1 Selection
7. Was the data analysis sufficiently rigorous?
Y/N 8. Is there a clear statement of findings? Y/N O ve rall L ow er /h igh er ri sk of b ias . D etai l of con ce rn s A nde rson 2003 1 2 7 Y es Y es Y es Y es No No Y es Y es L o we r B eil b y 2013 1 2 8 Y es Y es U nc le ar Y es Y es Y es U nc le ar Y es H ighe r, re cru it m en t and da ta ana ly si s unc lea r B obe rg 1990 1 2 9 Y es Y es U nc le ar Y es No No N ot re por te d Y es, H ighe r, de ta il of da ta m iss ing B ri ck er - K atz 2010 1 3 0 Y es Y es Y es Y es P art ia l P art ia l Y es Y es H ighe r, de ta il m iss ing B ut ler 2013 1 3 1 Y es Y es Y es Y es P art ia l Y es Y es Y es L o w er
159
Corcoran 1995132
Yes Yes No Yes Yes No Unclear Yes Higher- lack of
detail, unclear recruitment
Corcoran & Stewart 1998 133
Yes Yes Yes Yes Yes No Yes Yes Lower
Cream 2003134
Yes Yes Yes Yes Yes No Yes Yes Lower
Cream 2004135
Yes Yes Yes Yes Yes No Yes Yes Lower
Crichton- Smith 2002136
Yes Yes Yes Yes No Yes Yes Yes Lower
Daniels 2012137
Yes Yes Yes Yes Yes Partial Yes Yes Lower
Daniels 2006138
Yes Yes Yes Yes Yes Unclear Yes Yes Lower
Goodhue 2010139
Yes Yes Yes Yes Yes Yes Yes Yes Lower
Hayhow 2009140
Yes Yes Partial Yes Partial Unclear Yes Yes Higher
Lack of detail
160
2008141 Hughes 2011142
Yes Yes Yes Yes Yes No Yes Yes Lower
Irani 2012116
Yes Yes Yes Yes Yes Partial Yes Yes Lower
Kathard 2004143
Yes Yes Yes Yes Yes Yes Yes Yes Lower
Klompas 2004144
Yes Yes Yes Yes No Yes No Yes Higher, lack of
detail and superficial analysis Plexico
2005145
Yes Yes Yes Yes Yes Unclear Yes Yes Lower
Plexico 2009a146
Yes Yes Partial Yes Yes No Yes Yes Lower
Plexico 2009b147
Yes Yes Partial Yes Yes No Yes Yes Higher
Plexico 2010148
Yes Yes Partial Yes Yes No Yes Yes Lower
Plexico 2012149
Yes Yes Partial Yes Yes No Yes Yes Lower
Stewart 2004150
Yes Yes Yes Yes Partial No Yes Yes Lower
Trichon 2011151
Yes Yes Yes Yes No No Yes Yes Higher, detail
161 Appendix 4 Studies excluded at full paper review
Authors, date Reason
Armson 1997 Laboratory investigation of FAF during reading aloud Bajaj et al. 2005 Alludes to outcomes of therapy, that children use therapy
terms to describe their speech but nothing directly relevant Blood, 95 Case series 3 participants
Bothe et al. 2007 Letter to editor reply to critique of previous paper. May need to include and link to Finn et al. 2005
Butcher et al. Design - case series
Cai et al. 2012 No intervention, relates to diagnosis Carey et al. 2012 3 Participants
Carr et al. Describes fidelity of intervention. May be relevant for qualitative review?
