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Fuller C, Reed Gardner J, Speed O, Thomason A, Zaniletti I, Buckmiller L, Johnson A, Hartzell L. Outcomes After Pharyngeal Flap Surgery in Children: A Comparison of Lined Versus Unlined Flaps. Cleft Palate Craniofac J 2024; 61:1461-1469. [PMID: 37143290 DOI: 10.1177/10556656231172642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution. DESIGN Retrospective cohort study. SETTING Tertiary children's hospital. PATIENTS Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017. OUTCOME MEASURES We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA). RESULTS 160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p = 0.037) and more likely to have cleft palate (63/119 vs 14/41; p = 0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p = 0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p = 0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p = 0.032). PSA scores were found to be lower (less hypernasal) after PFU (p = 0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p = 0.001), while PFT (p = 0.525) did not demonstrate a statistical difference. CONCLUSION The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications.
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Affiliation(s)
- Colin Fuller
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - J Reed Gardner
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Olivia Speed
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ashlen Thomason
- Department of Audiology and Speech-Language Pathology, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Lisa Buckmiller
- Department of Ear, Nose and Throat, Cook Children's Hospital, Fort Worth, TX, USA
| | - Adam Johnson
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Larry Hartzell
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
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Alons E, Brauner L, Luinge M, Terwee CB, van Ewijk L, Gerrits E. Identifying Relevant Concepts for the Development of a Communicative Participation Item Bank for Children and Adolescents: A Systematic Review of Existing Instruments. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1186-1205. [PMID: 38358947 DOI: 10.1044/2024_jslhr-23-00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE This study aims to systematically identify items that measure communicative participation from measurement instruments that measure (aspects of) communication and/or participation in children and adolescents (5-18 years old) with communication disorders, for developing an item bank. METHOD A systematic literature search was performed in MEDLINE and Embase to search for patient-reported outcome measures (PROMs) or parent reports measuring aspects of communication and/or participation in children and adolescents. The individual items of the included measurement instruments were reviewed on whether they measure communicative participation. The items were then classified into one of the International Classification of Functioning, Disability and Health (ICF) for Children and Youth (World Health Organization, 2007) domains of activities and participation. RESULTS A total of 29 instruments were found, nine PROMs and 20 parent reports. One hundred forty-five items were identified that measure communicative participation. From these 145 items, 74 were retrieved from PROMs (51%), and 71 were retrieved from parent reports (49%). The majority of items were classified in ICF Domain 7, interpersonal interactions and relationships (73.8%), followed by Domain 8, major life areas (13.8%), and Domain 9, community, social, and civic life (8.3%). Only a few items were found in Domains 5 and 6, and none was found in Domains 1, 2, and 4. CONCLUSIONS We identified 145 items potentially useful for developing an item bank addressing communicative participation in children and adolescents with communication disorders. However, item development in collaboration with the target population is needed to ensure that these items fully reflect the construct.
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Affiliation(s)
- Eline Alons
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
- Department of Languages, Literature and Communication, Institute for Language Sciences, Utrecht University, the Netherlands
| | - Laurien Brauner
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
- Department of Languages, Literature and Communication, Institute for Language Sciences, Utrecht University, the Netherlands
| | - Margreet Luinge
- Centre of Expertise Healthy Ageing and Youth, Education and Society, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Caroline B Terwee
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit, the Netherlands
- Methodology Program, Amsterdam Public Health Research Institute, the Netherlands
| | - Lizet van Ewijk
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
| | - Ellen Gerrits
- Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
- Department of Languages, Literature and Communication, Institute for Language Sciences, Utrecht University, the Netherlands
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Hattori Y, Tu JCY, Chou PY, Lo LJ. Two-flap technique with interpositional dermofat graft for anterior oronasal fistula closure in patients with cleft: A case series. J Plast Reconstr Aesthet Surg 2024; 90:51-59. [PMID: 38359499 DOI: 10.1016/j.bjps.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Oronasal fistula at the anterior hard palate is one of the common sequelae after cleft surgery, and the leakage negatively affects the patient's quality of life. Although several surgical techniques have been proposed for reconstruction, it remains challenging because of the scarred regional tissue with a high rate of fistula recurrence. In this study, we present the anterior oronasal fistula repair using a two-flap technique with an interpositional dermofat graft (DFG). METHODS A retrospective review of anterior oronasal fistula repair performed by the senior author between April 2018 and August 2022 at the Craniofacial Center was conducted. Patients who underwent a fistula repair using the technique were further identified and investigated. RESULTS Thirty-four operations were performed using the technique, and 31 fistulas were completely closed, with a success rate of 91.2%. The fistula symptom improved but persisted postoperatively in 3 patients, of whom 2 patients underwent a second fistula repair using the same procedure, resulting in successful closure. Fistula recurrence was significantly correlated with fistula size (p = 0.04). The DFG was simultaneously utilized for nasal dorsum and/or vermillion reconstruction in 28 cases. CONCLUSION The two-flap technique enabled tension-free approximation, and the interpositional DFG facilitated watertight closure of the fistula, resulting in a high success rate of anterior oronasal fistula repair. The fistula closure could be combined with other revisional procedures for cleft-related deformities, where the DFG was simultaneously utilized.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Junior Chun-Yu Tu
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pang-Yun Chou
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.
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Kinter S, Susarla S, Delaney JC, Chapman K, Kapadia H, Weiss N. Does Distraction Lower Risk of VPI Compared to Conventional Maxillary Advancement? A Retrospective Cohort Study of Adolescents with Cleft Palate. Cleft Palate Craniofac J 2024; 61:422-432. [PMID: 36373608 PMCID: PMC10752384 DOI: 10.1177/10556656221138895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To determine whether method of maxillary advancement in adolescents with cleft palate with or without cleft lip (CP ± L) influences post-operative velopharyngeal function. DESIGN Retrospective cohort. SETTING Pediatric Tertiary Care Hospital. PARTICIPANTS One hundred and ninety-nine patients with CP ± L after LeFort I osteotomy for maxillary advancement at our institution between January 2007 and June 2019. INTERVENTIONS LeFort I osteotomy via distraction osteogenesis (DO) or conventional osteotomy (CO). MAIN OUTCOME MEASURES Patients who underwent DO or CO were compared for the presence of new velopharyngeal insufficiency (VPI), as measured by perceptual rating by a craniofacial speech-language pathologist. Of the 199 patients who underwent maxillary advancement, 126 were available for analysis. The DO group was younger, male, and had more severe maxillary hypoplasia. Following surgery, 17/41 (41.5%) of the DO group had new VPI, compared to just 23/85 (27.1%) of the CO group. After adjusting for cleft type and predicted maxillary advancement, however, there was not sufficient evidence to reject the null hypothesis of no difference in risk of post-operative VPI between the two surgical groups (prevalence ratio [PR] 1.40, 95% CI 0.68-2.90). Increased prevalence of VPI after DO versus CO was primarily observed among patients with a pre-operative velopharyngeal need ratio < 0.8 (PR = 2.01, 95% CI 0.79-5.10) and patients with normal velopharyngeal function pre-operatively (PR = 2.86, 95% CI 0.96-8.50). Our results suggest an increased rather than decreased risk of VPI following DO relative to CO. This association is primarily seen among those with a smaller velopharyngeal ratio or perceptually normal velopharyngeal function pre-operatively.
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Affiliation(s)
- Sara Kinter
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
| | - Srinivas Susarla
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Oral & Maxillofacial Surgery, University of Washington, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Joseph Christopher Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kathy Chapman
- Department of Communication Sciences & Disorders, University of Utah, Salt Lake City, UT, USA
| | - Hitesh Kapadia
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
- Department of Orthodontics, University of Washington, Seattle, WA, USA
| | - Noel Weiss
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Zhang Y, Zhang J, Li W, Yin H, He L. Automatic Detection System for Velopharyngeal Insufficiency Based on Acoustic Signals from Nasal and Oral Channels. Diagnostics (Basel) 2023; 13:2714. [PMID: 37627973 PMCID: PMC10453249 DOI: 10.3390/diagnostics13162714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Velopharyngeal insufficiency (VPI) is a type of pharyngeal function dysfunction that causes speech impairment and swallowing disorder. Speech therapists play a key role on the diagnosis and treatment of speech disorders. However, there is a worldwide shortage of experienced speech therapists. Artificial intelligence-based computer-aided diagnosing technology could be a solution for this. This paper proposes an automatic system for VPI detection at the subject level. It is a non-invasive and convenient approach for VPI diagnosis. Based on the principle of impaired articulation of VPI patients, nasal- and oral-channel acoustic signals are collected as raw data. The system integrates the symptom discriminant results at the phoneme level. For consonants, relative prominent frequency description and relative frequency distribution features are proposed to discriminate nasal air emission caused by VPI. For hypernasality-sensitive vowels, a cross-attention residual Siamese network (CARS-Net) is proposed to perform automatic VPI/non-VPI classification at the phoneme level. CARS-Net embeds a cross-attention module between the two branches to improve the VPI/non-VPI classification model for vowels. We validate the proposed system on a self-built dataset, and the accuracy reaches 98.52%. This provides possibilities for implementing automatic VPI diagnosis.
