain injury
acquired brain injury
Dementia
Alzheimers disease
nursing home*
Residential
home*
long term care
hospital
outpatient*
community
GP surger*
doctor* surger*
aphasia
expressive aphasia receptive aphasia
dysarthria
dysphonia
prosody
phonation
divided attention
challenging
behaviour