Craig & Calver 91 Survey data Craig & Kearns, 95 Two case studies
Dayalu et al. 807 Laboratory assessment of vowel insertion during reading aloud
De Vries 1990 Book chapter, general discussion
De Vries, 1990 General description of intervention only Eichstadt et al Non OECD Country
Foundas et al. 2004 Laboratory assessment of DAF during reading aloud Freeman & Armson 1998 Examines choral speech producing temporary reduction
during experiment Fry et al. 2014 Data for 3 participants Gabel et al. 2002 No intervention
Green et al 1997 Not qualitative or effectiveness study Guntupalli et al. 2011 Survey
Hayasaka 1993 Examines links with improvement but outcome data not possible to identify from reporting
Hearne et al. 2008 Case series 3 participants Helgadottir et al. 2009 Design
Hudock et al. 2011 Emphasis on evaluating if visual speech feedback adversely impacts on speech rate
Ingham et al. 1997 Case series
Ingham et al. 2001 Case series 3 participants Ingham et al. 2001 Duplicate of 798
Ingham et al. 2001 Duplicate of 794
Ingham et al. 2006 Compares effect of chorus reading on speech effort in stutterers vs normal speakers
Ingham et al. 2009 Compares self-rated speech effort in stutterers vs normal speakers
Iverach et al. 2009 Minor correction to previous paper only
Kalinowska 1996 Laboratory assessment of DAF during reading aloud Kalinowska 2000 Laboratory assessment of visual coral speech during
memorised reading aloud
Kalinowski et al. 1993 Examines elements of auditory feedback Kalinowski et al. 2000 Letter, no data
162
Kalinowski et al. 2002 Letter, no data
Kalinowski et al. 99 Examines types of auditory feedback
Kathard 2001 Discusses life history research, mentions need to engage with feelings and significance of stuttering in life but no data of direct relevance
Keifte al. 2008 Compares choral speech with AAF when reading Kuniszyk-Jozkowiak et al.
96
Explores different types of auditory feedback Langevin et al. 2010 Impact of stuttering on parents, no data regarding
interventions.
Lincoln et al. 2010 Explores DAF in different conditions Macleod et al. 95 Explores types of DAF
Metten et al. 2011 Laboratory testing prior to case series with three participants Miltenberger 96 2 case studies
Nakao et al. 2001 Letter to the editor, no data
Neiman & Rubin, 1991 Less than 50% stuttering participants Nejati et al. 2013 Non OECD (Iran)
Nicholas & Millard 1998 Conference abstract only OBrian & Onslow 2011 General overview
Onslow & O’Brien, 97 General discussion
Onslow et al. 1997 General discussion of Lidcombe Onslow et al. 2001 2 case studies
Onslow et al. 97 3 case studies
Packman et al. 2012 Overview of Lidcombe evidence
Paden et al. 2002 Examines phonological development in stuttering children Petrunik et al 1980 Published prior to cut off date
Ramig 93 Survey
Remi & Diederich 2005 Examines reading with reversed speech Saltuklaroglu et al. 2004 Examines visual speech/choral speech Saltuklaroglu et al. 2004 Examines nature of stuttering
Saltuklaroglu et al. 2009 Compares different types of DAF Sassi & Andrade 2004 Non OECD country (Brazil) Simon 1997 Survey (Conference abstract)
Snyder et al. 2009 Examines laboratory use of visual speech feedback Snyder et al. 2009 Examines use of self-generated visual feedback on overt
stuttering during reading aloud
Sparks et al. 2000 Examines effect of different rates of speech using DAF St Louis et al. 1996 Two case studies
St Louis et al. 2004 Explores listener judgement of fluency in cluttering Stewart & Brosh 1997 Case study of two particpants.
Story et al. 1996 Case series 3 participants
Stuart & Kalinowski 2004 Describes nature of speech naturalness no intervention Stuart 2008 Duplicate (with Stuart 1470)
Stuart et al. 1997 Examination of DAF frequency alterations during reading Stuart et al. 1997 Examines use of a passive resonator during reading a passage Stuart et al. 2008 Examines links between FAF and stuttering type
Stuart et al. 96 Examines types of DAF Swift 2011 Case series 3 participants
163
Teshima 2010 Participants are non-stutterers, no intervention. Trajkovski 2009 Case series 3 participants
Waddell et al. 2012 Laboratory examination of tactile feedback during reading of a passage
Webber et al 2004 Case series 3 participants Sandrieser 2003 Description only no data
Natke 2000 Evaluation of reading aloud under laboratory conditions Fry et al. 2014 3 participants
164 Appendix 5 Extraction tables effectiveness studies
Allen 2011 Country: UK
Study design: Cross sectional
Data collection method: Record of email content
Aim: To evaluate email as a component of a therapy programme
Detail of participants (number, any reported demographics):
Sixteen clients aged 19–52 years 14 M & 2 F. Severity of their overt and covert stammering ranged from mild to severe.
Methods:
Therapeutic intervention was based on individual presentation, blending speech modification techniques and counselling support in both face-to-face appointments and email exchanges. Email served two functions: administrative and therapeutic.
Number of hours: Email time
Delivered by who? Clinician
Control: None
Length of follow up: None
Response and/or attrition rate:
2 clients did not complete the intervention Outcome measures: Number of emails sent Content of emails Outcome of therapy Main results:
A total of 472 email messages was exchanged with the group, of which 328 (69%) were primarily
administrative, in arranging face-to- face appointments. The other 144 email messages (31%) were primarily therapeutic, in monitoring ongoing treatment goals or offering problem-solving guidance. Often email messages contained both administrative and therapeutic elements.
Of the sixteen clients who used email as part of therapy, eleven were discharged (two due to non- response). Five clients remained on the caseload.
The paper describes a range of benefits but these have no data underpinning them.
Limitations/comments
Amster 2007 Country: UK
Study design: Before and after
Data collection method:
Questionnaire/assessment evaluations
Aim: to determine if a modified cognitive
behavioural therapy approach alone and combined with Stuttering Modification could help reduce perfectionist tendencies and stuttering behaviours.
Detail of participants (number, any reported demographics):
N=8 5 M & 3 F age 27–56 years (M=44 years, SD=9.9 years)
Method: Modified CBT with and without stuttering modification therapy.
Hours: Treatment consisted of six individual one-hour sessions and six 90-minute group sessions with the authors serving as clinicians. At week four, stuttering modification was introduced and reviewed in bothindividual and group sessions.
Delivered by: Authors (clinicians) Control: None
Length of follow up: 15 weeks
Compared at pre-treatment, mid- treatment (3 weeks), after 6-weeks of treatment, and at 15 weeks
Outcome measures: Burns Perfectionism Scale, SSI Modified Erikson Communication Attitude Scale Main results:
From pre-treatment to post- treatment
stuttering severity and perfectionism significantly decreased. Participants related that they did not care as much about making mistakes when they spoke. They reported that their fears about stuttering reduced, and that they were no longer striving to speak perfectly.
At pre-treatment all participants met criteria for stuttering on the SSI-3 ranging from very mild to very severe. Pairwise comparisons as
165
follow-up, after treatment was withdrawn.
Response and/or attrition rate:
All participants attended all 12 sessions during the 6-week time frame.
measured by the Wilcoxon Signed Ranks Test reflected statistically significant improvements in
participants’ speech fluency from
pre-treatment to mid-treatment (when CBT was the sole treatment). Participants significantly
decreased stuttering (Z=−2.3;
p=.021). SSI-3 scores for PWS at pre-treatment were M=24.38, SD=9.01; and at mid-point, SSI-3 scores were M=16.88, SD=11.11. At post-treatment, SSI-3 scores were M=11.75, SD=8.79; and at follow-up, SSI-3 scores were M=13.75 and SD=8.63. Effects
sizes using Cohen’s d were.74 (pre- treatment to
mid-treatment) and .51 (mid- treatment to post-treatment). At pre-treatment all participants performed within the perfectionist range on both current (M=9.75; SD=5.1) and child recollection (M=9.75; SD=8.5) formats. Participants decreased an average of 13 points on the Burns
Perfectionism Scale (a 40 point scale). The Wilcoxon Test indicated that Perfectionism scores for PWS at pre-treatment (M=9.75, SD=5.06) significantly
decreased by mid-treatment
(M=−2.38, SD=8.09), Z=−2.1;
p=.035. The effect size using
Cohen’s d was 1.80. From mid- point to end of treatment when stuttering modification was
introduced, perfectionism continued to decline, however not significantly
(Z=−1.7; p>.05). Perfectionism
166 was withdrawn (Z=−2.2; p=.027)
By post-treatment, participants had significantly more positive attitudes about communication (pre-
treatment M=19.00, SD=3.46, mid- treatment M=17.00, SD=5.15, and post-treatment M=12.38, SD=4.95). Attitudes did not significantly change by the mid-point of the treatment, but by the end of the 6- week program participants showed a significant improvement in their attitude towards speaking as they found it easier to talk with others, were more confident about their speaking ability, and less nervous or embarrassed to talk (pre- treatment to post treatment
Z=−2.38, p=.017). This was
maintained at follow-up (M=12.13, SD=6.33).
