On the benefits of speech-language therapy for cleft lip and/or palate (Sand et al., 2022)

Purpose: Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50%of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP.

Method: A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies.

Results: Thirty-four eligible studies were found. Nineteen studies provided IPD (n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]).

Conclusions: The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful.

Supplemental Material S1. PRISMA-IPD Checklist of items to include when reporting a systematic review and meta-analysis of individual participant data (IPD), and where each item is reported in the article.

Supplemental Material S2. The specific database search strategies for each database.

Supplemental Material S3. Information on and exclusion reason for noteworthy studies excluded from this review.

Supplemental Material S4. Overview of all studies included in this systematic review and description of which study that contributed with what type of data to which analysis.

Supplemental Material S5. IPD tabulated from the included studies and all our clinical evaluations.

Supplemental Material S6. An R Script including all statistical analyses presented herein.

Supplemental Material S7. Narrative summary of the included studies with speech production as outcome measure for which we did not obtain IPD.

Sand, A., Hagberg, E., & Lohmander, A. (2022). On the benefits of speech-language therapy for individuals born with cleft palate: A systematic review and meta-analysis of individual participant data. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2021_JSLHR-21-00367