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JCPSLP
Volume 19, Number 2 2017
Journal of Clinical Practice in Speech-Language Pathology
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.
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.
Results
Attrition
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
Table 1. Baseline assessment information for
children who commenced rolling-group therapy
Characteristics
Commenced
Completed
Stage 1
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.