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Affiliation(s)
- Yu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Wen Li
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Heng Yin
- West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
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Alighieri C, Bettens K, Perry J, Hens G, Roche N, Van Lierde K. Achieving the next level in cleft speech intervention: A protocol of a randomized sham-controlled trial to provide guidelines for a personalized approach in children with cleft palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 36721996 DOI: 10.1111/1460-6984.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Compensatory cleft speech disorders can severely impact speech understandability and speech acceptability. Speech intervention is necessary to eliminate these disorders. There is, however, currently no consensus on the most effective speech therapy approach to eliminate the different subtypes of compensatory cleft speech disorders. AIMS To compare the immediate, short- and long-term effects of three well-defined speech intervention approaches (i.e., a motor-phonetic approach, a linguistic-phonological approach and a combined phonetic-phonological approach) on the speech and health-related quality of life (HRQoL) in Belgian Dutch-speaking children with cleft palate with or without cleft lip (CP±L) and different subtypes of compensatory speech disorders (i.e., anterior oral cleft speech characteristics (CSCs), posterior oral CSCs or non-oral CSCs). Besides, the perceived acceptability of these three speech intervention approaches will be investigated from the perspectives of caregivers and children with a CP±L. METHODS & PROCEDURES A two-centre longitudinal randomized sham-controlled trial was used. Children were randomly assigned to one of the three intervention programmes and received 10 h of speech intervention divided over 2 weeks. Block randomization was used, stratified by age and gender. Primary outcome measures included perceptual speech outcomes. Secondary outcome measures included patient-reported outcomes. OUTCOMES & RESULTS The results of this trial will provide speech-language pathologists evidence-based guidelines to better tailor intervention approaches to the specific needs of a child with a defined compensatory speech disorder. WHAT THIS PAPER ADDS What is already known on this subject Speech therapy approaches to address cleft palate speech disorders are broadly divided into two categories: motor-phonetic interventions and linguistic-phonological interventions. Some limited evidence demonstrated the positive effects of these approaches in eliminating compensatory cleft speech disorders. Different studies have reported inter-individual variation, suggesting that one child may benefit more from a particular intervention approach than the other child. Perhaps this variation can be attributed to the specific subtype of compensatory speech disorder (i.e., anterior oral CSC, posterior oral CSC or non-oral CSC). What this paper adds to existing knowledge This paper describes a randomized sham-controlled trial that compared the immediate, short- and long-term effects of three well-defined speech intervention approaches (i.e., a motor-phonetic approach, a linguistic-phonological approach and a combined phonetic-phonological approach) on the speech and HRQoL in Belgian Dutch-speaking children with CP±L and different subtypes of compensatory cleft speech disorders (i.e., anterior oral CSCs, posterior oral CSCs or non-oral CSCs) measured by perceptual and psychosocial outcome measures. Besides, the experienced acceptability of these three speech intervention approaches were investigated from the perspectives of caregivers and children. What are the potential or actual clinical implications of this work? This project provides evidence-based knowledge on patient-tailored cleft speech intervention considering both scientific evidence and the perspectives of caregivers and children. The results aid SLPs in better tailoring intervention approaches to the needs of a child with a specific type of compensatory cleft speech disorder.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences Ghent University, Gent, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences Ghent University, Gent, Belgium
| | - Jamie Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Greet Hens
- Department Neurosciences, KU Leuven, Leuven, Belgium
| | | | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences Ghent University, Gent, Belgium
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Chen N, Shi B, Huang H. Velopharyngeal Inadequacy-Related Quality of Life Assessment: The Instrument Development and Application Review. Front Surg 2022; 9:796941. [PMID: 35402476 PMCID: PMC8988257 DOI: 10.3389/fsurg.2022.796941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective For the patient-reported outcome (PRO) measures related to patients with velopharyngeal inadequacy (VPI), different quality of life (QOL) instruments have been developed. The present systematic review was designated to identify current VPI-related QOL instrument development, validation, and applicability. Methods Pubmed, Cochrane, Embase, Web of Science, and EBSCO databases were searched in January 2022. “Velopharyngeal” or “palatopharyngeal” and “quality of life” or “life quality” were searched in title, abstract, and keywords. This study followed Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Two investigators independently reviewed abstracts and full texts of the identified literature. An established checklist was used to evaluate the measurement properties of each identified instrument. Results A total of 375 articles and 13 instruments were identified, which can be divided into nine types of families according to their development procedures. Developmental and measurement characteristics, evidence of conceptual model, content validity, reliability, construct validity, scoring, interpretation, respondent burden, and presentation for all instruments were shown. Conclusion The patient's self-report assessment and parent-proxy assessment are both valuable. The conclusion that any QOL instrument is absolutely the best for patients with velopharyngeal inadequacy could not be drawn. Understanding the development and characteristics of different QOL instruments, including their reliability, validity, aim, target, language, and resource, should be important before application in clinic or research.
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Affiliation(s)
- Nan Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- *Correspondence: Hanyao Huang
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Alighieri C, Bettens K, Bruneel L, Perry J, Hens G, Van Lierde K. One Size Doesn't Fit All: A Pilot Study Toward Performance-Specific Speech Intervention in Children With a Cleft (Lip and) Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:469-486. [PMID: 35021015 DOI: 10.1044/2021_jslhr-21-00405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Speech-language pathologists usually apply a "one size fits all" approach to eliminate compensatory cleft speech characteristics (CSCs). It is necessary to investigate what intervention works best for a particular patient. This pilot study compared the effectiveness of two therapy approaches (a motor-phonetic approach and a linguistic-phonological approach) on different subtypes of compensatory CSCs in Dutch-speaking children with a cleft (lip and) palate (CP ± L). METHOD Fourteen children with a CP ± L (M age = 7.71 years) were divided into two groups using block randomization stratified by age, gender, and type of compensatory CSC. Six children received intervention to eliminate anterior oral CSCs (n = 3 motor-phonetic intervention, n = 3 linguistic-phonological intervention). Eight children received intervention to eliminate non-oral CSCs (n = 4 motor-phonetic intervention, n = 4 linguistic-phonological intervention). Each child received 10 hr of speech intervention divided over 2 weeks. Perceptual and psychosocial outcome measures were used to determine intervention effects. RESULTS Children who received linguistic-phonological intervention to eliminate anterior oral CSCs had significantly higher correctly produced consonant scores and health-related quality of life (HRQoL) scores compared to children who received motor-phonetic intervention to eliminate anterior oral CSCs. In the group of children who received intervention to eliminate non-oral CSCs, no significant differences were found in the correctly produced consonant scores nor in the HRQoL scores between the two intervention approaches. CONCLUSIONS Linguistic-phonological intervention seems to be more appropriate to eliminate anterior oral CSCs. The beneficial effects of linguistic-phonological intervention were less pronounced in children with non-oral CSCs. Perhaps, children with non-oral CSCs benefit more from a hybrid phonetic-phonological approach. This study is a step forward in the provision of performance-specific intervention in children with a CP ± L. Replication in larger samples is needed and will aid to tailor treatment plans to the needs of our patients.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Jamie Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Greet Hens
- Department of Neurosciences, Katholieke Universiteit Leuven, Belgium
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Sakran KA, Al‐Rokhami RK, Wu M, Chen N, Yin H, Guo C, Wang Y, Alkebsi K, Abotaleb BM, Mohamed AA, Al‐Watary MQ, Shi B, Huang H. Correlation of the Chinese velopharyngeal insufficiency-related quality of life instrument and speech in subjects with cleft palate. Laryngoscope Investig Otolaryngol 2022; 7:180-189. [PMID: 35155796 PMCID: PMC8823188 DOI: 10.1002/lio2.705] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Assessment of the hypothesized correlation between the Chinese Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument and measured speech parameters. METHODS A cross-sectional study was conducted in the Oral Clefts Center of West China Hospital of Stomatology between January 2019 and December 2019. Speech parameters including speech intelligibility deficit, VPI severity, VP gap, and need for speech therapy were evaluated by speech-language pathologists. All patients and their parents completed the VELO instrument. The correlation between aforementioned speech parameters and VELO scores was examined utilizing Spearman correlation coefficients. The reliability of VELO test-retest and parent proxy assessment was estimated utilizing intraclass correlation coefficients (ICC). A receiver operating characteristic curve was used to calculate the cutoff VELO score. RESULTS One hundred and forty patients with their parents were enrolled. The mean age was 12.58 ± 3.72 years. Both parent and youth VELO total and domain scores recorded moderate to strong correlations with all speech parameters (r > -.40, P ˂ .001) except the swallowing domain. Most VELO domain items have shown significant correlations with at least one speech parameter. Moreover, the scales of all speech parameters showed different VELO scores (P ˂ .001). The ICC reported test-retest correlation >.73 in all domains, and parent proxy correlation >.63 in most domains except the emotional and perception domains. The cutoff VELO score was 79.04 in parent version and 85.77 in youth version. CONCLUSIONS The correlations between VELO scores and measured speech parameters have provided evidence for test-retest and parent proxy reliability and criterion and construct validity of the Chinese version of the VELO instrument. A VELO score ≥79.04 (in parent version) or ≥85.77 (in youth version) mostly reflects proper speech-related quality of life. Hence, this instrument could serve as a simple tool to help clinicians understand the social, emotional, and physical influences of VPI.
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Affiliation(s)
- Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | | | - Min Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Nan Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth HospitalSichuan UniversityChengduChina
| | - Heng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Chunli Guo
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Yan Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Khaled Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | - Bassam Mutahar Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | - Abdo Ahmed Mohamed
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
- Department of Oral and Maxillofacial Surgery, Guanghua School of StomatologySun Yat‐sen UniversityGuangzhouChina
| | - Mohammed Qasem Al‐Watary
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
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Parents' perceptions on speech therapy delivery models in children with a cleft palate: A mixed methods study. Int J Pediatr Otorhinolaryngol 2021; 151:110958. [PMID: 34736010 DOI: 10.1016/j.ijporl.2021.110958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study investigated parents' perceptions on two different speech therapy delivery models in children with a CP ± L, namely an innovative high intensity speech intervention (i.e. HISI: 10 1-h sessions divided over 2 weeks) and a low intensity speech intervention (i.e. LISI: 10 1-h sessions divided over 10 weeks). METHOD Twelve parents of 12 children who received HISI (n = 6) or LISI (n = 6) were contacted with the request to participate to this study to review their opinion on the received therapy. Participation included the completion of a questionnaire containing items related to satisfaction, speech progress, intervention intensity and frequency, transfer, and need for further speech therapy. Additionally, semi-structured interviews were carried out. The interviews were analyzed using an inductive thematic approach. RESULTS There were no significant differences between the two groups in satisfaction with the "general speech therapy, "duration of one speech therapy session", "total intervention duration" and "degree of improvement of speech intelligibility". Following HISI, parents perceived more improvement in terms of spontaneous speech and better resolution of the speech disorders. The interviews revealed 3 themes of importance to the parents: (1) treatment-related expectations, (2) treatment-related burden, and (3) patient-therapist relationship. Parents in the HISI group reported two concerns: (1) the lack of variation when receiving daily intervention, and (2) the emotional burden when the child is confronted with his/her speech disorder on a daily basis. CONCLUSIONS Parents were equally satisfied with the provided intervention. Parents in the HISI group perceived more speech progress following the intervention compared to parents in the LISI group. The intensive contact with the speech pathologist enhanced the patient-therapist relationship. To support a cultural shift away from low intensity therapy delivery models, it will be important to counsel and inform parents of the benefits of HISI and to counterbalance concerns.
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Thouvenin B, Soupre V, Caillaud MA, Henry-Mestelan C, Chalouhi C, Houssamo B, Chapuis C, Lind K, Royer A, Vegas N, Amiel J, Couly G, Picard A, Vaivre-Douret L, Abadie V. Quality of life and phonatory and morphological outcomes in cognitively unimpaired adolescents with Pierre Robin sequence: a cross-sectional study of 72 patients. Orphanet J Rare Dis 2021; 16:442. [PMID: 34670591 PMCID: PMC8527704 DOI: 10.1186/s13023-021-02072-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/10/2021] [Indexed: 01/28/2023] Open
Abstract
Background Pierre Robin sequence (PRS) is a heterogeneous condition involving retro(micro)gnathia, glossoptosis and upper airway obstruction, very often with posterior cleft palate. Patients with PRS, either isolated or associated with Stickler syndrome have good intellectual prognosis. Nevertheless, the quality of life in adolescence and the phonatory and morphological outcomes are rarely analysed. We assessed the phonatory and morphological outcomes of 72 cognitively unimpaired adolescents with PRS, studied their oral (COHIP-SF19), vocal (VHI-9i) and generic quality of life (QoL; KIDSCREEN-52), and searched for determinants of these outcomes.
Results Two-thirds of our adolescents retained low or moderate phonation difficulties, but risk factors were not identified. For 14%, morphological results were considered disharmonious, with no link to neonatal retrognathia severity. Only one vs two-stage surgery seemed to affect final aesthetic results. The oral QoL of these adolescents was comparable to that of control patients and was significantly better than that of children with other craniofacial malformations (COHIP-SF19 = 17.5, 15.4 and 25.7, respectively). The oral QoL of the adolescents with non-isolated PRS was significantly worse (COHIP-SF19 = 24.2) than that of control patients and close to that of children with other craniofacial malformations. The vocal QoL of the adolescents (mean [SD] VHI-9i = 7.5 [5.4]) was better than that of patients with other voice pathologies and better when phonation was good. The generic QoL of the adolescents was satisfactory but slightly lower than that of controls, especially in dimensions concerning physical well-being, relationships and autonomy. QoL results were lower for adolescents with non-isolated than isolated PRS. Only non-isolated PRS and low oral QoL affected generic QoL. Conclusion Morphological or phonatory impairments remain non-rare in adolescents with PRS but do not seem to be directly responsible for altered QoL. These adolescents, especially those with non-isolated PRS, show self-confidence and social-relation fragility. We must focus on long-term functional and psychological results for PRS patients and improve therapy protocols and follow-up, notably those affecting the oral aspects of the disease.
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Affiliation(s)
- Béatrice Thouvenin
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Véronique Soupre
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | | | - Charlotte Henry-Mestelan
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France
| | - Christel Chalouhi
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Bachar Houssamo
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | - Cécile Chapuis
- Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | - Katia Lind
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France
| | - Aurélie Royer
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Nancy Vegas
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Imagine Institute, Paris, France
| | - Jeanne Amiel
- Imagine Institute, Paris, France.,Genetics Department, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Gérard Couly
- Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Arnaud Picard
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Laurence Vaivre-Douret
- Imagine Institute, Paris, France.,Paris University, Paris, France.,INSERM Unit 1178, CESP, Paris, France
| | - Véronique Abadie
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France. .,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France. .,Imagine Institute, Paris, France. .,Paris University, Paris, France. .,INSERM Unit 1178, CESP, Paris, France.
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Alighieri C, Van Lierde K, De Caesemaeker AS, Demuynck K, Bruneel L, D'haeseleer E, Bettens K. Is High-Intensity Speech Intervention Better? A Comparison of High-Intensity Intervention Versus Low-Intensity Intervention in Children With a Cleft Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3398-3415. [PMID: 34433000 DOI: 10.1044/2021_jslhr-21-00189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this study was to compare the effect of speech intervention provided with a low intensity with speech intervention provided with a high intensity on the speech and health-related quality of life (HRQoL) in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years. Method A longitudinal, prospective, randomized controlled trial with a multiple baseline design was used. Twelve children with a CP ± L (M age = 8.0 years, SD = 1.54) were divided into two groups using block randomization stratified by age and gender: One group received low-intensity speech intervention (LISI; n = 6) and one group received high-intensity speech intervention (HISI; n = 6). Children in the LISI group received intervention with a session duration of 1 hr, a dose frequency of 1 session per week, and a total intervention duration of 10 weeks. Children in the HISI group received intervention with a session duration of 1 hr, a dose frequency of 5 sessions per week, and a total intervention duration of 2 weeks. The cumulative intervention intensity was kept constant. Both groups received identical therapy programs provided by the same experienced speech therapist. Perceptual speech assessments were performed on baseline and posttreatment data points. Changes in HRQoL were assessed using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) questionnaire. Both groups were compared over time using (generalized) linear mixed models. Results No significant Time × Group interactions were observed for the percentage of correctly produced consonants at the word and sentence levels, indicating no differences in evolution over time among the two groups. The variables speech understandability, speech acceptability, and the total VELO scores significantly improved following HISI, but not following LISI. Conclusions Children in the HISI group made equal and, for some variables, even superior progress in only 2 weeks of therapy compared to children in the LISI group who received 10 weeks of therapy. HISI is a promising strategy to improve speech outcomes and HRQoL in a shorter time period.
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Affiliation(s)
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Ghent University, Belgium
- Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | | | - Kris Demuynck
- Department of Electronics and information systems, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | | | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
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Lu L, Yakupu A, Wu Y, Li X, Zhang P, Aihaiti G, Xu H. Quality of Life in Patients With Velopharyngeal Insufficiency in West China. Cleft Palate Craniofac J 2021; 59:1024-1029. [PMID: 34460333 DOI: 10.1177/10556656211034107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the quality of life (QOL) of patients with cleft lip and palate and velopharyngeal insufficiency (VPI) in relation to sex, age, age at initial cleft lip surgery, and age at initial cleft palate surgery. DESIGN This is a cross-sectional study. SETTING The study was conducted in a tertiary medical center. PARTICIPANTS The participants were caregivers of 72 patients with cleft lip and palate and VPI aged 4 to 20 years. MAIN OUTCOME MEASURE(S) Participants completed the Chinese version of the caregiver report of the VPI Effects on Life Outcomes (VELO) questionnaire. The Mann-Whitney U test was used to evaluate the patients' sex, age, age at initial cleft lip repair, and age at initial cleft palate repair in relation to VELO total score and domains. Spearman correlation analysis was completed including all study variables. Associations between the study variables and the VELO total score were tested using a generalized linear mixed model. RESULTS In the univariate analysis, patients' age and age at initial cleft palate surgery influenced the QOL of patients with VPI. There were no differences in the VELO total score or domains based on sex or age at first cleft lip surgery. In the generalized linear mixed model, patients older than 8 years had higher VELO total scores. CONCLUSIONS By caregiver report, the QOL of patients under age 8 years with VPI was lower than older patients. In addition, the caregiver impact domain was higher for parents of children who had their initial cleft palate surgery at age 2 years or younger.
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Affiliation(s)
- Lidan Lu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Aipiziguli Yakupu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Yanhui Wu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Xiangnan Li
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Pengxin Zhang
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Guliziba Aihaiti
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Hui Xu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Stomatology School of Xinjiang Medical University, Urumqi, China
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Birch AL, Jordan ZV, Ferguson LM, Kelly CB, Boorman JG. Speech Outcomes Following Orticochea Pharyngoplasty in Patients With History of Cleft Palate and Noncleft Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2021; 59:277-290. [PMID: 34085559 DOI: 10.1177/10556656211010623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report speech outcomes following Orticochea pharyngoplasty in 43 patients with cleft palate and noncleft velopharyngeal dysfunction. DESIGN A retrospective surgical audit of patients undergoing Orticochea pharyngoplasty between 2004 and 2012, with speech as a primary outcome measure. SETTING Patients known to a regional UK cleft center. METHODS Forty-three patients underwent Orticochea pharyngoplasty by a single surgeon in a UK regional cleft center. Twenty-one patients had undergone a prior procedure for velopharyngeal dysfunction. Pre- and postoperative speech samples were assessed blindly using the Cleft Audit Protocol for Speech-Augmented by a specialist cleft speech and language therapist, external to the team. Speech samples were rated on the following parameters: hypernasality, hyponasality, audible nasal emission, nasal, turbulence, and passive cleft speech characteristics. Statistical differences in pre- and postoperative speech scores were tested using the Wilcoxon matched-pairs signed-ranks test. Inter- and intrareliability scores were calculated using weighted Cohen κ. RESULTS Whole group: A statistically significant difference in pre- and postoperative scores for hypernasality (P < .001), hyponasality (P < .05), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported. Patients with cleft diagnoses: A statistically significant difference in scores for hypernasality (P < .001), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported for this group of patients. Patients with noncleft diagnoses: The only parameter to demonstrate a statistically significant difference was hypernasality (P < .01) in this group. CONCLUSIONS Orticochea pharyngoplasty is a successful surgical procedure in treating velopharyngeal dysfunction in both the cleft and noncleft populations.
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Affiliation(s)
- Alison L Birch
- South Thames Cleft Service, Evelina London, 8945Guys and St Thomas' NHS Foundation Trust, Northern Ireland, United Kingdom
| | - Zoe V Jordan
- South Thames Cleft Service, Evelina London, 8945Guys and St Thomas' NHS Foundation Trust, Northern Ireland, United Kingdom
| | - Louisa M Ferguson
- South Thames Cleft Service, Evelina London, 8945Guys and St Thomas' NHS Foundation Trust, Northern Ireland, United Kingdom
| | - Clare B Kelly
- Department of Women and Children's Health, 4616Kings College London, Northern Ireland, United Kingdom
| | - John G Boorman
- South Thames Cleft Service, Evelina London, 8945Guys and St Thomas' NHS Foundation Trust, Northern Ireland, United Kingdom
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Stiernman M, Klintö K, Persson M, Becker M. Comparison of Corresponding Scores From the Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q in Swedish Patients With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2021; 58:736-745. [PMID: 33047614 PMCID: PMC8165751 DOI: 10.1177/1055665620964124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to compare corresponding scores between 2 existing cleft-specific patient-reported outcome measures (PROMs)-Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q. The second aim of the study was to investigate patient opinion on the 2 PROMs. DESIGN Cross-sectional questionnaire study. SETTING Participants were recruited from a University Hospital. They answered CHASQ and CLEFT-Q either in the hospital or at home. PARTICIPANTS Thirty-three participants with cleft lip and/or palate, aged 10 to 19 years. MAIN OUTCOME MEASURE CHASQ and CLEFT-Q. RESULTS The CHASQ scores and the corresponding CLEFT-Q scores on appearance correlated significantly. Corresponding scores regarding speech did not correlate significantly. A majority, 15 (58%) participants, answered that they liked CLEFT-Q more than CHASQ, 18 participants (69%) thought CHASQ was easier to complete, and 19 (76%) thought CLEFT-Q would better inform health care professionals. CONCLUSION Both instruments showed strengths and limitations. Clinicians will have to consider each instrument's respective qualities when choosing to implement either PROM.
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Affiliation(s)
- Mia Stiernman
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Kristina Klintö
- Department of Clinical Sciences in Malmö, Lund University, Sweden
- Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
| | - Martin Persson
- Department of Health and Society, Kristianstad University, Sweden
| | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
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Willis J, Zeratkaar D, Ten Hove J, Rosenbaum P, Ronen GM. Engaging the Voices of Children: A Scoping Review of How Children and Adolescents Are Involved in the Development of Quality-of-Life-Related Measures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:556-567. [PMID: 33840434 DOI: 10.1016/j.jval.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Patient-reported outcomes are increasingly recommended to guide patient care, develop and evaluate interventions, and modify health systems. However, not enough is known about whether and how children and adolescents, as "experts" in their own health and quality of life (QoL), are being engaged in the development of instruments. Our goals in this review were (1) to identify all QoL-related instruments that have included children and/or adolescents in the development of questionnaire content, including identification of themes and items; and (2) to report how this was done; and (3) to highlight those that used qualitative methods. METHODS MEDLINE and Embase were searched for child- or adolescent-completed QoL-related instruments, supplemented by hand-searching of relevant reviews until 2020. Original development papers were identified and retrieved when possible, from which instrument characteristics and details of qualitative development methods were extracted. RESULTS We identified 445 instruments, of which 88 used qualitative methods for content development. Interviews and focus groups were the most common methods. A variety of play techniques were used to engage the child and adolescent participants. The specific criteria for the inclusion of children and adolescents (age, developmental stage, duration, and nonclinical location) varied considerably. CONCLUSIONS Researchers frequently involve children and adolescents in qualitative methods when developing QoL-related measures; however, there is little information about the methods used. Better reporting of methodology, improved dissemination of methods guidelines, and research into optimal ways of including children and adolescents in the process of instrument development would be useful.
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Affiliation(s)
- Jessica Willis
- Department of Pediatrics, Western University, London, Ontario, Canada.
| | - Dena Zeratkaar
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Julia Ten Hove
- University of Waterloo, Department of Kinesiology, Warerloo, Ontario, Canada.
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Fuller C, Brown K, Speed O, Gardner J, Thomason A, Dornhoffer J, Johnson AB, Hartzell L. Impact of Surgery for Velopharyngeal Insufficiency on Eustachian Tube Function in Children: Pharyngeal Flap Versus Sphincter Pharyngoplasty. Cleft Palate Craniofac J 2021; 58:1473-1481. [PMID: 33678034 DOI: 10.1177/1055665621991740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Velopharyngeal insufficiency (VPI) is a common speech disorder in patients with a history of cleft palate (CP) or 22q11.2 deletion syndrome. Pharyngeal flap (PF) and sphincter pharyngoplasty (SP) are 2 common surgeries to treat this disorder by decreasing unwanted nasal air emission and hypernasal resonance. Because Eustachian tube dysfunction (ETD) in patients with CP may be more frequent after surgery for VPI, we examined whether ETD was associated with either type of surgery. DESIGN Retrospective cohort study. SETTING Children's hospital-based tertiary referral center. PATIENTS A total of 225 children with VPI who underwent primary PF (201) or SP (24) between 2006 and 2017. OUTCOME MEASURES We examined differences in risk of ETD according to both surgical groups and proxies for postoperative nasal obstruction. These proxies included postoperative resonance measures and development of obstructive sleep apnea (OSA). RESULTS Both surgical groups had similar preoperative measures, except the PF group had higher hypernasality by PSA. Postoperatively, the PF group demonstrated lower hypernasal resonance by nasometry and PSA. There were no differences between PF and SP groups with regard to ETD. Proxies for postoperative nasal obstruction also were not predictive of postoperative ETD. Degree of CP and younger age were found to be risk factors for ETD. CONCLUSION There was no significant difference in the effects of PF and SP on ETD in this study. Neither lower hypernasality nor incidence of OSA had any impact on ETD. Degree of CP and younger age were the only significant risk factors for ETD that this study identified.
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Affiliation(s)
- Colin Fuller
- Department of Otolaryngology, Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Division of Pediatric Otolaryngology, 14423Arkansas Children's Hospital, Little Rock, AR, USA
| | - Kesley Brown
- Department of Otolaryngology, Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Olivia Speed
- Department of Otolaryngology, Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James Gardner
- Department of Otolaryngology, Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ashlen Thomason
- Division of Pediatric Otolaryngology, 14423Arkansas Children's Hospital, Little Rock, AR, USA
| | - John Dornhoffer
- 12215University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA
| | - Adam B Johnson
- Division of Pediatric Otolaryngology, 14423Arkansas Children's Hospital, Little Rock, AR, USA
| | - Larry Hartzell
- Department of Audiology and Speech-Language Pathology, 14423Arkansas Children's Hospital, Little Rock, AR, USA
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Alighieri C, Bettens K, Bruneel L, D'haeseleer E, Van Gaever E, Van Lierde K. Effectiveness of Speech Intervention in Patients With a Cleft Palate: Comparison of Motor-Phonetic Versus Linguistic-Phonological Speech Approaches. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3909-3933. [PMID: 33253622 DOI: 10.1044/2020_jslhr-20-00129] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this study was to compare the effect of two different speech therapy approaches, a traditional motor-phonetic approach and a linguistic-phonological approach, on the speech and health-related quality of life in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years old. Method A block-randomized, sham-controlled design was used. Fourteen children with a CP ± L (M age = 7.71 years) were divided into two groups using block randomization stratified by age and gender: one receiving motor-phonetic intervention (n = 7) and one receiving linguistic-phonological intervention (n = 7). Each group received 10 hr of speech therapy divided over 2 weeks. Perceptual speech assessments were performed on several baseline and posttreatment data points. The psychosocial effects of the intervention were assessed using the patient-reported Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire. Both groups were compared over time using (generalized) linear mixed models. Within-group effects of time were determined using pairwise comparisons with post hoc Bonferroni correction. Results Significant Time × Group interactions with large effect sizes were revealed in terms of consonant proficiency, indicating significant differences in evolution over time among the two groups. Only in the group receiving linguistic-phonological intervention, percentage of correctly produced consonants and places significantly improved after the treatment. Total Velopharyngeal Insufficiency Effects on Life Outcomes scores of the parents significantly improved in both groups after the intervention. Conclusions Both motor-phonetic and linguistic-phonological speech interventions can have a positive impact on the occurrence of cleft speech characteristics and consonant proficiency in children with a CP ± L. A linguistic-phonological approach, however, was observed to be more effective in terms of improving these speech outcomes compared with a motor-phonetic approach. Speech intervention, irrespective of the used approach, significantly improved the participant's health-related quality of life.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | | | - Ellen Van Gaever
- Department of Rehabilitation Sciences, Ghent University, Belgium
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Ecuadorian Spanish translation and validation of the VELO quality of life instrument. Int J Pediatr Otorhinolaryngol 2020; 138:110312. [PMID: 32882600 PMCID: PMC7649090 DOI: 10.1016/j.ijporl.2020.110312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Adapt the Spanish translation of VPI Effects on Life Outcome (VELO) instrument into Ecuadorian Spanish; test the resulting instrument for reliability and validity. METHODS A cross-sectional, prospective design, set at a humanitarian mission within a community hospital. Linguistic validation: native Ecuadorian-Spanish speakers modified the Spanish VELO to Ecuadorian Spanish. Cognitive interviews were conducted with children with cleft palate (CP) and their parents (n = 50), guiding instrument modifications. An expert panel reviewed changes, resulting in the VELO-Ecuadorian dialect (VELO-Ec). INSTRUMENT ASSESSMENT 88 participants with CP (88 parents, 46 children) and 33 non-cleft controls (33 adult, 11 children) completed the VELO-Ec, Spanish-Pediatric Voice Handicap Index (pVHI), and Spanish-Intelligibility in Context Scale (ICS). Internal consistency was assessed with Cronbach's alpha; test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC); standard error of measurement (SEM) was calculated. Concurrent validity was assessed with Pearson correlations of VELO-Ec with pVHI and ICS. Discriminant validity assessment used an established ICS cutoff. Construct validity was assessed by grouping patients by parent report of hypernasality and early vs. late cleft repair (>24 months) using the Wilcoxon Rank-Sum test. RESULTS VELO-Ec showed excellent internal consistency (alpha 0.96) and test-retest reliability (ICC = 0.85, 95% CI 0.68-0.93, SEM 5.71). It had strong concurrent validity, correlating with ICS (r = 0.75, p < 0.001) and pVHI (r = -0.79, p < 0.001). Discriminant validity was strong with better VELO-Ec scores among subjects with normal vs. abnormal ICS score (median 95 & 61, p < 0.001). Strong construct validity was identified: those with parent-reported hypernasality had worse VELO-Ec scores than those without (median 59 & 75, p < 0.001). Those with repair before or after 24 months had similar VELO-Ec scores (p = 0.882). CONCLUSION The VELO-Ec is a valid and reliable measure of VPI-related quality of life, useful to clinicians and researchers treating Ecuadorian CP patients, especially in areas with limited resources such as on humanitarian missions.
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Pedersen HM, Goodie PA, Braden MN, Thibeault SL. Comparing Quality of Life and Perceptual Speech Ratings in Children With Cleft Palate. Cleft Palate Craniofac J 2020; 58:139-145. [PMID: 32799664 DOI: 10.1177/1055665620949435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To delineate the relationship between patient and parent-reported quality of life (QOL) ratings and perceptual characteristics of speech assigned by a speech-language pathologist (SLP) in children with repaired cleft palate. DESIGN Prospective. SETTING Academic Children's Hospital. PARTICIPANTS This population-based sample included children, aged 3 to 18 with a history of repaired cleft palate, and their parents. INTERVENTION Participants completed the Velopharyngeal Insufficiency Effects on Life Outcomes Questionnaire (VELO). Children's speech was judged perceptually by an expert SLP using the Pittsburgh Weighted Speech Scale (PWSS). MAIN OUTCOME MEASURE(S) Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire assessed participant and parent perceptions of impact of velopharyngeal function on QOL. Pittsburgh Weighted Speech Scale assessed nasal emissions, facial grimacing, nasality, quality of phonation, and articulation. RESULTS Enrollment included 48 participant parent dyads. Overall, participants reported high QOL scores within the 95% CI with children reporting slightly better yet not significantly different QOL (86.27 ± 8.96) compared to their parents (81.81 ± 15.2). Children received an average score of 1.38 ± 1.96 on the PWSS corresponding to borderline velopharyngeal competence. A significant moderate negative correlation was found between PWSS total score and parent VELO total score (r = -0.51103, P = .0002). Mild-moderate significant negative correlations were measured between PWSS total and the 5 subscales of the VELO. No significant correlations were measured between PWSS and child VELO total responses or between total scores and subscales. CONCLUSIONS Results suggest that as perceptual analysis of speech improves, overall QOL improves moderately.
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Affiliation(s)
- Hailey M Pedersen
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
| | - Paige A Goodie
- Department of Otolaryngology, 5718Vanderbilt University, Nashville, TN, USA
| | - Maia N Braden
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
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Paulsgrove K, Miller E, Seidel K, Kinter S, Tse R. Crowdsourcing to Assess Speech Quality Associated With Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2020; 58:25-34. [PMID: 32806948 DOI: 10.1177/1055665620948770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess crowdsourced responses in the evaluation of speech outcomes in children with velopharyngeal dysfunction (VPD). DESIGN Fifty deidentified speech samples were compiled. Multiple pairwise comparisons obtained by crowdsourcing were used to produce a rank order of speech quality. Ratings of overall and specific speech characteristics were also collected. Twelve speech-language pathologists (SLPs) who specialize in VPD were asked to complete the same tasks. Crowds and experts completed each task on 2 separate occasions at least 1 week apart. SETTING On-line crowdsourcing platform. PARTICIPANTS Crowdsource raters were anonymous and at least 18 years of age, North American English speakers with self-reported normal hearing. Speech-language pathologists were recruited from multiple cleft/craniofacial teams. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Correlation of repeated assessments and comparison of crowd and SLP assessments. RESULTS We obtained 6331 lay person assessments that met inclusion criteria via crowdsourcing within 8 hours. The crowds provided reproducible Elo rankings of speech quality, ρ(48) = .89; P <.0001, and consistent ratings of intelligibility and acceptability (intraclass correlation coefficient [ICC] = .87 and .92) on repeated assessments. There was a significant correlation of those crowd rankings, ρ(10) = .86; P = .0003, and ratings (ICC = .75 and .79) with those of SLPs. The correlation of more specific speech characteristics by the crowds and SLPs was moderate to weak (ICC < 0.65). CONCLUSIONS Crowdsourcing shows promise as a rapid way to obtain large numbers of speech assessments. Reliability of repeated assessments was acceptable. Large groups of naive raters yield comparable evaluations of overall speech acceptability, intelligibility, and quality, but are not consistent with expert raters for specific speech characteristics such as resonance and nasal air emission.
