Retrieving and synthesising the evidence to  guide clinical practice: Development of an  evidence-based framework for stuttering  interventions for adults who stutter

Background

Despite evidence-based practice advocating for the synthesis of multiple forms of evidence to inform clinical decision-making, the stuttering literature remains primarily represented by an efficacy evidence base. Other valuable forms of knowledge, such as patient and practice evidence remain less represented. Stuttering intervention is characterised by ongoing challenges reported by adults who stutter and speech and language therapists (SLTs). There is therefore the need to generate other evidence forms to inform the development of an evidence-based and stakeholder-informed framework for stuttering intervention for adults.

Aims

The overall aim of this doctoral research was to develop a framework to guide the design and development of evidence-based stuttering interventions for adults using an evidence synthesis approach and involvement of key stakeholders.

Methods

A mixed methods approach was employed across three research phases. Phase one reviewed the literature using a meta-ethnography on the lived experience of stuttering, and a systematic review and meta-analysis of effective stuttering interventions. Phase two used semi-structured interviews to obtain the perspectives of academic and clinical experts (n=10) on the principles and components of effective stuttering intervention. Phase three employed e-Delphi methodology to establish consensus on core stuttering intervention components with an expert panel of adults who stutter and SLTs (n=48).

Results

The meta-ethnography identified the predominantly negative impact that stuttering has on an adult’s life. The systematic review highlighted the diverse range of effective treatments available and the primary use of speech-related outcome measures to determine effectiveness. Practice evidence, generated by the semi-structured interviews, identified the multiple variables influencing treatment outcomes and the need for individualised intervention. The e-Delphi survey obtained stakeholder consensus on the core components of effective stuttering intervention. Following categorisation of these components using numerous frameworks and models, the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering was selected to guide the generation of the framework for stuttering intervention.

Discussion

Multiple forms of evidence were generated to develop an evidence-based and stakeholder-informed framework to guide the design of stuttering interventions in clinical practice. The collection of knowledge forms beyond efficacy evidence identified the need for individually tailored interventions and the multiple variables that influence treatment outcomes, including person-related factors and therapeutic alliance.

Conclusion

The generation of practice and patient evidence addressed a gap in the literature and provided new insights into components of effective stuttering intervention for adults. Further research into the co-design of a stuttering intervention based on the framework, and the development of national clinical practice guidelines for treating stuttering is recommended.