Title: Non-pharmacological treatments for stuttering in children and adults: a systematic review of effectiveness and exploration of barriers to successful outcomes.
Funder: Department of Health (England)

Abstract: There is an increasing range of treatments available for stuttering in children and adults and a need to examine the evidence base for these interventions in order to inform future guidelines and service delivery. Systematic reviews provide a structured summary of available evidence and can identify consistencies and inconsistencies in the research in order to present service providers and practitioners with evidence-based information. They also enable researchers to identify where future trials might be needed. DESIGN & STRATEGY The proposed project will be a systematic review of international published evidence of interventions for non-pharmacological stuttering. The review will comprise an overarching synthesis of two linked elements: firstly a review of evidence of effectiveness in populations of pre-school children school aged children and adolescents and adults; and secondly a review of patient and staff perceptions of barriers and facilitators to intervention effectiveness. The review will use conventional systematic review methods as outlined by the Centre for Reviews and Dissemination (CRD 2009) encompassing: development of a detailed review protocol identifying research evidence by searching electronic databases and other sources; selecting studies which meet the inclusion criteria for examination; systematically extracting data from studies which meet the inclusion criteria; assessing the methodological rigour of included studies; and completing a synthesis of findings from the included studies. Data will be synthesised by sub questions (qualitative studies and effectiveness studies) and findings from the analysis of effectiveness data will be examined via both conventional methods and via comparison to features of barriers and facilitators reported by intervention participants. This additional method of analysis will aim to shed light on positive or negative trial results; consider issues of implementation; and assist in the interpretation of significance and applicability for practitioners and service planners (Dixon-Woods et al. 2001). The division of evidence into the three sub-populations is based on the differing intervention focus with young children (which may include indirect rather than direct intervention) and differences between the content of programmes for young people and that aimed at adults. The two syntheses will be combined to produce an overarching report describing and evaluating the international evidence on treatments for stuttering. Where the data permit we will produce recommendations regarding which interventions are most likely to be effective and produce a broad and long term impact. The report will outline where uncertainties exist and future research is needed. Results from this work will inform the selection and implementation of stuttering treatments in the NHS that are the most effective and cost effective.POPULATIONThe population under consideration is children adolescents and adults who have a stutter (usually termed stammer in the UK). The project will include studies from any OECD country. HEALTH TECHNOLOGIES BEING ASSESSEDThe health technologies that will be assessed in the proposed work are non-pharmacological treatments for stuttering in children and adults. The interventions evaluated may be delivered in any setting including health service premises and residential locations and by any agent including interventions delivered by health professionals individuals in private clinics and charitable or voluntary organisations. Any intervention which is described as being a treatment for stuttering/stammering which is non-pharmacological will be within the scope of the work. Interventions which are pharmacological will be excluded.MEASUREMENT OF COSTS AND OUTCOMESCore Outcomes for stuttering have not yet been established via the COMET Initiative. Much previous review work has focussed on measuring overt stammering behaviours. We intend to take a broader approach to evaluating outcome with the inclusion criterion being any outcome relating to a positive effect on stuttering or the emotional wellbeing of people who stutter and a-priori limitations on outcomes will not be set. Relevant outcome measures may include: test scores on a standardised assessment such as frequency of non-fluent words patient self-report of covert stammering patient experience report of frequency of stuttering from a significant other such as a teacher or employer patient or staff views and perceptions of obstacles to intervention effectiveness.PROJECT TIMETABLEMonth 1 - protocol development months 1-6 searching months 3-7 data extraction months 6-7 quality appraisal months 7-10 synthesis months 10-11 consultation and re-drafting months 11-12 dissemination.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: MENTAL HEALTH