JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Measurement and evaluation in practice

A five-year file audit of paediatric stuttering management A research to practice comparison Kate Bridgman, Shane Erickson, Rachael Unicomb and Bernadette O’Connor

The efficacy of treatment programs for paediatric stuttering (e.g., the Lidcombe Program) has been well established in clinical trials. However, due to the highly controlled nature of this research, translation to typical clinical settings and caseloads may be challenging. Little evidence has been published capturing data from community caseloads about paediatric stuttering. This is essential to inform the translational research process. The aims of this study were to: (a) establish key characteristics of clients seeking paediatric stuttering treatment; (b) compare these characteristics to eligibility criteria from published stuttering clinical trials; and (c) determine the service and treatment types required for these clients. This five-year file audit from a private practice in Melbourne Australia extracted descriptive data from 40 consecutive paediatric fluency files. Results confirm a gap between stuttering research and practice largely due to differences in the characteristics of this community caseload compared to clinical trial samples, particularly regarding the presence of co- morbidities. Further research and education is needed that addresses the needs of typical clinical presentations of this caseload. T here are many treatment options available for Australian speech-language pathologists (SLPs) to treat stuttering. Providing effective treatment in the preschool years is considered best practice, as stuttering becomes less tractable with age (Onslow, 2018). The Lidcombe Program is one of the most efficacious treatments for preschool children who stutter with supporting evidence from many well conducted clinical trials (e.g., Arnott et al., 2014; Bridgman et al., 2016; Jones et al., 2005; Lincoln & Onslow, 1997; O’Brian et al., 2013; Onslow, Costa, & Rue, 1990). The Lidcombe Program is a behavioural treatment that requires the parent and child to attend weekly 45–60 minute treatment sessions with a SLP. The SLPs teach the parent how to complete daily severity

ratings and treatment that is then administered for 10–15 minutes daily in the child’s own environment. A detailed treatment guide is available online (Onslow et al., 2017). More recently the efficacy of the Westmead Program (which utilises syllable timed speech) has also been investigated in several Australian clinical trials for preschool age children (Trajkovski, Andrews, O’Brian, Onslow, & Packman, 2006; Trajkovski et al., 2009; Trajkovski et al., 2011). Currently, there is no treatment guide available; however, an outline of the treatment protocol is published in Trajkovski and colleagues’ article (2011). Both programs also report evidence from clinical trials involving school- aged children (Andrews et al., 2012; Lincoln, Onslow, Lewis, & Wilson, 1996). The Speech Pathology Australia Clinical Guideline for Stuttering Management (SPA, 2017) rates the overall trial evidence for the Lidcombe Program as ‘Level B’ on the NHMRC grading scale (where A = excellent and D = poor) and the trial evidence for the Westmead Program as “Level D”. While these treatment approaches are the most widely used for young children who stutter in Australia, a more detailed review of other treatment options is provided in the SPA clinical guideline (SPA, 2017) and Donaghy and Smith (2016). The research–practice gap Although research trials are ultimately designed to inform clinical practice, direct translation is challenging. One reason for this may be due to the highly controlled nature of clinical trials. This control is necessary to counter extraneous variables and establish whether reported outcomes can be attributed to the treatment under investigation. In stuttering clinical trials, control of extraneous variables typically includes using highly trained, experienced SLPs to deliver treatment, ensuring compliance with treatment guide procedures and protocols, and employment of rigorous eligibility criteria (O’Brian et al., 2013). Such criteria often relate to a participant’s age, time since stuttering onset, severity or frequency of stuttering, previous treatment for stuttering, level of English proficiency, and presence of co-occurring communication or non- communication disorders. While randomised controlled trials are the gold standard in clinical trials, due to the control of bias offered by the research design, a paradox of this control is that findings can be hard to apply beyond the research setting because the research conditions may not reflect a typical clinical context. For example, some of the treatment conditions outlined in Lidcombe Program clinical trials have been

KEYWORDS STUTTERING FLUENCY COMMUNITY RESEARCH TRANSLATION

THIS ARTICLE HAS BEEN PEER- REVIEWED

Kate Bridgman (top) and Shane Erickson

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology