JCPSLP Vol 19 No 2 2017

paediatric sample of stuttering. The eight SLPs rated this sample using the SR scale. All SR scores were within one point, demonstrating rater consistency as per the LP guidelines. Each clinician’s clinical hours per child to the completion of Stage 1 were calculated by dividing the minutes taken for each group by the number of children (Arnott et al., 2014). Number of clinic visits and weeks per child to completion of Stage 1 included all attended group sessions, other than the initial parent training session (PTS). Direct treatment did not begin until after the groups had commenced. As such, the PTS was deemed part of the assessment and planning stage, in line with multiple assessment sessions as seen within stuttering research (Franken, Kielstra-Van der Schalk, & Boelens, 2005; McCulloch, Swift, & Wagnitz, 2017). The number of weeks was calculated from the date of each child’s first attendance to the date of the last group in which criteria for Stage 2 was met. Generalised estimating equation method (GEE) for a normally distributed outcome was used to analyse %SS and SR for the repeated assessment times of pre-treatment (T1), 6 months (T2) and 9 months (T3) post-commencement. Analysis was by intention to treat, where all participants commencing the program were included, resulting in analyses of 19 participants. The GEE method enables participants with missing data at the 6- or 9-month assessment times to be retained in the analysis. Assessment times were clustered by participant and an exchangeable covariance structure was assumed which is equivalent to the compound symmetry structure used in a repeated measures analysis of variance. The within-participant factor for time was assessed and its two components T1 with T2 and T2 with T3. An independent t -test was used to compare those who completed to Stage 1 against those who withdrew from treatment, on variables of age, stuttering severity (%SS & SR). Differences between those who completed to Stage 1 and those who withdrew from treatment in terms of gender were assessed using a chi-square test. All analysis was conducted using SPSS (v. 22) statistical software with statistical significance defined as p-value < 0.05. Twenty-one children enrolled in the study; however, two children withdrew prior to attending groups. The data from the remaining 19 children was included for analysis. Twelve participants completed Stage 1 and seven did not complete Stage 1. Reasons for not completing Stage 1 and early withdrawal (n = 2) prior to group commencement included parental uncertainty about the treatment (n = 1), prioritising other areas of treatment such as speech sound disorders (n = 1), moving out of area (n = 1), failure to contact the service after missed sessions thereby activating discharge policy (n = 1), maternal health (n = 1), balancing siblings needs (n = 1) and continuing with ongoing stuttering treatment as the criteria for Stage 2 had not been met within the time frame of the research (n = 3). Factors leading to non-completion of Stage 1 and/or withdrawal from the present study and the percentage of participants (37%) are in line with other stuttering treatment studies (McCulloch et al., 2017; Trajkovski et al., 2011). It was beyond the remit of this clinician-led community study to carry out ongoing follow-up to monitor long-term treatment outcomes. In line with the real-world ethos underpinning the design was that participating SLPs Results Attrition

and child–parent pairs should not have extra demands placed on them that were not contingent with standard LP treatment. Children entered treatment at different points due to the “rolling” nature of the groups, some towards the end of the research protocol timeframe. Children who moved from Stage 1 to Stage 2 were seen individually at three sites and within a Stage 2 group at one site. Where possible the post-commencement assessments were integrated into Stage 1 or Stage 2 sessions. As such there is variation in numbers of clients at the 6- and 9-months post-commencement assessments. O’Brian et al. (2013) experienced similar variation in their translational study at the 9-months post-treatment assessment due to withdrawals (21%), Stage 1 completers (65%), and those still in Stage 1 (14%). Outcomes Measurements of stuttering severity were collected for all available children at the 6 months post-commencement (n = 14) and 9 months post-commencement (n = 10) assessments. Baseline characteristics for all 19 children who commenced the study groups are shown in Table 1. There was no significant difference at baseline between those who completed to Stage 1 and those who withdrew from treatment.

Table 1. Baseline assessment information for children who commenced rolling-group therapy

Characteristics

Completed Stage 1

Commenced

Gender n (%) Boy Girl

7 (36.8) 12 (63.2)

7 (58.3) 5 (41.7)

Age (years;months) < 3;5 3;5 – 4;5 > 4;5

3 (15.8) 10 (52.6) 6 (31.6)

1 (8.3) 6 (50.0) 5 (41.7)

Mean age in months (SD)

49.05 (7.9)

50.58 (8.1)

Mean %SS pre-treatment (SD)

7.39 (3.9)

6.02 (5.2)

Mean SR pre-treatment (SD)

5.26 (1.6)

5.0 (1.7)

The mean number of SLP hours per child to complete Stage 1 was 7.3 clinical hours (SD = 2.7, range = 2.69–11.58). The median number of clinic visits to the completion of Stage 1 was 15 visits (interquartile range 12.3). The interquartile range values show that 75% of the children completed Stage 1 within 23 visits. The median number of weeks to complete Stage 1 was 27 (interquartile range 19.2), with 75% of the children reaching Stage 2 within 34.7 weeks. The mean %SS score at the completion of Stage 1 for the entire sample (n = 12) was 0.37 %SS (SD = 0.38 Range = 0.00–0.98). Measures of %SS and SR at initial assessment, 6 months post-commencement and 9 months post-commencement showed a trajectory towards little or no stuttering across the treatment period (Table 2, figures 1 and 2). Children (n = 10) who were assessed at 9 months post-commencement of treatment scored a mean %SS of 1.3 %SS (SD = 2.1; Range = 0–5.3), while the subset of those who had completed Stage 1 (n = 7) scored a mean %SS of 0.9%SS (SD = 1.9; Range = 0–5.3). The downward trend was similar for both those who completed Stage 1 and those who were continuing in treatment.

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology