title: Outcomes after caregiver-provided speech and language or other allied health therapy: a systematic review.
abstract: OBJECTIVE
  To investigate whether allied health therapy provided by caregivers improves patient outcomes.
  
  
  METHODS
  Electronic databases MEDLINE, CINAHL, Embase, Allied Health Evidence, and Cochrane Central Register of Controlled Trials were searched from the earliest available date until July 2011.
  
  
  METHODS
  The search strategy included synonyms for allied health disciplines, caregivers, and randomized controlled trials. Of 1761 potentially relevant articles evaluated by 2 reviewers independently, 29 trials met inclusion criteria.
  
  
  METHODS
  After data were extracted, 2 reviewers independently assessed the quality of trials using the Physiotherapy Evidence Database Scale. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess quality of evidence across studies.
  
  
  RESULTS
  The 29 trials included 1196 participants and investigated speech and language therapy (n=19), physical therapy (n=2), social work (n=1), psychology (n=1), and combinations of 2 or more disciplines (n=6). Meta-analysis provided high-quality evidence that when compared with no intervention, caregiver-administered speech and language therapy improved language outcomes in children. Meta-analysis provided moderate-quality evidence that therapy provided by speech and language therapists was not superior to caregiver-administered therapy for children with speech impairments. The smaller number of physical therapy, psychology, and social work trials could not be combined in meta-analyses but provided examples of caregiver-administered therapy being more effective than no intervention and as effective as clinician-administered therapy.
  
  
  CONCLUSIONS
  There is moderate-quality evidence that caregivers can be trained to provide effective speech and language therapy interventions. This approach needs more evaluation, but may be applicable in the disciplines of physical therapy, occupational therapy, social work, psychology, dietetics, and podiatry.
authors.affiliation: Faculty of Health Sciences, School of Allied Health, Department of Physiotherapy, La Trobe University, Bundoora, VIC 3086, Australia. klawler@students.latrobe.edu.au
authors.forename: Katherine
authors.initials: K
authors.lastname: Lawler
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Taylor
authors.forename: Nora
authors.initials: N
authors.lastname: Shields
mesh_terms: D016390:Allied Health Occupations; D000488:Allied Health Personnel / Q000523:psychology*; D006801:Humans; D016272:Occupational Health; D010043:Outcome and Process Assessment, Health Care; D026741:Physical Therapy Modalities; D011032:Podiatry; D011584:Psychology; D016032:Randomized Controlled Trials as Topic; D012947:Social Work; D013066:Speech-Language Pathology