Comparison of Stuttering Severity and Anxiety During Standard and Challenge Phone Calls

Purpose: This study was designed to answer three questions. (a) Does percentage of syllables stuttered (%SS) differ between standard and challenge phone calls. (b) Does anxiety differ between standard and challenge phone calls. (c) Is there a relationship between %SS and anxiety during standard and challenge phone calls? Method: Participants were 230 adults diagnosed with stuttering, who were participants from five clinical trials. Each participant received two 10-min phone calls at pretreatment and a further two phone calls 6 months or 20 weeks postrandomization. One phone call was standard, and the other presented challenge: occasionally disagreeing with, interrupting, and talking over participants, or asking for clarification of their views. Results: Statistically significant, but clinically minor, increases of %SS and anxiety occurred during the challenge phone calls. There was a statistically significant association between %SS and anxiety. Conclusions: Variable phone call procedures to assess stuttering severity in clinical trials are not likely to spuriously inflate or deflate treatment outcomes to a clinically important extent. Regardless, the present results suggest that there is statistical merit in controlling the nature of phone calls during clinical trials with the simple and replicable method developed in this report. Additionally, there is procedural merit in the challenge phone call procedure; it is a more valid representation of the challenges of everyday speech than the standard procedure. However, a disadvantage of the challenge phone call procedure is the practical issues associated with its use. The clinical and theoretical applications of the results are discussed. </jats:sec

A graphical method for assessing agreement with the mean between multiple observers using continuous measures

Background: Currently, we are not aware of a method to assess graphically on one simple plot agreement between more than two observers making continuous measurements on the same subjects. Methods: We aimed to develop a simple graphical method to assess agreement between multiple observers using continuous measurements. The Bland-Altman graphical method for assessing agreement between two observers using continuous measures was modified and extended to accommodate multiple observers. Mathematical formulae are derived and real data examples used to illustrate the proposed method. Results: The examples show that the proposed graphical method of assessing agreement provides clinically useful information. This information includes estimates of the limits of agreement with the mean and a visual means for determining these limits over the range of measurements. In a data example that included five readers' measurements of 40 lung lesions, the intra-class correlation (ICC) was 0.84 indicating readers can reliably measure the lesions. However, the estimated limits of agreement with the mean were -1.1 to 1.1 cm implying that the readers' measurements can plausibly differ from the mean estimated tumour size by more than 1 cm. This is a clinically significant difference according to the study authors. In addition, a plot of the limits of agreement with the mean by mean tumour size shows heterogeneous agreement presumably due to the varying degrees of definition at the edge of the lesions. Conclusions The proposed graphical method of assessing agreement can be used alongside other measures such as ICC for reporting on reproducibility in studies of multiple observers making continuous measurements

Verbal contingencies in the lidcombe program: a\ua0noninferiority trial

Purpose: The Lidcombe Program is an efficacious and effective intervention for early stuttering. The treatment is based on parent verbal response contingent stimulation procedures, which are assumed to be responsible for treatment effect. The present trial tested this assumption. Method: The design was a parallel, open plan, noninferiority randomized controlled trial. In the experimental arm, the five Lidcombe Program verbal contingencies were removed from parent instruction. The primary outcome was beyondclinic percentage syllables stuttered at 18-month follow-up. Seventy-four children and their parents were randomized to one of the two treatment arms. Results: Findings of noninferiority were inconclusive for the primary outcome of stuttering severity, based on a margin of 1.0 percentage syllables stuttered. Conclusions: The inconclusive finding of noninferiority means it is possible that verbal contingencies make some contribution to the Lidcombe Program treatment effect. However, considering all primary and secondary outcomes, an overriding impression from the trial is a similarity of outcomes between the control and experimental arms. The clinical applications of the trial are discussed, along with further research that is needed

Stuttering and health economics (Norman et al., 2023)

Purpose: For those who stutter, verbal communication is typically compromised in social situations. This may attract negative responses from listeners and stigmatization by society. These have the potential to impair health-related quality of life across a range of domains, including qualitative and quantitative impacts on speech output, mental health issues, and failure to attain educational and occupational potential. These systematic reviews were designed to explore this matter using traditional health economics perspectives of utility measures and cost of illness.Method: Studies were included if they involved children, adolescents, or adults with stuttering as a primary diagnosis. The quality of life search strategy identified 2,607 reports, of which three were included in the quality of life analysis. The cost of illness search strategy identified 3,778 reports, of which 39 were included in the cost of illness analysis.Results: Two of the three studies included in the quality of life analysis had a high risk of bias. When measured using utility scores, quality of life for people who stutter was in the range of those reported for chronic health conditions such as diabetes mellitus, cardiovascular disease, and cancer. However, there is little such evidence of quality of life impairment during the preschool years. Studies included in the cost of illness analysis carried considerable risk of bias overall.Conclusions: For people who stutter, there are substantive direct and indirect costs of illness. These include impairment, challenges, and distress across many domains throughout life, including income, education, employment, and social functioning. Evidence of quality of life impairment using utility measures is extremely limited. If this situation is not remedied, the lifetime impairment, challenges, and distress experienced by those who stutter cannot be documented in a form that can be used to influence health policy and health care spending.Supplemental Material S1. Search terms.Supplemental Material S2. Data extraction form.Supplemental Material S3. Risk of bias for the quality of life and cost studies.Supplemental Material S4. Summary of studies included in the cost of illness analysis.Norman, A., Lowe, R., Onslow, M., O’Brian, S., Packman, A., Menzies, R., & Schroeder, L. (2023). Cost of illness and health-related quality of life for stuttering: Two systematic reviews. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2023_JSLHR-23-00072</p

The Complexity of Stuttering Behavior in Adults and Adolescents: Relationship to Age, Severity, Mental Health, Impact of Stuttering, and Behavioral Treatment Outcome

PURPOSE: This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender. METHOD: For this study, a taxonomy was developed-LBDL-C7-which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression. RESULTS: The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering. CONCLUSION: Clinical and research applications of these findings are discussed