Maximising the Impact of Speech and Language Therapy for Children With Speech Sound Disorder (The MISLToe-SSD) Study: Developing a Core Outcome Set (COS) for Routine Data Collection From UK NHS Speech and Language Therapy Services

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.

WHAT THIS PAPER ADDS

What is already known on this subject

Speech and language therapy services in the United Kingdom are ideally placed to contribute to large-scale evaluations of services provided for children with speech sound disorder (SSD) due to the computerised routine collection of data related to client management and interventions. However, these routine data cannot currently be used to evaluate the effectiveness or efficiency of interventions for children with different subtypes of SSD due to a lack of uniformity in data collection. There are no agreed and validated outcomes, outcome measures, diagnostic protocols or agreed labels and definitions for the evidence-based interventions that can be used by services across the United Kingdom.

What this study adds to existing knowledge

Building on information from an umbrella review and practitioner workshops, a modified Delphi process with 66 SSD expert speech and language therapists from across the United Kingdom, was utilised to develop a core outcome set (COS) and a minimum dataset of common data elements.

What are the potential or actual clinical implications of this study?

The COS and minimum dataset can be used by speech and language therapy services to collect routine data in a way that can contribute to large-scale evaluations of the effectiveness and efficiency of interventions for children with SSD.