title: Which alternative communication methods are effective for voiceless patients in Intensive Care Units? A systematic review.
abstract: OBJECTIVE
  To assess the effectiveness of Augmentative and Alternative Communication (AAC) strategies to enable people who are temporarily voiceless due to medical intervention, to communicate.
  
  
  METHODS
  A systematic review informed by a protocol published on an international register. Ten databases were searched from January 2004 to January 2017. Included studies assessed the effect of using AAC strategies on patient related outcomes and barriers to their use. All included studies were quality appraised. Due to the heterogeneity of interventions and outcome measures findings were narratively reviewed.
  
  
  RESULTS
  Twelve studies met the inclusion criteria and were included in the review reporting outcomes from 1981 patient and 454 health professional participants. The quality of included studies were moderate to weak. AAC communication strategies increased the number of communication interactions, improved patient satisfaction with communication and reduced communication difficulties. Barriers to usage were device characteristics, the clinical condition of the patient, lack of timeliness in communication and staff constraints.
  
  
  CONCLUSIONS
  There is preliminary, but inconsistent evidence that AAC strategies are effective in improving patient satisfaction with communication and reducing difficulties in communication. A lack of comparable studies precluded the identification of the most effective AAC strategy.
authors.affiliation: School of Health Science, University of Salford, Salford, UK. Electronic address: H.Carruthers@salford.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Carruthers
authors.affiliation: School of Human and Health Sciences, University of Huddersfield, Calderdale and Huddersfield NHS Trust, Huddersfield, UK. Electronic address: F.Astin@hud.ac.uk.
authors.forename: Felicity
authors.initials: F
authors.lastname: Astin
authors.affiliation: School of Health Science, University of Salford, Salford, UK. Electronic address: W.Munro@salford.ac.uk.
authors.forename: Wendy
authors.initials: W
authors.lastname: Munro
mesh_terms: D003142:Communication; D003143:Communication Devices for People with Disabilities / Q000639:trends; D003144:Communication Barriers; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards; D009723:Nurse-Patient Relations; D017060:Patient Satisfaction
keywords: Alternative and augmentative communication; Communication; Critical care; Intensive care; Mechanical ventilation; Systematic review