Recently Published Projects

Published on January 25, 2024
Screening for Speech and Language Delay and Disorders in Children Age 5 Years or Younger (Screening)
23 Citations • 1 Key Questions • 21 Extraction Forms
Project created on June 07, 2022
Last updated on January 23, 2024
Objectives: Purpose: To systematically review the evidence on screening for speech and language delay and disorders in children age 5 years or younger. Data Sources: PubMed/MEDLINE, the Cochrane Library, APA PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through November 24, 2023. Study Selection: Two investigators independently selected English language studies using a priori criteria. Eligible studies included cohort studies or trials directly comparing screening versus no screening, as well as studies of screening test accuracy for speech and language delay or disorders among children age 5 years or younger. Randomized, controlled trials (RCTs) of interventions for speech and language delay or disorders enrolling children age 6 years or younger reporting on the benefits and harms of interventions were also eligible. Data Extraction: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. Data Synthesis: Thirty-eight studies reported in 41 articles (N=9,006) were included. No study evaluated the direct benefits of screening compared with no screening. Twenty-one studies (23 articles; N=7,489) assessed the accuracy of 23 instruments for detecting speech and language delay and disorders in young children. The sensitivity and specificity varied widely across included studies, and no more than one or two studies reported on the accuracy of each instrument. Ten instruments, described in 10 studies (11 articles), used parent reports to detect speech and language delay and disorders, and 13 instruments, described in 14 studies, required a trained examiner to administer the instrument to children. Most included instruments were designed to screen for global language problems (provide an overall score for “language”) and nine provided scores for specific aspects of language (e.g., expressive language skills only). Sensitivity and specificity of the three parent-reported instruments of emerging expressive language skills were consistent; median sensitivity was 91 percent, (range, 88% to 93%) and specificity was 88% (range, 88% to 85%). The accuracy of global language instruments based on parent reports was inconsistent, with a median sensitivity of 74 percent (range, 55% to 93%). Accuracy of provider-reported global and specific language problems varied significantly across tools. Seventeen RCTs (18 articles; N=1,517) compared an intervention for a speech and language delay or disorder with an inactive control. Eight RCTs of treatment were limited to children with language delay and no obvious speech-sound or fluency disorder. Three assessed parent-delivered, group training interventions. Of these, two that evaluated longer, more intensive interventions (11 bimonthly 60- to 75-minute sessions, and 11 weekly 2.5-hour sessions followed by 3 weekly home visits) found benefit on different measures of expressive language outcomes, and one RCT of a shorter parental group training intervention (6 weekly 2-hour sessions) found no statistically significant difference between groups for any language outcome measure. Other RCTs of interventions for language delay that enrolled heterogeneous populations and assessed different interventions showed mixed results. Two RCTs delivered interventions featuring school-based, whole-class curriculum components (or Tier 1 interventions) designed to advance language and literary skills over the course of an academic year. Both demonstrated improved receptive and expressive language outcomes in favor of the intervention; however, one found improvement for some measures but not others. Two RCTs that assessed fluency treatment in young children focused on the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists (SLPs) and featured parent training to provide verbal contingencies for stutter-free speech (e.g., “that was smooth talking”) and stuttering (e.g., “that was a bit bumpy”). Both found benefit for stuttering fluency associated with the intervention at 9 months. One RCT, which delivered the intervention face-to-face in a clinic setting, showed a 2.3 percent lower proportion of syllables stuttered (95% confidence interval [CI], 0.8 to 3.9) compared with the control group, whereas the second RCT, which was delivered via telehealth, showed a larger reduction from the baseline mean number of syllables stuttered in the intervention group than in controls (-3.0; p=0.02). Three RCTs assessed interventions for three different types of speech-sound disorders and reported on various measures of speech-sound; results were generally inconsistent across different measures of speech. Two RCTs that evaluated treatment for children newly referred from primary care for any speech or language problem found inconsistent results, with improvement on some domains of speech and language but not others and no consistent benefit for a similar outcome domain. Eight RCTs (N= 1,239) reported on one or more outcomes specific to school performance or early literacy, health-related quality of life, function, behavior, or socialization. No studies assessing the same type of intervention among similar groups of children reported on similar outcomes, and most studies found no difference between groups for measures of early literacy, function, and quality of life. No RCTs reported on the harms of interventions. Limitations: No studies reported on the benefits and harms of screening vs. no screening, or on the potential harms of interventions. Studies of screening test accuracy and interventions for children with speech and language problems were heterogeneous in terms of the enrolled population and specific type of speech or language disorders targeted. Very few studies of screening test accuracy evaluated the same instrument. Similarly, few studies of interventions for speech and language delay or disorder enrolled similar populations and evaluated similar types of interventions. Two RCTs of treatment enrolled children who were newly referred from primary care; however, it is not clear whether children were identified via routine screening and if the studies differed in terms of setting, mean age of enrolled children, and other factors. Conclusions: We found no eligible studies that reported on benefits directly arising from screening when compared with usual care or no screening. Parent-reported screening tools of emerging expressive language skills had reasonable accuracy for detecting expressive language delay; however, the accuracy of global language instruments based on parent reports was inconsistent. Accuracy of examiner-administered instruments was also variable, especially for examiner-administered instruments of specific language skills. Existing evidence supports the benefit of group parent training programs for speech delay that provide at least 11 parental training sessions for improving receptive language skills, as well as the Lidcombe Program of Early Stuttering Intervention delivered by SLPs for reducing stuttering frequency.
