Rating scales and measurement of speech treatment outcomes in young children with cleft palate : a systematic review
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Objective. (1) To identify the methods by which speech outcomes are measured with subjective rating scales for children with cleft palate and (2) to examine the usefulness of these commonly used measures for assessing treatment outcomes. Design. Six databases were searched between inception and April 2016 to identify published articles relating to rating-scale based measurement of speech and language outcomes for children with cleft palate with or without cleft lip. Studies that included at least one participant and reported intelligibility and/or resonance outcome measures for speech were included. All of the studies had participants who were age six and younger and assessed the measurement of speech development following cleft palate repair. Results. Six papers out of the 88 identified by the literature search met all of the criteria and were evaluated by this review. These included one randomized controlled trial, three observational and retrospective studies that had experimental components, and two non-experimental studies that reported on results and speech development following surgical cleft palate repair. Outcome measures for speech included perceptual rating scales, formal and informal articulation measures, and objective instrumental evaluation. Conclusions. The review found evidence to support that perceptual rating scales, when used in combination with other measures such as articulation assessments and instrumental exams, can be effective outcome measures in clinical studies. Measuring speech outcomes from therapy, surgery, and maturation is an important component of increasing the knowledge base so that the best possible outcomes can be provided with the most effective intervention, with minimal time devoted to elaborate measures and analyses of speech sounds. Demonstrating that measurement using less technology can also be effective at measuring treatment outcomes allows future studies to focus more resources on manipulating variables to optimize speech outcomes, while still obtaining statistically significant results. Building an evidence base for speech-language therapy practice in children with cleft palate with or without cleft lip allows treatment resources to be used in more effective ways.