Wednesday, August 03, 2005

Battle of the Therapies

Which form of therapy is the best? Answering such an explosive question is not easy, and might even be impossible when including practical considerations on costs, logistics, therapist-dependent-outcome and even defining outcome measures. I do not know of any published serious research comparing different therapies with enough clients to do decent statistics.

To my knowledge, PEVOS from the Demosthenes Institute of the German Stuttering Association is the only such attempt currently running. The Demosthenes institute deals with educational and research issues on PDS. PEVOS stands for "project of evaluation of stuttering therapies". The linked webpage is in German. They have written an English article for a forum discussion at the ISAD 2003: look here.

They write in the abstract: "On the initiative of the German self-help organisation the PEVOS program was developed to evaluate different stuttering therapies over a time period of two years after therapy. The concept was designed by a group of therapists and scientists and was tested since 2001. In the test-phase data were collected from ten therapists with 100 clients. Fluency data were obtained by telephone calls. Functional outcomes and changes in attitudes and emotions were measured with questionnaires. Results of the test-phase¹s evaluation including the first two assessments will be presented, organisational problems and possible solutions will be discussed."

Their results do not suprise me, and confirm what many have found before. The clients have on average significantly improved in fluency. Unfortunately, they do not have long-term data yet. At least one-year data is needed to evaluate the success of a therapy. They have also not compared between therapies for example, but such a comparison might not be very meaningful until long-term data is available. They are refreshingly frank about the difficulties that they faced. They conclude: "In addition the program is very time-consuming and therefore expensive. PEVOS has been financed by the German stuttering association during the test-phase and its follow-ups. Several unsuccessful attempts have been made to secure funding for the main implementation of PEVOS. Considering these failed attempts it is necessary to think the concept over: it must be considered that therapists and/or professional associations of therapists contribute to the costs. At the same time it must be considered how the program could be less time-consuming." Unfortunately, the issues (e.g. of data collection) will only get worse as time from end of therapy (to get the long-term data) will increase. And I can think of other important theoretical issues that they have not even discussed... It is very very tricky to do the research sensibly... But they should be applauded for their efforts and courage to launch such a project! I am more of an advocat for a "quality stamp" approach by national assocations than evaluation which is difficult, tricky and messy. Such an approach would entail a checklist of features a "good" therapy should have: giving information on PDS, maintenance phase, no claim of a cure, etc.

The article was as of End of 2003. A new statistical study of the current PEVOS data (which should include more long-term data) is underway, and new results should be out in a few months.

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