Our mission

To enable speech pathology clinicians and researchers to efficiently access the best available evidence to inform speech pathology practice and research

The evolution of speechBITE™

speechBITE™ is modeled upon the highly successful PsycBITE™, which in turn, was based in part upon PEDro, an evidence based practice database for physiotherapists. PsycBITE™ is a freely available established database of psychologically based therapies for acquired brain injury rehabilitation which was launched in July 2004. The database includes all published reports that provide empirical data regarding the effectiveness of one or more interventions. Dr Leanne Togher is a founding member of the PsycBITE™ committee, which is led by Associate Professor Robyn Tate in collaboration with Professor Skye McDonald and Dr Michael Perdices.

While PsycBITE™ lists treatment studies which address communication problems arising from acquired brain impairment, it became apparent that this type of resource would be useful if extended to the full scope of Speech Pathology Practice. In 2006, Dr Leanne Togher successfully approached Speech Pathology Australia to provide seeding funds for a new database for speech pathologists called speechBITE™. A committee was formed consisting of:

The speechBITE™ committee gratefully acknowledges and thanks the PsycBITE™ committee for their support, guidance and intellectual contributions to the speechBITE™ website. Many of the features found on the speechBITE™ website mirror those found on PsycBITE™, including the types of trials which are accepted and the methodological quality rating systems used to rate papers.

What are the criteria for treatment studies to be entered onto speechBITE™?

Papers accepted onto speechBITE™ must fulfill the following criteria:

  1. The paper is published as a full-length paper (not an abstract) in a peer-reviewed scientific journal
  2. The population treated are representative of those whom the intervention may be applied to in the course of speech pathology practice. The population treated will have, or be at risk of, a communication disorder and/or dysphagia.
  3. The treatment is currently part of speech pathology practice or could become part of speech pathology practice. The intervention need not be carried out by speech pathologists.
  4. The trial includes evaluation of at least one intervention and includes empirical data regarding treatment efficacy (i.e.; editorials, non-systematic reviews or case descriptions are not included)

How are treatment studies identified?

The trials on this website were identified through a comprehensive retrospective search of the relevant literature on 8 databases. These databases include Medline, Embase, Cinahl, PsycInfo, Eric, Amed, Llba and the EBM Reviews (incorporating the Cochrane Central Register of Controlled Trials). Auto alerts have also been set up on these databases to ensure that the treatment studies catalogued on this website are regularly updated.

Members of the speechBITE™ advisory committee also contributed key papers from their personal collections. In addition, speech pathologists from the University of Sydney and other academic institutions have also generously contributed treatment studies for inclusion in the database.

Financial support for speechBITE™

The speechBITE™ team would like to acknowledge the vision of Speech Pathology Australia, in providing the first substantial and recurrent funding for the establishment of speechBITE™. This has enabled us to employ a part-time Project Officer, Kate Smith, and to engage IT support from Niche IT to set up the Filemaker Pro database and website. This funding has also been used to engage the web designer, Penny Ransby from Quince Creative.

In 2008-09, additional support has been provided by the Motor Accidents Authority of NSW to assist with the establishment of the database.

Guild Insurance has also generously provided a donation for library fees associated with the library costs and database maintenance of speechBITE™. Additional in-kind support has been provided by the Faculty of Health Sciences, The University of Sydney, particularly, from the Discipline of Speech Pathology and the Health Sciences Library.

Rating methodological quality

How are the treatment studies rated on speechBITE™?

Three research designs on speechBITE™ are rated according to methodological quality. Randomised controlled trials (RCTs) and non randomised controlled trials (NRCTs) are rated using the PEDro scale and single case experimental designs (SCEDs) are rated with the SCED scale. Case series and systematic reviews are not rated according to quality.

In order to reach a consensus rating on the paper, it is required that the treatment studies be reviewed by two separate raters. Raters have been trained in the use of the PEDro scale and are either members of the speechBITE™ advisory committee or other allied health clinicians who are part of the raters network and have completed the rating training.

