title: The state of the art in non-pharmacological interventions for developmental stuttering. Part 1: a systematic review of effectiveness.
abstract: BACKGROUND
  The growing range of available treatment options for people who stutter presents a challenge for clinicians, service managers and commissioners, who need to have access to the best available treatment evidence to guide them in providing the most appropriate interventions. While a number of reviews of interventions for specific populations or a specific type of intervention have been carried out, a broad-based systematic review across all forms of intervention for adults and children was needed to provide evidence to underpin future guidelines, inform the implementation of effective treatments and identify future research priorities.
  
  
  OBJECTIVE
  To identify and synthesize the published research evidence on the clinical effectiveness of the broad range of non-pharmacological interventions for the management of developmental stuttering.
  
  
  METHODS
  A systematic review of the literature reporting interventions for developmental stuttering was carried out between August 2013 and April 2014. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for the identification of relevant studies included electronic database searching, reference list checking, citation searching and hand searching of key journals. Appraisal of study quality was performed using a tool based on established criteria for considering risk of bias. Due to heterogeneity in intervention content and outcomes, a narrative synthesis was completed.
  
  
  RESULTS
  The review included all available types of intervention and found that most may be of benefit to at least some people who stutter. There was evidence, however, of considerable individual variation in response to these interventions. The review indicated that effects could be maintained following all types of interventions (although this was weakest with regard to feedback and technology interventions).
  
  
  CONCLUSIONS
  This review highlights a need for greater consensus with regard to the key outcomes used to evaluate stuttering interventions, and also a need for enhanced understanding of the process whereby interventions effect change. Further analysis of the variation in effectiveness for different individuals or groups is needed in order to identify who may benefit most from which intervention.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Baxter
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Maxine
authors.initials: M
authors.lastname: Johnson
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Blank
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Cantrell
authors.affiliation: Department of Human Communication Sciences, University of Sheffield, Sheffield, UK.
authors.forename: Shelagh
authors.initials: S
authors.lastname: Brumfitt
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Enderby
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goyder
mesh_terms: D000328:Adult; D002648:Child; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans; D013070:Speech Therapy; D013342:Stuttering / Q000628:therapy*
keywords: clinical effectiveness; stammering; stuttering; systematic review