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Affiliation(s)
- Kaylee Paulsgrove
- Speech & Language Services, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Erin Miller
- Division of Plastic Surgery, Department of Surgery, 21617University of Washington, Seattle, WA, USA
| | - Kristy Seidel
- CSATS Inc, A Division of Johnson & Johnson, Seattle, WA, USA
| | - Sara Kinter
- Speech & Language Services, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Raymond Tse
- Division of Plastic Surgery, Department of Surgery, 21617University of Washington, Seattle, WA, USA.,Division of Craniofacial and Plastic Surgery, Department of Surgery, 7274Seattle Children's Hospital, Seattle, WA, USA
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Alighieri C, Kissel I, D'haeseleer E, Bruneel L, Bettens K, Sseremba D, Pype P, Van Lierde K. A cleft care workshop for speech and language pathologists in resource-limited countries: The participants' experiences about cleft care in Uganda and satisfaction with the training effect. Int J Pediatr Otorhinolaryngol 2020; 134:110052. [PMID: 32361255 DOI: 10.1016/j.ijporl.2020.110052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES workshops and specialized training programs are often inaccessible for speech and language pathologists (SLPs) based in resource-limited countries given the lack of supply, the long travel distances and the excessive participation fees. To stimulate life-long learning opportunities for all, this study described and measured the effect of a free, two-day cleft care workshop for SLPs in Uganda. The workshop included different topics related to the assessment and treatment of children with a cleft of the palate with or without a cleft of the lip (CP ± L). METHODS The participants who presented during the two-day course were asked to complete a pre- and post-workshop questionnaire to evaluate their satisfaction. The pre-workshop form also included some questions concerning cleft care in Uganda. Both the pre- and post-workshop forms included three visual analogue scales to investigate the evolution of the participants' estimation of their knowledge regarding speech in patients with a CP ± L and to assess the changes in their self-confidence in the diagnosis and treatment of this population. RESULTS seventeen SLPs completed the pre- and post-workshop questionnaires. In general, the participants were highly satisfied with the different themes covered in the program. After the training course, the participants rated their general knowledge about CP ± L and their self-confidence in the diagnosis and treatment of children with a CP ± L significantly higher than before the workshop. CONCLUSION the vast majority of the SLPs reported that cleft care was not easily accessible in Uganda. The most commonly reported obstacle for cleft care was a lack of knowledge about this matter in the SLPs themselves highlighting the importance of the organization of additional education opportunities. The participants reported a significantly higher level of self-confidence in diagnosing and treating children with a CP ± L after the workshop. The content of this workshop can form the basis for future learning opportunities for SLPs based in resource-limited countries.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium.
| | - Imke Kissel
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Daniel Sseremba
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Road Hillcrest, Pretoria, South Africa
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Brazilian-Portuguese Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcome Instrument. J Craniofac Surg 2020; 30:2308-2312. [PMID: 31233001 DOI: 10.1097/scs.0000000000005679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to conduct a linguistic validation of the velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for use in Brazilian-Portuguese patients with VPI. METHODS The original English version of the VELO instrument was translated into Brazilian-Portuguese, back-translated, and adapted among the Brazilian patients (n = 21) with VPI and their parents, based on the standardized guidelines for the cross-culture adaption process. Discrepancies in the forward and backward translation steps were computed. Comprehension rates were captured for each debriefing interview. The content validity index (CVI) per item (I-CVI) and of the scale (S-CVI universal agreement [S-CVI/UA] and averaging [S-CVI/Ave]) were calculated. RESULTS Reconciliation of the 2 forward translations and the comparison between the back translation and the original VELO version resulted in some item wordings with discrepancies which were reviewed by the research team (translators, expert committee, and original developers of instrument). Three rounds of cognitive interviews also led to some revisions of wording. Comprehension rates of patients and their parents were 60% to 100%, 80% to 100%, and 100% in the first, second, and third rounds of cognitive interviews, respectively. The I-CVI, S-CVI/AU, and SCI/Ave for the Brazilian-Portuguese VELO version were 0.83 (or higher), 0.83 (or higher), and 0.97, respectively. CONCLUSIONS The linguistic validation process of the VELO instrument created a cross-culturally equivalent Brazilian-Portuguese version for use in Brazilian-Portuguese speaking patients with VPI.
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Li L, Strum D, Larson S, Preciado D. Quality of life outcomes following velopharyngeal insufficiency surgery. Int J Pediatr Otorhinolaryngol 2019; 127:109643. [PMID: 31442731 DOI: 10.1016/j.ijporl.2019.109643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Velopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life. METHODS This study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing children's hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their child's quality of life post-VPI surgery. RESULTS Twenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores. CONCLUSION Children who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.
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Affiliation(s)
- Lilun Li
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - David Strum
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - Stephen Larson
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA
| | - Diego Preciado
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA.
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Santillana R, Skirko J, Roth C, Tollefson TT. Spanish Linguistic Validation for the Velopharyngeal Insufficiency Effects on Life Outcomes. JAMA FACIAL PLAST SU 2019. [PMID: 29522150 DOI: 10.1001/jamafacial.2018.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rosario Santillana
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Jonathan Skirko
- Department of Otolaryngology, University of Utah, Salt Lake City
| | - Christina Roth
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
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Bruneel L, Alighieri C, Bettens K, Musasizi D, Ojok I, D'haeseleer E, Van Lierde K. Assessing health-related quality of life in patients with cleft palate in resource-limited countries: A preliminary evaluation of the VELO questionnaire in Uganda. Int J Pediatr Otorhinolaryngol 2019; 124:39-46. [PMID: 31158570 DOI: 10.1016/j.ijporl.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Studies evaluating health-related quality of life (HRQoL) in patients with cleft palate living in resource-limited countries such as Uganda are scarce. The VELO questionnaire evaluates the impact of speech (and swallowing) difficulties on the patient's HRQoL. The aim was to evaluate an adapted English version of the VELO questionnaire with reduced response options in Ugandan patients with a cleft lip and palate in order to identify influencing factors and future perspectives to implement HRQoL assessement in this population. METHODS Based on the responses of 16 parents of patients with cleft palate, 6 adolescent/adult patients with cleft palate and 12 control participants without cleft palate, observations regarding linguistic and cultural difficulties were noted and the discriminant validity and internal consistency of this adapted version of the questionnaire were evaluated. Additionally, the relationship between these responses and perceptually assessed speech parameters was assessed. RESULTS Half of the participants (11/22) completed the questionnaire independently, frequently resulting in incomplete responses (8/11). Difficulties with wording and cultural aspects influencing the responses were identified. The subscales showed excellent internal consistency, with the exception of the subscale 'swallowing problems'. The score on the subscale 'perception by others' of the parent report showed no significant difference with the score of the control group. The total score on the parent report and the youth report was (borderline) significantly related to the speech variables speech understandability, speech acceptability and the VPC-SUM. DISCUSSION AND CONCLUSION Promising results regarding the validity and internal consistency of the adapted instrument were found, indicating the potential of the VELO questionnaire for HRQoL assessment at the CoRSU hospital in Uganda. However, results should be interpreted cautiously, given that all participants had a primary language other than English, the small sample size with skewed distribution of speech characteristics, and the bias induced by socially desirable responses. In future studies, adaptations based on qualitative research to account for linguistic and cultural aspects, followed by a rigorous forward-backward translation of the questionnaire to English and Luganda are needed.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium.
| | - Cassandra Alighieri
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Duncan Musasizi
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Isaac Ojok
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Evelien D'haeseleer
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
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Egger-Rainer A, Lorenzl S, Trinka E. Considerations in preparing a multicenter study: Lessons learned from the Epilepsy Monitoring Unit Comfort Questionnaire (EMUCQ) validation feasibility study. Epilepsy Behav 2019; 98:53-58. [PMID: 31299533 DOI: 10.1016/j.yebeh.2019.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE It is recommended to perform a pilot testing before conducting a validation study of a novel questionnaire. Pilot studies may serve different purposes. The aim of this study was to assess the feasibility of a multicenter validation study, to recruit additional study centers, and to undertake orientating descriptive item analysis of the 44-item Epilepsy Monitoring Unit (EMU) Comfort Questionnaire (EMUCQ). METHODS During a six-month sampling period, the EMUCQ was administered to eligible EMU patients. The patients filled out the questionnaire at two time points. Additional centers were recruited in Germany and Austria, and ethics votes obtained. In descriptive item analysis central tendency, variability, item distribution and item difficulty were calculated. RESULTS A total of 44 EMU patients participated in the study. Eight additional EMUs agreed to join the planned validation study. Recruitment of the centers took four months. Another six months passed to obtain all the ethics votes. Floor and ceiling effects could be detected in 32 items. One item with the lowest median showed the low item difficulty. Another five items showed medians with the height of 6. In four items, high difficulty indices could be observed. CONCLUSION A good network has turned out to be very helpful while planning a multicenter study. Enough time must be scheduled, because obtaining an ethics vote may take quite a long time. No conclusive statements regarding item properties could be made as this was a feasibility study.