The PEDro scale

One of the breakthroughs provided by the group of researchers (based at The University of Sydney) who developed the PEDro website was the creation of the PEDro scale (Maher, Sherrington, Herbert, Moseley & Elkins, 2003; Moseley, Sherrington, et al., 2000). The PEDro scale consists of 11 items, and incorporates the 9-item Delphi list (Verhagen, de Vet, de Bie, Kessels, Boers, Boutler, & Knipschild 1998), the 3-item Jadad scale (Jadad, Moore, Carroll, Jenkinson, Reynolds, Gavaghan & McQuay, 1996), and also covers a number of the items from the CONSORT statement (Moher, Schulz & Altman, 2001). This scale assesses the internal validity of a trial and whether it contains sufficient statistical information to make it interpretable. The first item relates to external validity, and is not counted in the final methodological quality rating score which is out of 10. The remaining items address biases prior to the treatment phase including random allocation, concealed allocation and groups being statistically similar at baseline; performance biases during treatment including blinding of participants, therapists and assessors, and biases at data analysis including drop out rates, intention to treat analysis and statistical reporting. The PEDro scale has acceptable inter-rater reliability (Maher et al, 2003) and has been extensively used to rate research reports published on PEDro. The rating scale is also used to rate papers on OTseeker, a web based database of evidence for occupational therapists.

The SCED scale

PsycBITE™ is the first website to list single case experimental designs (SCEDs) as part of their database (unlike PEDro and OTseeker). Inclusion of single subject designs was undertaken on PscyBITE™ in recognition of the clinical value inherent in well designed SCEDs, and also the prevalence of these research designs in the literature. For example, a survey of research designs used in 1,298 reports archived in the PsycBITE™ database showed that SCEDs constituted the largest proportion (39%), followed by case series (22%), RCTs (21%), other non-RCT group studies (11%), and systematic reviews (7%; Perdices et al., 2006). Similarly, Beeson and Robey (2006) have demonstrated that of 620 published articles on interventions in aphasiology over the past five decades, 252 (41%) were single-case experimental designs. Togher et al., (in press) found that in a subset of papers listed on PsycBITE™ which had been listed in the target area Communication/Language/Speech on the PsycBITE™ database 69% were SCEDs. The SCED Scale is an 11-item rating scale for SCEDs, of which 10 items are used to assess methodological quality and use of statistical analysis. The SCED Scale shows an excellent level of inter-rater reliability (Tate et al., in press).

Research designs included on speechBITE™

The following definitions are drawn and adapted from those used on PsycBITE™ (Perdices, Shultz, Tate, McDonald, Togher, Savage, Winders & Smith, 2006).

Systematic Review

A systematic review is an overview of primary studies that contains an explicit statement of objectives, materials, and methods and has been conducted according to explicit and reproducible methodology. The aim of such a review is to address a specific clinical question by assembling, synthesising and appraising the results of all relevant studies in the area, using methods which limit bias. A meta analysis is one form of systematic review. It is a mathematical synthesis of the results of two or more primary studies that addressed the same hypothesis in the same way. A meta analysis must be a component of a systematic review or adhere to systematic review methodology to be included in speechBITE™.

Randomised controlled trial (RCT)

An RCT compares at least two treatments/interventions (one of which can be a no-treatment of wait-list control), which involves random allocation (participants are randomly allocated to groups for either the intervention/treatment being studied or control/placebo using a random mechanism, such as coin toss, random number table, or computer generated random numbers) and the outcomes are compared.

Non Randomised Controlled Trial (non-RCT)

This type of trial is similar to an RCT in that it compares at least two treatments/interventions (one of which can be a no-treatment control or a wait-list control condition) with the exception that participants have not been randomly allocated to groups. Non-RCTs however may be observational in nature, such that the researcher does not have control over the intervention being received by one group (see cohort study below). Outcomes of the treatment group and control group may be examined prospectively or retrospectively. In other non-RCTs, participants with an already established outcome or disease are selected and information is obtained about the previous exposure to the treatment/intervention or other factor being studied (see case-control studies below).

Case Series (CS)

A group/s or series of participants are exposed to one treatment/intervention where outcomes are measured in participants before and after exposure to the treatment / intervention. No control group is included. Detailed information regarding individual participants is often presented.

Single Case Experimental Design (SCED)

This type of trial compares the effectiveness of interventions using the same (single) participant as his/her own control by assessing treatment effects over several different points in time as treatments are systematically applied and sometimes withdrawn. The single-case trial may take the form of variations of an ABAB (cross-over) or multiple baseline design.

Levels of Evidence

There are a range of ways to classify levels of evidence including those suggested by the National Health and Medical Research Council of Australia (http://www.nhmrc.gov.au/consult/_files/levels_grades05.pdf). Another system is proposed by the Quality Standards Subcommittee of the American Academy of Neurology, (Miller et al., 1999) and which has been adopted by the Academy of Neurologic Communication Disorders and Sciences: