International expert perspectives on the principles and components of effective intervention for adults who stutter

Abstract

Background: While evidence-based practice is widely endorsed by researchers, clinicians and professional bodies as a guiding framework for the provision of quality care to clients, the reliance on efficacy evidence may overshadow the benefits of other knowledge forms in supporting intervention design and evaluation. Due consideration needs to be given to varied forms of evidence, including practice and patient evidence. Stuttering intervention for adults is one area in which there is a significant shortage of practice-based research literature. Aims: This study aimed to add to practice evidence by exploring the perspectives of international researchers and clinical experts on the components of effective stuttering intervention. This practice-based evidence will be used to inform the multi-stakeholder co-design of an evidence-based stuttering intervention for adults. Methods & Procedures: Criteria defining expertise were developed based on a review of the literature. Experts were recruited using purposive sampling and snowballing. Seventeen international experts were approached, of which 10 completed semi-structured interviews. Interview questions were developed and centred on five topics: the nature of stuttering; efficacy evidence base; intervention techniques, principles of effective intervention; and outcome measurement. Outcomes & Results: Inductive thematic analysis identified three overarching themes: 'One size doesn't fit all', 'A really collaborative relationship where we are both bringing our sense of expertise to this' and 'Some of the most frustrating things'. Conclusions & Implications: These findings emphasize the complexity of stuttering intervention, the need for individually tailored treatments and the role of multiple factors, beyond therapeutic technique, that influence treatment outcomes. Findings also demonstrate the benefit of collecting practice-based evidence to support clinical decision-making and intervention evaluation.

Obtaining consensus on core components of stuttering intervention for adults: An e‐Delphi Survey with key stakeholders

“…Examples include taking responsibility for change and motivation to engage with intervention. This is in line with research demonstrating that multiple factors beyond therapeutic technique influence treatment outcomes, including therapeutic alliance and readiness for change (Connery et al, 2020a;Floyd et al, 2007;Manning, 2010;Sønsterud et al, 2019b;Turnbull, 2000). Despite such findings, the influence of these components on outcomes is often neglected in efficacy studies.…”

“…The Round 1 questionnaire was developed from findings of three previous research phases which included a meta-ethnography on the lived experience of stuttering, a systematic review and meta-analysis on stuttering intervention effectiveness, and semi-structured interviews with expert academics and clinicians in the field of stuttering (Connery et al, 2019(Connery et al, , 2020a(Connery et al, , 2020b. The questionnaire consisted of 25 statements generated by two authors (A.C., A.M.) to represent the themes, subthemes and categories identified in the results of these studies (see Table S2 in the additional supporting information).…”

“…the result of efficacy research such as systematic reviews and randomized controlled trials (McCurtin et al, 2019). Less attention has been paid to other forms of knowledge such as patient-based evidence (knowledge from patient experience, e.g., a client's intervention preferences) and practice-based evidence (knowledge from clinical experience, e.g., a clinician's opinion) (Buetow & Kenealy, 2000;Connery et al, 2020a;Green-halgh et al, 2014;McCurtin et al, 2019). More recent frameworks of evidence-based practice have highlighted the need for inclusivity of all evidence forms to support clinical decision-making and treatment evaluation (Buetow & Kenealy, 2000;McCurtin et al, 2019).…”

“…In comparison, systematic reviews of efficacy evidence point to significantly more studies examining stuttering intervention efficacy (Baxter et al, 2015;Connery et al, 2020b). Some recent studies have demonstrated the value in collecting other forms of knowledge such as patient-and practice-based evidence to inform clinical decision-making and ensure intervention efficacy for adults who stutter (Connery et al, 2020a;Sønsterud et al, 2020). In their qualitative examination of the perspectives of expert academics and clinicians on the components of effective intervention, Connery et al (2020a) demonstrated the need for individualized intervention that considers multiple factors beyond therapeutic technique.…”

“…Some recent studies have demonstrated the value in collecting other forms of knowledge such as patient-and practice-based evidence to inform clinical decision-making and ensure intervention efficacy for adults who stutter (Connery et al, 2020a;Sønsterud et al, 2020). In their qualitative examination of the perspectives of expert academics and clinicians on the components of effective intervention, Connery et al (2020a) demonstrated the need for individualized intervention that considers multiple factors beyond therapeutic technique. These included person-related variables such as client motivation or clinician's knowledge, and therapeutic alliance to enhance treatment outcomes for adults who stutter.…”