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Affiliation(s)
- Andrea Egger-Rainer
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria; Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
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Denadai R, Raposo-Amaral CE, Sabbag A, Ribeiro RA, Buzzo CL, Raposo-Amaral CA, Hung M, Skirko JR. Measuring Patient-Reported Health-Related Quality of Life in Velopharyngeal Insufficiency: Reliability and Validity of the Brazilian Portuguese Version of the VELO Instrument. Cleft Palate Craniofac J 2019; 56:1195-1205. [PMID: 31079479 DOI: 10.1177/1055665619846763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To test the Brazilian Portuguese velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for reliability and validity. DESIGN Cross-sectional methodological study. SETTING Tertiary craniofacial medical center. PARTICIPANTS Participants with VPI (VPI group, n = 60), with cleft and without VPI (no VPI/cleft group, n = 60), and with no cleft nor VPI (no VPI/no cleft group, n = 60) and their parents (n = 180). INTERVENTIONS All patients with VPI 8+ years old and their parents completed the Brazilian-Portuguese VELO instrument and other questionnaires (Pediatric Quality of Life Inventory4.0, PedsQL4.0; Pediatric Voice-Related Quality of Life, PVRQOL; and Intelligibility in Context Scale, ICS) at baseline; patients with VPI and their parents completed the VELO instrument again 2 weeks later. MAIN OUTCOME MEASURES The VELO instrument was tested for internal consistency, test-retest reliability, discriminant validity (participants with VPI against participants with no VPI), concurrent validity against other questionnaires, criterion validity against hypernasality severity, and construct validity against nasal air emission and overall velopharyngeal competence (speech construct) and velopharyngeal gap (anatomic construct). RESULTS The VELO had excellent internal consistency (Cronbach α 0.99 for parents and 0.98 for participants with VPI) and test-retest reliability (all intraclass correlation coefficient > 0.87). The VELO discriminated well between VPI group and unaffected groups (all P < .05). The VELO was significantly correlated with the PedsQL4.0, PVRQOL, and ICS (-r > 0.75; P < .001). The VELO met criterion validity, speech construct validity, and anatomic construct validity (r > 0.7; P < .001). CONCLUSIONS The Brazilian-Portuguese VELO instrument demonstrated reliability (internal consistency and test-retest) and validity (discriminant, concurrent, criterion, and construct).
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Affiliation(s)
- Rafael Denadai
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Anelise Sabbag
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Rafael Andrade Ribeiro
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Celso Luiz Buzzo
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Man Hung
- 2 College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA.,3 Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA
| | - Jonathan R Skirko
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Greenberg M, Caloway C, Hersh C, Ryan D, Goldenberg P, Hartnick C. Pharyngeal flap using carotid artery mobilization in 22q11.2 deletion syndrome with velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol 2019; 120:130-133. [PMID: 30784809 DOI: 10.1016/j.ijporl.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION 22q11.2 deletion syndrome is the most common microdeletion syndrome in children. Many patients with this disease develop craniofacial defects including cleft palate, bifid uvula, and velopharyngeal insufficiency. Our study adds to the current body of literature by describing a novel technique of carotid mobilization performed in conjunction with pharyngeal flap surgery in patients with extensive medialization of the carotid artery. METHODS Carotid artery mobilization followed by insertion of a superiorly based pharyngeal flap was performed on two patients, a 10-year-old girl and a 5-year-old boy, with 22q11.2 deletion syndrome concurrent with velopharyngeal insufficiency. RESULTS Neither patient experienced significant post-operative issues. Following the procedure, parents of both patients noted significant speech and voice improvement. Both patients had improvements in VPI Effects On Life Outcome (VELO) scores, nasometry, and production of paragraph passages following surgery. CONCLUSIONS Our study describes a novel surgical treatment for children with 22q11.2 deletion syndrome with significant velopharyngeal insufficiency (VPI). The procedure wherein is characterized by an extensive mobilization of the carotid artery followed by implantation of a pharyngeal flap. This technique resulted in no significant intra-operative bleeding, and was measured to be successful as noted by nasometry scores and changes in pre- and post-op VELO scores.
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Affiliation(s)
- Max Greenberg
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Christen Caloway
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Cheryl Hersh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel Ryan
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Paula Goldenberg
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
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Bruneel L, Bettens K, Van Lierde K. The relationship between health-related quality of life and speech in patients with cleft palate. Int J Pediatr Otorhinolaryngol 2019; 120:112-117. [PMID: 30776568 DOI: 10.1016/j.ijporl.2019.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire. MATERIALS AND METHODS Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Belgian Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients. RESULTS Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (rs = -0.476), speech understandability (rs = -0.657), passive CSC's (rs = -0.654), speech acceptability (rs = -0.591) and the need for C(L)P-related speech therapy (rs = -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire. DISCUSSION AND CONCLUSION Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium.
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium; University of Pretoria, Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria, South Africa
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Health-related quality of life in patients with cleft palate: Reproducibility, responsiveness and construct validity of the Dutch version of the VELO questionnaire. Int J Pediatr Otorhinolaryngol 2019; 119:141-146. [PMID: 30708181 DOI: 10.1016/j.ijporl.2019.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/13/2018] [Accepted: 01/19/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Recently, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire, which evaluates the impact of speech and swallowing difficulties on health-related quality of life (HRQoL) in patients with VPI (Skirko et al., 2012), was translated to Dutch (Bruneel et al., 2017). The purpose of this study was to evaluate the reproducibility, responsiveness and construct validity of this Dutch version of the questionnaire. METHODS To evaluate the reproducibility, 50 parents and 14 children with cleft palate re-completed the questionnaire after two weeks. Thirty-five parents and 8 children with cleft palate completed the VELO questionnaire after one year for the evaluation of the responsiveness. The correlation between age and the VELO questionnaire (construct validity), and the internal consistency (Cronbach's α) were re-determined based on the responses of 73 parents and 24 children. RESULTS Based on descriptive statistics, results of the Wilcoxon signed rank-test, and the absolute (SEM) and relative (ICC) consistency, the questionnaire showed good reproducibility. VELO scores did not significantly differ after one year, neither when performing separate analyses for the intervention (speech therapy) and the non-intervention group. Correlations indicated higher HRQoL, as perceived by the parents, with increasing age. The reverse was the case for the youth report. Cronbach's α showed excellent internal consistency for both reports. CONCLUSIONS The VELO questionnaire showed good reproducibility and internal consistency. Moreover, results reconfirmed the age effect on VELO scores. To understand the implications of the results regarding the questionnaire's responsiveness, future research should focus on the identification of factors influencing the patient's evolution in HRQoL.
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Huang H, Chen N, Yin H, Skirko JR, Guo C, Ha P, Li J, Shi B. Validation of the Chinese Velopharyngeal Insufficiency Effects on Life Outcomes Instrument. Laryngoscope 2019; 129:E395-E401. [PMID: 30671957 DOI: 10.1002/lary.27792] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Nan Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children and Office of Educational AdministrationWest China Second University Hospital, Sichuan University Chengdu China
| | - Heng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Jonathan R. Skirko
- Pediatric Otolaryngology (ENT) and Pediatric Facial Plastic SurgeryUniversity of Utah and Primary Children's Medical Center Salt Lake City Utah U.S.A
| | - Chunli Guo
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Pin Ha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
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Spanish Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcomes: VELO-Spanish. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1986. [PMID: 30881793 PMCID: PMC6414130 DOI: 10.1097/gox.0000000000001986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/05/2018] [Indexed: 11/26/2022]
Abstract
Background: Quality of life (QOL) assessments are useful tools that measure a patient’s health status and monitor patient-reported outcome measures. This study highlights the process of linguistic validation of a QOL assessment to serve Spanish-speaking families and ultimately help decrease language barriers in the treatment of velopharyngeal insufficiency (VPI). Methods: The standardized linguistic validation process included forward and backward translation, reconciliation, and cognitive interviews with patients and families. Preliminary instrument test-retest measurement was assessed. Eligibility for cognitive interviews included families with familiarity of velopharyngeal insufficiency. Exclusion criteria included illiteracy and parent and child respondents who do not speak Spanish. Reliability was tested by intraclass correlation (ICC) on VPI Effects on Life Outcomes (VELO)–Spanish instruments completion on 2 measurements from the medical record. Results: The instrument was optimized through a standardized forward and backward translation process. Further problematic language was identified during cognitive interviews with families and their children. In the second interview, only minimal changes were needed. Twenty-one patients (8 males and 13 females) were included. Mean (SD) age was 8.0 (5.3) years (range, 3–21 years). The mean (SD) Velo-Spanish score was 65 (22.1); range 32.7–100. The VELO-Spanish instrument demonstrated excellent test–retest reliability [ICC = 0.91; n = 21 and internal consistency (α = 0.96)]. Conclusions: The Spanish VELO has been developed and refined for use in Spanish-speaking populations as a VPI-specific QOL instrument. The linguistic validation process including cognitive interviews and initial reliability testing. The instrument may improve the understanding of patient-reported outcomes and potential disparities from linguistic and cultural barriers in VPI treatment
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de Blacam C, Smith S, Orr D. Surgery for Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2017; 55:405-422. [DOI: 10.1177/1055665617735102] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This systematic review sought to evaluate the consensus in the literature regarding the surgical management of VPD and to determine whether a particular procedure results in superior speech outcome or less morbidity Design: A systematic review was carried out according to PRISMA-P guidelines. Systematic review software was used to facilitate 3-stage screening and data extraction by 2 reviewers. Setting: University teaching hospital. Patients, Participants: Studies that reported perceptual speech assessment or obstructive sleep apnea (OSA) in patients who had undergone surgery for VPD were included in the review. Interventions: Four categories of surgery for VPD were examined—pharyngeal flap, sphincter pharyngoplasty, palatoplasty, and posterior pharyngeal wall augmentation. Main outcome measures: Perceptual speech assessment, need for further surgery, and occurrence of OSA were the outcomes of interest. Results: Eighty-three relevant studies were identified, comprising data on 4011 patients. Pharyngeal flap was the most common procedure (64% of patients). Overall, 70.7% of patients attained normal resonance and 65.3% attained normal nasal emission. There was no notable difference in speech outcomes, need for further surgery, or occurrence of OSA across the 4 categories of surgery examined. Heterogeneous groups of patients were reported upon and a variety of perceptual speech assessment scales were used. Conclusions: There is a lack of consensus in the literature to guide procedure selection for patients with VPD. The development of a standardized minimum data set to record postoperative speech, OSA, and patient-reported outcomes is required.
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Affiliation(s)
- Catherine de Blacam
- Department of Plastic and Reconstructive Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Orr
- Departments of Surgery and Paediatrics, Trinity College Dublin, Dublin, Ireland
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Impieri D, Tønseth K, Hide Ø, Feragen K, Høgevold H, Filip C. Change in quality of life after treatment of mild velopharyngeal insufficiency with autologous fat transplantation. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bruneel L, Van Lierde K, Bettens K, Corthals P, Van Poel E, De Groote E, Keppler H. Health-related quality of life in patients with cleft palate: Validity and reliability of the VPI Effects on Life Outcomes (VELO) questionnaire translated to Dutch. Int J Pediatr Otorhinolaryngol 2017; 98:91-96. [PMID: 28583513 DOI: 10.1016/j.ijporl.2017.04.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disease-specific health-related quality of life (HRQOL) questionnaires provide the clinician with important information regarding the impact of the disease on functioning and well-being. For patients with velopharyngeal insufficiency (VPI), the VPI Effects on Life Outcomes (VELO) questionnaire was developed and validated in English by Skirko et al. (2012). However, a valid and reliable Dutch translation of this questionnaire is not available yet. METHODS The English questionnaire was translated to Dutch following a forward-backward translation procedure. A linguistic validation and the evaluation of the internal consistency (Cronbach's α) of this Dutch version were performed based on the responses of 39 parents of patients with cleft (lip and) palate (mean age: 6.8 years) (parent report) and the responses of 14 patients older than 8 years (mean age: 9.5 years) (child report). Additionally, the concurrent validity was assessed by comparing the scores on the parent report to those on the pediatric voice handicap index. Furthermore, the validity of the parent proxy assessment and the relationship between age and responses on the VELO questionnaire were investigated. Based on the responses of an age and gender matched control group without cleft palate, the discriminant validity was evaluated. RESULTS The parent report was easy to complete for all parents. Nine of the fourteen (64%) patients were able to complete the child report independently. The median scores on the parent report and the child report were 82.7 and 95.1 respectively. The patient group had a significantly worse perception of HRQOL compared to the control group (p < 0.001; p = 0.029). There were no significant differences between the responses of the parent and their child's (p = 0.345). A significant positive correlation was found between the score on the parent report and the age of the patients (p = 0.001). Furthermore, a significant negative correlation was found between the parent report and the P-VHI (p < 0.001). Cronbach's α was 0.955 and 0.817 for the parent report and the child report respectively. CONCLUSION The Dutch VELO questionnaire is a valid, reliable and user-friendly tool that provides important information about HRQOL in patients with cleft (lip and) palate.
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Affiliation(s)
- Laura Bruneel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Kristiane Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Paul Corthals
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Esther Van Poel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Evelien De Groote
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Hannah Keppler
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
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Raol N, Diercks G, Hersh C, Hartnick CJ. Stress velopharyngeal incompetence: Two case reports and options for diagnosis and management. Int J Pediatr Otorhinolaryngol 2015; 79:2456-9. [PMID: 26531005 DOI: 10.1016/j.ijporl.2015.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
Stress velopharyngeal incompetence (SVPI) commonly affects brass and wind musicians. We present a series of two patients who presented with nasal air emission following prolonged woodwind instrument practice. Neither patient demonstrated audible nasal air emission during speech, but endoscopy revealed localized air escape/bubbling from different sites for each patient with instrument playing only. Both underwent tailored surgical treatment with resolution of symptoms during performance. Diagnosis of SVPI requires examination during the action that induces VPI to allow for directed management. Treatment should be targeted based on nasopharyngoscopy findings.
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Affiliation(s)
- Nikhila Raol
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Gillian Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Cheryl Hersh
- Department of Speech Language Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
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Skirko JR, Weaver EM, Perkins JA, Kinter S, Eblen L, Martina J, Sie KCY. Change in Quality of Life with Velopharyngeal Insufficiency Surgery. Otolaryngol Head Neck Surg 2015; 153:857-64. [PMID: 26124262 DOI: 10.1177/0194599815591159] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 05/22/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) To define the minimal clinically important difference (MCID) of the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument, and (2) to test for the change in quality of life (QOL) after VPI surgery. STUDY DESIGN Prospective observational cohort. SETTING VPI clinic at a tertiary pediatric medical center. SUBJECTS AND METHODS Children with VPI and their parents completed the VELO instrument (higher score is better QOL) at enrollment and then underwent VPI surgery (Furlow palatoplasty or sphincter pharyngoplasty, n = 32), other treatments (obturator or oronasal fistula repair, n = 7), or no treatment (n = 18). They completed the VELO instrument again and an instrument of global rating of change in QOL at 1 year. The MCID was anchored to the global change instrument scores corresponding to "a little" or "somewhat" better. Within-group (paired t test) and between-group (Student t test) changes in VELO scores were tested for the VPI surgery and no treatment groups. The association between treatment group and change in VELO scores was tested with multivariate linear regression, adjusting for confounders. RESULTS Follow-up was obtained for 37 of 57 (65%) patients. The mean (±standard deviation) change in VELO scores corresponding to the MCID anchor was 15 ± 13. The VELO score improved significantly more in the VPI surgery group (change, 22 ± 15; P < .001) than in the no treatment group (change, 9 ± 12; P = .04), after adjusting for confounders (P = .007 between groups). CONCLUSION VPI surgery using the Furlow palatoplasty or sphincter pharyngoplasty improves VPI-specific QOL, and the improvement is clinically important.
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Affiliation(s)
- Jonathan R Skirko
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Edward M Weaver
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Jonathan A Perkins
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA Childhood Communication Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sara Kinter
- Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Linda Eblen
- Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Julie Martina
- Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA Childhood Communication Center, Seattle Children's Hospital, Seattle, Washington, USA
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Skirko JR, Weaver EM, Perkins JA, Kinter S, Eblen L, Sie KCY. Validity and responsiveness of VELO: a velopharyngeal insufficiency quality of life measure. Otolaryngol Head Neck Surg 2013; 149:304-11. [PMID: 23585146 DOI: 10.1177/0194599813486081] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Test the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument for validity, reliability, and responsiveness. STUDY DESIGN Observational cohort. SETTING Academic tertiary medical center. SUBJECTS Children with VPI (n = 59) and their parents (n = 84) were prospectively enrolled from a pediatric VPI clinic. METHODS Pediatric speech language pathologists diagnosed VPI using perceptual speech analysis and rated VPI severity and speech intelligibility deficit (each as minimal, mild, moderate, or severe). All parents and youth 8+ years old (n = 24) completed the VELO instrument and other quality-of-life questionnaires at baseline; the first 40 subjects completed the VELO instrument again 2 weeks later. Treatments included Furlow palatoplasty (n = 20), sphincter pharyngoplasty (n = 14), or an obturator (n = 2), and 29 of 36 (81%) subjects completed the questionnaires 3 months posttreatment. VELO was tested with correlations for criterion validity against VPI severity, construct validity against speech intelligibility and velopharyngeal gap size, and concurrent validity against other quality-of-life measures (r > .40 demonstrating validity); for test-retest reliability using intraclass correlation (>.6 demonstrating reliability); and for responsiveness with the 3-month posttreatment measure using the paired t test. RESULTS Parental responses are reported; youth responses showed similar results. The VELO instrument did not meet criterion validity (r = -.18, P = .10), or functional construct validity (r = -.37, P = .001), but did meet anatomic construct and concurrent validity (each r > .50, P < .01). VELO scores demonstrated excellent test-retest reliability (r = .85, P < .001) and responsiveness (baseline 54 ± 14 to posttreatment 70 ± 18, P < .001). CONCLUSION VELO provides a VPI-specific quality-of-life instrument that demonstrates concurrent validity, test-retest reliability, and responsiveness to change in quality of life with treatment.
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Affiliation(s)
- Jonathan R Skirko
- Department of Otolaryngology, University of Washington, 1959 NE Pacific Street, Box 356515, Seattle, WA 98195-6515, USA.
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