Treatment Integrity and Differentiation in the Very Early Rehabilitation in SpEech (VERSE) trial

Figures & data

Table 1. Participant demographic and stroke characteristics

Demographic	Whole group (n = 44)^a	VERSE (n = 25)	Usual Care-Plus (n = 19)	VERSE High Intensity cohort (n = 164)^b
Age, Mean (SD)	72.0 (14.8)	75.0 (14.2)	68.0 (14.7)	75 (18)
Female	19 (43%)	12 (48%)	7 (37%)	80 (49%)
Oxford Stroke Classification ^c
Haemorrhagic	3 (7%)	2 (8%)	1 (5%)	13 (8%)
PACs	34 (77%)	18 (72%)	16 (84%)	110 (67%)
PoCs	1 (2%)	0 (0%)	1 (5%)	6 (4%)
TACs	6 (14%)	5 (20%)	1 (5%)	35 (21%)
Baseline WABR-AQ Severity
Mild	15 (34%)	8 (32%)	7 (37%)	47 (29%)
Moderate	13 (30%)	7 (28%)	6 (32%)	49 (30%)
Severe	16 (36%)	10 (40%)	6 (32%)	68 (41%)
Modified Rankin Scale Score (mRS)
Low disability (mRS 0–2)	6 (14%)	5 (20%)	1 (5%)	16 (10%)
High disability (mRS 3–5)	38 (86%)	20 (80%)	18 (95%)	148 (90%)
National Institutes of Health Scale Score, Mean (SD)	9.1 (7.1)	9.4 (7.5)	8.7 (6.5)	9 (6)

Note. ^a Within this substudy, 53 videos were selected through randomisation with 8 participants having more than one video in the sample. Therefore, 44 different participants are included in this demographics table. ^b This column represents the VERSE high intensity cohort as a whole from the primary study for comparison purposes. ^c PACs = Partial Anterior Circulation syndrome; PoCs = Posterior Circulation syndrome; TACs = Total Anterior Circulation syndrome.

Table 2. Summary of coding for task adherence

Goal level	Definition	Utterance level coding	Minimum MLU Expected in Session
1a	Receptive: Identification of verb pictures from spoken words	Any verbal output is appropriate. Cannot mark as being below goal level. Can mark as above goal level for any verbal output that is not an error.	0
1b	Receptive: Identification of noun pictures from spoken words		0
1c	Receptive: Identification of adjectives pictures from spoken words		0
2	Verbal production of single words	If not responding verbally then mark as below the appropriate goal level. Can mark as above goal level if above this level.	1
3	Verbal production of two element phrases or clauses	If responding at single-word level including yes/no responses then mark as below the appropriate goal level. Can mark as above goal level if above this level.	2
4	Verbal production of three element phrases or clauses	If responding below three element clause then mark as below the appropriate goal level. Can mark as above goal level if above this level.	3
5	Verbal production of complex clauses and/ or phrases	If responding with three element clauses or less then mark as below the appropriate goal level. Can mark as above goal level if above this level.	4
6	Verbal production of complex phrases (verb and noun) and clauses	If responding below a complex phrase mark as below the appropriate goal level. Can mark as above goal level if above this level.	5
7	Verbal conversation about familiar topics	Cannot mark as above goal level. At conversation level utterances must be above a complex phrase otherwise they will be marked as below the appropriate goal level.	>5
8	Verbal conversation about unfamiliar topics		>5

Note. MLU = Mean Length of Utterance

Table 3. Client act calculations for differentiating treatments

Calculation	Formula
Spontaneous verbal utterances	The number of verbal utterances that were generated spontaneously, e.g., not a repetition of a model or a gesture (verbal utterances) – (repetitions + gestures)
Utterance Level Errors	Total of the number of errors that occur at the utterance level based on codes in the transcript.
Word Level Errors	Total of the number of errors that occurred at the word level based on codes in the transcript.
% errors self-corrected	Self-corrections/Total errors x 100
Average no. of errors per utterance	Verbal errors/Verbal utterances
Average no. of utterances per error	Verbal utterances/Verbal errors
% total words with errors	Errors/Total words x 100
Verbal utterances	Total utterances – Gestures

Table 4. Measures of central tendency for protocol adherence to task

Measure	VERSE (n = 28 videos)
Error free and at appropriate goal level
Mean (SD)	197.2 (124.6)
Median	172.5
Interquartile range (IQR)	161
% total utterances	38.6%
Error free not at appropriate goal level^a
Mean (SD)	128.4 (87.6)
Median	122.0
IQR	114.0
% total utterances	25.1%
Contains an error and at the appropriate goal level
Mean (SD)	185.7 (123.9)
Median	149.0
IQR	129
% total utterances	36.4%
Contains an error and not at appropriate goal level ^a
Mean (SD)	64.0 (56.3)
Median	48.0
IQR	55.0
% total utterances	12.5%
Above goal level
Mean (SD)	36.2 (31.7)
Median	31.0
IQR	63.0
% total utterances	7.0%
% utterances above goal level
Mean (SD)	8.2 (8.5)
Median	6.1
IQR	12.1
Not at target goal level
Mean (SD)	192.4 (124.3)
Median	159.0
IQR	175
% utterances at correct goal level
Mean (SD)	67.2 (24.4)
Median	66.3
IQR	38.2

Note. ^a Not at appropriate goal level includes utterances that were below the target goal level only.

Table 5. Means and standard deviations for session protocol adherence – therapeutic inputs

Measure	VERSE (n = 28 videos)
Total deviant utterances Mean (SD)	14.9 (17.3)
Protocol deviant utterances (same cue)	4.3 (7.5)
Protocol deviant utterances – x 3 errors	10.0 (12.5)
Protocol adherent behaviours	656.3 (273.6)
% Utterances that adhere to protocol	97.6 (3.2)

Table 6. Tasks for overall treatment differentiation

Measure	Whole group (n = 53)	VERSE (n = 28)	Usual Care-Plus (n = 25)
Total number of tasks	152	56	96
Total number of verbal tasks (%)	114 (75%)	48 (86%)	66 (69%)
Total verbal tasks at single word level (%)	53 (46%)	13 (27%)	40 (61%)
Total verbal tasks at conversation level (%)	16 (14%)	12 (25%)	4 (6%)

Table 7. Descriptive and t-test statistic for treatment differentiation – therapeutic inputs

Measure	VERSE (n = 28 videos)	Usual Care-Plus (n = 25 videos)	p value
Therapist total utterances Mean (SD)	671.1 (278.1)	679.6 (226.0)	.577
Cues used with success by therapist	29.6 (27.4)	38.5 (48.5)	.424
Total cues used by therapist	77.3 (72.3)	86.6 (74.8)	.631
% Cues that were successful	41.5 (20.0)	38.2 (26.9)	.625
Therapist total words	2687 (948.5)	2848.6 (857.9)	.518
Therapist utterances per minute	12.5 (4.9)	14.5 (7.6)	.283

Table 8. Descriptive and t-test statistic for treatment differentiation – client acts

Measure	VERSE (n = 28 videos)	Usual Care-Plus (n = 25 videos)	p value
Total Verbal Utterances Mean (SD)*	474.2 (213.7)	483.4 (225.1)	.651
Error free utterances*	311.8 (135.5)	302.5 (139.6)	.979
Errors*	242.9 (134.6)	211.9 (135.7)	.521
Spontaneous verbal*	250.0 (161.0)	257.3 (144.5)	.661
Self-Corrections*	49.2 (64.0)	22.0 (22.0)	.040
% errors self-corrected	17.6 (18.1)	12.6 (14.4)	.276
Total words*	1847.4 (1460.7)	1511.6 (1128.2)	.402
MLU (words) ^a	3.5 (2.1)	2.9 (1.4)	.230
MLU (morphemes) ^a	3.9 (2.3)	3.2 (1.5)	.212
Average errors per utterance (errors/utt.)	0.5 (0.3)	0.4 (0.2)	.115
Average utterances per error (utt/errors)	2.4 (1.3)	2.8 (1.3)	.349
Utterance Level Errors	24.3 (27.2)	23.4 (34.0)	.854
Word Level Errors*	232.4 (162.0)	227.4 (162.3)	.997
% total words with errors	33.5 (52.1)	22.5 (25.5)	.326
Utterances per minute	9.7 (3.1)	9.8 (3.6)	.892
Words per minute	35.7 (27.7)	29.5 (19.8)	.355

Note. ^a Mean Length of Utterance, * Variables that were adjusted for time as the session length of the videos was not equal (measure/session time (mins).