On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data.

Anders Sand,Emilie Hagberg,Anette Lohmander

doi:10.1044/2021_jslhr-21-00367

Anders Sand, Emilie Hagberg + Show 1 more

Open Access

https://doi.org/10.1044/2021_jslhr-21-00367

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Abstract

Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP. A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies. Thirty-four eligible studies were found. Nineteen studies provided IPD (n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]). The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. Supplemental Material https://doi.org/10.23641/asha.17700992.

Highlights

Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT)
We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT
Nineteen studies contributed with IPD on speech production

Summary

Introduction

Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). Conclusions: The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. In 1965, Prins and Bloomer observed that the majority of individuals with CLP who receive SLT do not achieve a speech production at the level of their peers They stated, “The burden of proof to demonstrate the effectiveness of therapy for oral cleft patients is increasing, and a prerequisite for this is the development of meaningful procedures for studying changes in speech behavior” We believe that the unclear literature stems from how interventions have been evaluated on a fundamental level and that intervention outcomes mostly have been evaluated based on statistical significance (e.g., Alighieri et al, 2020; Hardin-Jones & Chapman, 2008; Pamplona et al, 2005, 2014), rather than clinical relevance

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