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2016 ; 20
(2
): 1-302, v-vi
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English Wikipedia
Non-pharmacological treatments for stuttering in children and adults: a
systematic review and evaluation of clinical effectiveness, and exploration of
barriers to successful outcomes
#MMPMID26767317
Baxter S
; Johnson M
; Blank L
; Cantrell A
; Brumfitt S
; Enderby P
; Goyder E
Health Technol Assess
2016[Jan]; 20
(2
): 1-302, v-vi
PMID26767317
show ga
BACKGROUND: Despite many years of research, there is no certainty regarding the
cause of stuttering. Although numerous interventions have been developed, a
broad-based systematic review across all forms of intervention for adults and
children was needed including views and perceptions of people who stutter.
OBJECTIVE: The aims of the study were to report the clinical effectiveness of
interventions for people who stutter (or clutter), to examine evidence regarding
the views of people who stutter and the views of professionals regarding
interventions. DATA SOURCES: A systematic review of quantitative and qualitative
literature was carried out between August 2013 and April 2014. The following
electronic databases were searched: (1) MEDLINE, (2) EMBASE, (3) The Cochrane
Library (including The Cochrane Database of Systematic Reviews, Cochrane Central
Register of Controlled Trials, Database of Abstracts of Reviews of Effects,
Health Technology Assessment Database and NHS Economic Evaluations Database), (4)
PsycINFO, (5) Science Citation Index, (6) Social Science Citation Index, (7)
Cumulative Index to Nursing and Allied Health Literature, (8) ASSIA, (9)
Linguistics and Language Behavior Abstracts, (10) Sociological Abstracts and (11)
the EPPI Centre. Reference lists of included papers and other reviews were
screened and also key journals in the subject area were hand-searched. REVIEW
METHODS: The searches aimed to identify (1) evidence of clinical effectiveness in
populations of pre-school children, school-aged children, adolescents and adults,
and (2) data relating to perceptions of barriers and facilitators to intervention
clinical effectiveness among staff and people who stutter. A metasynthesis of the
two linked elements via development of a conceptual model was also carried out to
provide further interpretation of the review findings. RESULTS: A systematic
search of the literature identified a large number of potentially relevant
studies. Of these, 111 studies examining the clinical effectiveness of
interventions, 25 qualitative papers and one mixed-methods paper met the criteria
for inclusion in this review. Review of the effectiveness literature indicated
evidence of positive outcomes across all types of interventions. Virtually all
evidence we identified reported at least some positive effect for some
participants. However, there was evidence of considerable individual variation in
outcome for study participants. The qualitative literature highlighted the need
for programmes to be tailored to individual need with variation at the levels of
the intervention, the individual and interpersonal/social elements. Metasynthesis
of the data highlighted the complexity of elements that need to be considered in
evaluation of long-term impacts following stuttering interventions. LIMITATIONS:
Around two-thirds of the studies were considered to be at higher risk of bias.
The heterogeneous nature and variability in outcomes meant that we were unable to
complete a meta-analysis. CONCLUSIONS: Although much of the evidence we
identified was from studies at risk of bias, it is suggested that most available
interventions for stuttering may be of benefit to at least some people who
stutter. There is a requirement for greater clarity regarding what the core
outcomes following stuttering intervention should be and also enhanced
understanding of the process whereby interventions effect change. Further
analysis of those for whom interventions have not produced a significant benefit
may provide additional insights into the complex intervention-outcomes pathway.
STUDY REGISTRATION: This study is registered as PROSPERO CRD42013004861.
free
free
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