Monday, October 05, 2009

Summary of Treatment Reviews

Sandra Merlo was so kind as to summarize two important papers on treatment outcome by Bothe et. al for us. I consider them both as important.



Anne Bothe et al. published two papers about stuttering treatment research in 2006. One of them is related to behavioral treatment and the other is about pharmacological treatment of stuttering. I will focus on the paper about behavioral treatment.


The authors use three methodological criteria to assess the quality of stuttering treatment research: repeated speech evaluations (before, during and after therapy); speech evaluations outside the clinical settings (to check how much PWS can transfer their fluency skills); and control of speech rate and speech naturalness.


The authors analyzed 162 papers published between 1970 and 2005 in peer-reviewed journals.


Positive results were considered as following: stuttering frequency was reduced to 5% or less after therapy; stuttering frequency was reduced by 50% or less after therapy; there was improvement in social, emotional, or cognitive variables after therapy. The improvements should be maintained by, at least, 6 months.


The authors concluded that the methodological quality of stuttering treatment research is low. Of the 162 papers, just 39 showed the three quality criteria. The behavioral treatments proposed by the 39 papers were classified as following: acupuncture, cognitive/emotional, EMG (electromyography), GILCU (gradual increase in length and complexity of utterance), indirect therapy, language training, masking, metronome, prolonged/smooth speech, regulated breathing, response contingencies, self-modeling, shadowing, Speech Easy, stuttering modification, and token economy.


The authors concluded that, up to this moment, there are positive evidences to:
- EMG: two studies showed quality methodological criteria. The approach improved speech fluency and also social, cognitive, and emotional variables after treatment and 6 months later. The method was tested with children from 6 to 12 years old.
- GILCU: two studies showed quality methodological criteria. The approach improved speech fluency after treatment and 6 months later. The method was tested with children from 6 to 12 years old.
- Prolonged/smooth speech: 13 studies showed quality methodological criteria. Seven of them showed improvement of speech fluency after treatment and 6 months later; two of them showed improvement of speech fluency and also social, cognitive, and emotional variables after treatment and 6 months later. The method was tested with people from 7 to 58 years old.
- Response contingencies: 11 studies showed quality methodological criteria. The method was tested with children until 12 years old.


The authors say that systematic reviews are important because they analyze scientific findings in order to do recommendations to clinical decisions. Thus it is important to be careful about the level of evidence that supports clinical procedures.

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