Andrews 2012 Country: Australia
Study design: Before and after Data collection method: Parent rating
Aim: To determine the outcomes of a simple syllable-timed speech (STS) treatment for school-age children who stutter.
Detail of participants (number, any reported demographics):
N=10 8 M & 2 F age 6 - 12 years (mean = 8.8 years).
Seven participants had received previous Lidcombe Program treatment of varying duration and with variable success.
Method:
Syllable Timed Speech Treatment involved training the children and their parents to use STS at near normal speech rates. The technique was practiced in the clinic and at home with the parents during everyday conversations. The only additional procedures being prompts to use the speech pattern and reinforcement for using it. The treatment was delivered by a parent and was supervised by an SLP. Treatment was provided in two stages. The aim of Stage 1 was to instate a low level of stuttering with STS; the aim of Stage 2 was to maintain this low level of stuttering for the long term.
Outcome measures:
%SS.
Parent severity rating using the 10-point Lidcombe Program scale. Participant self- reports of stuttering severity, avoidance, speech satisfaction, and quality of life.
Main results:
Nine months after commencing treatment, stuttering had decreased by >50% for half of the children, with 2 children attaining 81% and 87% reduction. Intention-to-treat analysis showed a clinically and statistically significant reduction in stuttering for the group even when a withdrawn participant was included. These results were mostly
confirmed by self-reported stuttering severity ratings and were supported by improved
situation avoidance and quality-of- life scores. There was considerable individual variation in response to the treatment.
The group mean %SS at
167
Hours: Delivered by:
Control: none
Length of follow up: 9 months.
Assessment 1 occurred within 2 weeks before the start of
treatment; Assessment 2 occurred 9 months after the start of
treatment.
Response and/or attrition rate:
One child withdrew from treatment before Assessment 2.
Assessment 1 was 14.4 (SD = 16.5) and at
Assessment 2 was 6.7 (SD = 6.8). This difference was significant, t(9) = 2.99, p = .015. The
Cohen d effect size (Cohen, 1988) was medium, at 0.7.
Half of the children reduced their stuttering by >50%, with two children attaining 81% and 87% reduction. Three children attained reductions in the 30%–50% range. Two children showed no reduction. Self-reported stuttering severity. The group mean
SR at Assessment 1 was 5.4 (SD = 1.4) and at Assessment 2 was 2.8 (SD = 1.1). This difference was significant, t(9) = 4.85,
p = .00089.
Eight of the 10 children reported reduced avoidance of speaking situations at Assessment 2, with a reduction for the group from 14.7 to 11.7. This difference was
significant, t(9) = 2.87, p = .018. Individual results are presented in Table 2.
All children except Participant 9 were reportedly more satisfied with their speech
at Assessment 2. The group mean decreased from 6.0 to 2.7. This difference was significant, t(9) = 5.14, p < .001.
Quality-of-life scores improved for all but one of the children
(Participant 3). The mean dropped from 54 at Assessment 1 to 40 at
168
Assessment 2. This difference was significant, t(9) = 3.37, p < .005.
