Background
Children with speech sound disorder (SSD) are at risk of long-term adverse consequences if appropriate intervention is not provided in a timely way. Although there are interventions of proven efficacy, these are often not implemented with good fidelity in clinical practice. Children with SSD in the United Kingdom are commonly managed in care pathways within NHS and independent speech and language therapy services. It is not known which care pathways are most effective because there is currently no systematic recording or analysis of intervention outcomes for children with SSD.
Aims
The objective of the MISLToe-SSD study is to develop an evidence-based protocol for collecting routine data on a large-scale so that UK SSD care pathways can be evaluated for clinical- and cost-effectiveness. The development of the core outcome set (COS) is reported here.
Methods and Procedures
Following the Core Outcome Measures in Effectiveness Trials methodology, a modified Delphi process was used to reach a consensus on a COS for SSD interventions. The Delphi process comprised two online survey rounds and one online meeting. Anonymity between panel members was maintained during the online survey rounds. Round one required a consensus of =50%, rising to =75% in round two.
Outcomes and Results
A group of 66 UK speech and language therapists identified as experts in SSD by their peers were recruited through specialist clinical and research networks. A long list of 30 outcome statements was reduced by consensus to a final list of seven outcomes with associated measurement instruments. Increased speech intelligibility was agreed as the primary outcome by 100% of panel members. Six secondary outcomes were identified.
Conclusions and Implications
The final COS can be used in future research to evaluate care pathways and intervention effectiveness for children with SSD. Furthermore, it provides a basis for measuring outcomes in future intervention trials for SSD.
76,000 children with Speech Sound Disorder (SSD) are referred to speech and language therapy (SLT) in the UK every year. Untreated, SSD leads to poor outcomes in education, employment, and mental health. SLT intervention in the UK is delivered via care pathways and these are often resource rather than evidence driven and there is significant national variation. There is a pressing need to identify which care pathways are most effective and efficient within NHS service constraints to improve outcomes and maximise cost-effectiveness. Before we can determine which care pathways are most effective and efficient, we must establish a Core Outcomes Set (COS) and minimum dataset.
The objectives of this work are as follows:
1. Develop a robust protocol for collection of a COS and minimum dataset for children with SSD that is meaningful to stakeholders and can be feasibly implemented within SLT services;
2. Agree a standard approach to the diagnostic process for identification of subtypes of SSD;
3. Determine the range and specification of interventions provided for SSD subtypes in UK NHS SLT services;
4. Identify process for future health economic analysis.
Chief Investigator: Dr Yvonne Wren
Director of Bristol Speech and Language Therapy Research Unit (BSLTRU), North Bristol NHS Trust
Co-investigators:
Dr Sam Harding (BSLTRU)
Dr Joanne Cleland (University of Strathclyde)
Dr Helen Stringer (University of Newcastle)
Sam Burr (BSLTRU)
Yvonne Wren (BSLTRU)
Dr Sarah Wallace (University of Queensland)
Carolyn Hawkes (Lead Clinical SLT, NHS Lothian)
Lesley Hemmings (SLT, Sirona Health and Care)
Linda Lascelles (CEO, Association for All Speech Impaired Children)
The MISLToe_SSD Expert Panel
Disease Category: Child health, Ear, nose, & throat
Disease Name: Speech sound disorders
Age Range: 0 - 25
Sex: Either
Nature of Intervention: Any
- Charities
- Families
- Patient/ support group representatives
- Researchers
- Service providers
- Service users
- COS for clinical trials or clinical research
- COS for practice
- Minimum dataset
- Recommendations for outcome measures (measurement/how)
- Delphi process
- Focus group(s)
- Semi structured discussion
- Survey
- Systematic review
This study comprises 3 workstreams:
WS1: Umbrella review of current literature to create preliminary content for all four objectives
WS2: Virtual participatory workshop to refine the COS and minimum dataset and to agree the diagnostic process and list of interventions
WS3: A two-round modified Delphi process and expert panel meeting to finalise content for the COS and minimum dataset.
PPI input has guided plans so far and will continue to be a key part of all activity.