Connery Amy, Yaruss J Scott, Lomheim Holly, Loucks Torrey M, Galvin Rose, McCurtin Arlene
School of Allied Health, University of Limerick, Limerick, Ireland.
HSE Dublin South West, Tallaght, Dublin, Ireland.
Int J Lang Commun Disord. 2022 Jan;57(1):112-127. doi: 10.1111/1460-6984.12680. Epub 2021 Nov 24.
Evidence-based practice involves the synthesis of multiple forms of evidence to inform clinical decision-making and treatment evaluation. Practice- and patient-based evidence are two forms of evidence that are under-represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults.
To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence-based interventions for adults who stutter.
METHODS & PROCEDURES: Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three-round e-Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering.
OUTCOMES & RESULTS: A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors.
CONCLUSIONS & IMPLICATIONS: Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence-based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter.
What is already known on the subject Evidence-based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision-making and treatment evaluation. The stuttering literature is characterized by an over-representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge This study adds valuable practice- and patient-based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work? This research presents a stakeholder-informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence-based interventions. The framework supports the adoption of a person-centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy.
循证实践涉及综合多种形式的证据，以为临床决策和治疗评估提供依据。基于实践和患者的证据是口吃文献中代表性不足的两种证据形式。收集此类知识对于支持针对成年人的有效口吃干预措施的设计和实施至关重要。
就口吃成年人干预的核心组成部分达成利益相关者共识，并为口吃成年人循证干预措施的设计和开发建立指导框架。
口吃成年人以及有口吃干预经验的言语和语言治疗师（SLT）参与了三轮电子德尔菲调查，重点关注：（1）确定关键的口吃干预组成部分，包括原则、实践以及结构和背景因素；（2）就口吃干预组成部分达成群体共识。使用适用于口吃研究的《国际功能、残疾和健康分类》（ICF）模型对陈述进行分类。
共有48人同意参与：48/48（100%）完成了第一轮问卷，40/48（83%）回复了第二轮，36/40（90%）参与了第三轮。在对第一轮进行内容分析后，制定了101条陈述，其中89条被视为代表口吃成年人干预核心组成部分的陈述达成了共识。这些陈述的分类反映了与个人对口吃的反应、生活参与限制和环境因素相关的关键口吃干预组成部分。
通过与关键利益相关者的参与，对口吃干预的核心组成部分达成了共识。所提出的循证框架突出了临床医生在为口吃成年人设计干预措施时应考虑的关键干预组成部分的范围。
关于该主题已知的内容 循证实践认可综合多种知识形式，包括研究、实践和患者证据，以支持临床决策和治疗评估。口吃文献的特点是疗效证据占比过高，而指导临床实践的实践和患者证据明显较少。本文对现有知识的补充 本研究为口吃成年人有效口吃干预组成部分增加了宝贵的基于实践和患者的证据。这些与个人对口吃的反应、生活参与限制和环境因素有关。这项工作的潜在或实际临床意义是什么？本研究提出了一个利益相关者参与的口吃干预框架，以指导与口吃成年人合作的言语和语言治疗师设计循证干预措施。该框架支持采用以患者为中心的干预方法，以确保探索每个客户的独特需求、偏好、价值观和期望结果并将其纳入治疗。
