Mouton Tara, Van Lierde Kristiane, Verhaeghe Nick, Alighieri Cassandra, Allemeersch Fien, Goeleven Ann, Hens Greet, Bettens Kim
Department of Rehabilitation Sciences, Centre of Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium.
Department of Neurosciences, Experimental Otorhinolaryngology, Catholic University Leuven, Leuven, Belgium.
Int J Lang Commun Disord. 2025 Jul-Aug;60(4):e70061. doi: 10.1111/1460-6984.70061.
Traditional low-intensity speech therapy in children with cleft palate with or without cleft lip (CP ± L), provided twice weekly for 30 min over months or even years, lacks solid scientific evidence and may lead to poor outcomes, treatment fatigue, and high costs. Different authors have proposed the implementation of high-intensity speech intervention through promising proof-of-concepts. However, this approach has not yet been widely adopted in clinical practice. To assess its impact on a broader scale, the investigation will focus on the perceptions and acceptability of high- and low-intensity speech intervention as provided by primary care speech-language pathologists (SLPs).
This protocol article outlines a qualitative study designed to explore the perceptions and experiences of intervention providers (primary care SLPs) and recipients (children with CP ± L [4-12 years old] and their caregivers) regarding high- and low-intensity speech interventions. The study aims to evaluate the acceptability, feasibility, and perceived impact of both intervention approaches.
Both providers and recipients of the intervention from a previous randomized controlled trial (RCT) conducted by our research group-which will compare the outcomes of high- versus low-intensity speech intervention-will be recruited. Separate, tailored semi-structured interview guides will be used for SLPs, caregivers, and children to explore their unique perspectives on the intervention, including its acceptability and feasibility. Age-appropriate methods such as play-based activities, puppets, and emotion mapping will be used to facilitate engagement with younger children. Additionally, all participants will complete a questionnaire regarding their demographics. Qualitative data will be evaluated using inductive coding for emergent themes and deductive coding based on the theoretical framework of acceptability (TFA).
Drawing from prior qualitative investigations by the research group, a hypothesis is put forth suggesting that a high-intensity speech intervention could garner greater acceptance from both intervention recipients and their caregivers. This hypothesis stems from the expectation that an intensified intervention can reduce therapy fatigue, dropout rates, and emotional strain. Furthermore, it is anticipated that such an approach might enhance intrinsic motivation. The findings will provide valuable insights into the feasibility and acceptability of different intervention intensities, contributing to the development of evidence-based speech therapy practices for children with CP ± L.
What is already known on this subject There is an increasing interest in assessing the effectiveness of intensive speech therapy interventions in children with CP ± L. Several quantitative studies have demonstrated positive speech outcomes following high-intensity interventions. Nevertheless, the extent to which both recipients and providers perceive these interventions as acceptable remains uncertain. This study aims to compare the acceptability of high-intensity speech therapy (i.e., 5 × 30 min/week for 2 × 4 weeks [2 × 10 h]) with low-intensity speech therapy (i.e., 2 × 30 min/week for 20 weeks [20 h]), from the viewpoint of children with CP ± L, their caregivers, and primary care SLPs. What this study adds This study will contribute significantly to the existing literature by examining the perceptions and acceptability of high-intensity speech intervention among children with CP ± L. By investigating the differences between high- and low-intensity speech therapy approaches, it aims to provide valuable insights into the acceptability and feasibility of these interventions from the viewpoint of both recipients and providers. These findings will be crucial for informing clinical practices and enhancing the delivery of speech therapy services to children with CP ± L, ultimately striving for optimal outcomes in their speech development and overall well-being. What are the clinical implications of this study? Depending on the findings of this study, we might have to rethink the conventional methods of delivering cleft speech interventions, often characterized by low-intensity speech therapy. By comparing perceptions of high- and low-intensity speech interventions, we aim to identify the most feasible and acceptable method for both recipients and providers. Insights gained from this study could lead to improvements in the overall delivery of speech therapy services, potentially enhancing treatment adherence and outcomes for children with CP ± L, guiding clinical practice with evidence-based recommendations.
传统的低强度言语治疗应用于伴有或不伴有唇裂的腭裂（CP±L）患儿时，每周进行两次，每次30分钟，持续数月甚至数年，缺乏确凿的科学依据，可能导致治疗效果不佳、治疗疲劳和高成本。不同的作者通过有前景的概念验证提出了实施高强度言语干预的方法。然而，这种方法尚未在临床实践中广泛应用。为了在更广泛的范围内评估其影响，本研究将聚焦于初级保健言语治疗师（SLP）提供的高强度和低强度言语干预的认知和可接受性。
本方案文章概述了一项定性研究，旨在探索干预提供者（初级保健SLP）和接受者（4 - 12岁的CP±L患儿及其照顾者）对高强度和低强度言语干预的认知和体验。该研究旨在评估两种干预方法的可接受性、可行性和感知影响。
将招募我们研究小组之前进行的一项随机对照试验（RCT）中的干预提供者和接受者，该试验将比较高强度与低强度言语干预的效果。将为言语治疗师、照顾者和儿童分别使用量身定制的半结构化访谈指南，以探索他们对干预的独特观点，包括其可接受性和可行性。将使用适合年龄的方法，如基于游戏的活动、木偶和情绪映射，以促进年幼儿童的参与。此外，所有参与者将完成一份关于其人口统计学特征的问卷。定性数据将使用归纳编码来识别新出现的主题，并基于可接受性理论框架（TFA）进行演绎编码。
根据研究小组之前的定性调查，提出一个假设，即高强度言语干预可能会获得干预接受者及其照顾者更高的接受度。这一假设源于这样的预期，即强化干预可以减少治疗疲劳、辍学率和情绪压力。此外，预计这种方法可能会增强内在动机。研究结果将为不同干预强度的可行性和可接受性提供有价值的见解，有助于为CP±L患儿制定基于证据的言语治疗实践。
关于该主题已知的信息 人们越来越关注评估强化言语治疗干预对CP±L患儿的有效性。几项定量研究表明，高强度干预后言语结果呈阳性。然而，接受者和提供者认为这些干预可接受的程度仍不确定。本研究旨在从CP±L患儿、其照顾者和初级保健言语治疗师的角度，比较高强度言语治疗（即每周5次，每次30分钟，共2×4周[2×10小时]）和低强度言语治疗（即每周2次，每次30分钟，共20周[20小时]）的可接受性。本研究的补充内容 本研究将通过考察CP±L患儿对高强度言语干预的认知和可接受性，为现有文献做出重大贡献。通过研究高强度和低强度言语治疗方法之间的差异，旨在从接受者和提供者的角度为这些干预的可接受性和可行性提供有价值的见解。这些发现对于指导临床实践和加强对CP±L患儿的言语治疗服务至关重要，最终努力在他们的言语发展和整体福祉方面实现最佳结果。本研究的临床意义是什么？根据本研究的结果，我们可能不得不重新思考传统的腭裂言语干预方法，这些方法通常以低强度言语治疗为特征。通过比较对高强度和低强度言语干预 的认知，我们旨在确定对接受者和提供者来说最可行和可接受的方法。从本研究中获得的见解可能会导致言语治疗服务整体提供的改善，有可能提高CP±L患儿的治疗依从性和治疗效果，以基于证据的建议指导临床实践。