Antipova 2008 Country: NZ
Study design: Cross sectional
Data collection method: Speech samples from DVD recording
Aim: To investigate the immediate effects of eight altered auditory feedback (AAF) parameters on stuttering frequency
during monologue speech production on two occasions.
Detail of participants (number, any reported demographics):
N=8 participants aged 16–55 years (mean 35 years, standard deviation 12.95).
Method: The Pocket Speech Lab
(Casa FuturaTechnologies®) was used to produce auditory feedback alterations.
Six types of combined delayed auditory feedback (DAF) and frequency shifted auditory feedback (FAF) and two types of DAF alone were tested.
Hours: 3x 90 min sessions: an
introductory session and 2 testing sessions.
Delivered by:
Control: No AAF compared to
eight altered auditory feedback conditions.
Length of follow up: Immediate
Response and/or attrition rate:
None Outcome measures: Stuttering frequency. Lidcombe Behavioural Data Language (LBDL) to identify stuttering moments. Main results:
The present study found that AAF is an effective means to reduce stuttering frequency during monologue speech production. All eight AAF experimental conditions reduced stuttering frequency however, there was substantial variability in the stuttering reduction effect across experimental conditions and across participants. The type of speech task had no significant effect on stuttering frequency [t = 1.77; d.f. = 7; p = 0.119].
The reduction of stuttering
frequency varied across individuals from 23 to 97% during the first testing session and from 3 to 88% during the second one.
There was also instability in stuttering reduction across the two testing sessions. On average, a 75ms time delay on its own and a combination of the 75 ms time delay and a half octave downward frequency shift were found to be more effective than other combinations of AAF parameters
169
that were investigated.
Armson 1998 Country: Canada
Study design: Cross sectional
Data collection method:
Aim: To examine the effect of frequency altered feedback
Detail of participants (number, any reported demographics):
N=12 10 M & 2 F age range 20-50 mean 35 years. Four currently receiving treatment others had received in past between 1 month and 15 years previously. 5 mild, 6 moderate 1 severe. 6 no previous experience of AAF, 2 had used Edinburgh masker, 1 DAF, 5 briefly used in previous study.
Methods: Recruited via a local
clinic and self-help group. Each individual recorded for 5 minutes without FAF then 10 minutes with FAF then 5 minutes without FAF.
Number of hours: N/A Delivered by who? FAF device Control: None
Length of follow up: None Response and/or attrition rate:
N/A Outcome measures: Stuttering episodes, Syllables produced % stuttering Speech rate Main results:
FAF effective for some participants during reading only. Significant difference when using FAF for total number of syllables produced increased, number of stuttering episodes decreased and percent stuttering decreased for reading. Number stuttering events – p<0.001 ES 0.62, number syllables
p=0.0071 ES 0.39, percent stuttering p=0.0056 ES 0.41. Ten of the twelve participants showed no positive effect on stuttering frequency of FAF during monologue. Significant difference only for number of stuttering events during monologue p=0.10 ES 0.14. Not significant - number syllables p=0.41 ES 0, or percent stuttering p=0.46 ES 0.
Considerable variation between participants. Three showed large reduction in stuttering during FAF returning to baseline following FAF. Six showed initial large reduction in stuttering which faded during the intervention, the final 3 experienced little effect of the intervention.
See Bloodstein 1999 critique
See Armson 1999 response to this
170
Armson 2006 Country: Canada
Study design: Cross sectional
Data collection method: One of two graduate
students in speech-language pathology counted stuttering episodes for each sample.
Aim: To evaluate the effect of SpeechEasy
Detail of participants (number, any reported demographics):
N=13 adults
Method: SpeechEasy Stuttering frequencies in two baseline conditions were
compared to stuttering frequencies with the device fitted according to
the manufacturer’s protocol. For
each of the four conditions—the two baseline and two experimental conditions— participants produced speech in three contexts: oral reading, monologue, and conversation.
Each participant was fitted with a programmable SpeechEasy Basic BTE unit. The BTE model is an external device that is worn behind the pinna and connects to a mould that fits in the ear canal.
SpeechEasy software permits manipulation of settings for three