Published on January 25, 2024
Screening for Speech and Language Delay and Disorders in Children Age 5 Years or Younger (Treatment)
18 Citations • 2 Key Questions • 17 Extraction Forms
Project created on June 13, 2022
Last updated on January 23, 2024
Objectives: Purpose: To systematically review the evidence on screening for speech and language delay and disorders in children age 5 years or younger. Data Sources: PubMed/MEDLINE, the Cochrane Library, APA PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through November 24, 2023. Study Selection: Two investigators independently selected English language studies using a priori criteria. Eligible studies included cohort studies or trials directly comparing screening versus no screening, as well as studies of screening test accuracy for speech and language delay or disorders among children age 5 years or younger. Randomized, controlled trials (RCTs) of interventions for speech and language delay or disorders enrolling children age 6 years or younger reporting on the benefits and harms of interventions were also eligible. Data Extraction: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. Data Synthesis: Thirty-eight studies reported in 41 articles (N=9,006) were included. No study evaluated the direct benefits of screening compared with no screening. Twenty-one studies (23 articles; N=7,489) assessed the accuracy of 23 instruments for detecting speech and language delay and disorders in young children. The sensitivity and specificity varied widely across included studies, and no more than one or two studies reported on the accuracy of each instrument. Ten instruments, described in 10 studies (11 articles), used parent reports to detect speech and language delay and disorders, and 13 instruments, described in 14 studies, required a trained examiner to administer the instrument to children. Most included instruments were designed to screen for global language problems (provide an overall score for “language”) and nine provided scores for specific aspects of language (e.g., expressive language skills only). Sensitivity and specificity of the three parent-reported instruments of emerging expressive language skills were consistent; median sensitivity was 91 percent, (range, 88% to 93%) and specificity was 88% (range, 88% to 85%). The accuracy of global language instruments based on parent reports was inconsistent, with a median sensitivity of 74 percent (range, 55% to 93%). Accuracy of provider-reported global and specific language problems varied significantly across tools. Seventeen RCTs (18 articles; N=1,517) compared an intervention for a speech and language delay or disorder with an inactive control. Eight RCTs of treatment were limited to children with language delay and no obvious speech-sound or fluency disorder. Three assessed parent-delivered, group training interventions. Of these, two that evaluated longer, more intensive interventions (11 bimonthly 60- to 75-minute sessions, and 11 weekly 2.5-hour sessions followed by 3 weekly home visits) found benefit on different measures of expressive language outcomes, and one RCT of a shorter parental group training intervention (6 weekly 2-hour sessions) found no statistically significant difference between groups for any language outcome measure. Other RCTs of interventions for language delay that enrolled heterogeneous populations and assessed different interventions showed mixed results. Two RCTs delivered interventions featuring school-based, whole-class curriculum components (or Tier 1 interventions) designed to advance language and literary skills over the course of an academic year. Both demonstrated improved receptive and expressive language outcomes in favor of the intervention; however, one found improvement for some measures but not others. Two RCTs that assessed fluency treatment in young children focused on the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists (SLPs) and featured parent training to provide verbal contingencies for stutter-free speech (e.g., “that was smooth talking”) and stuttering (e.g., “that was a bit bumpy”). Both found benefit for stuttering fluency associated with the intervention at 9 months. One RCT, which delivered the intervention face-to-face in a clinic setting, showed a 2.3 percent lower proportion of syllables stuttered (95% confidence interval [CI], 0.8 to 3.9) compared with the control group, whereas the second RCT, which was delivered via telehealth, showed a larger reduction from the baseline mean number of syllables stuttered in the intervention group than in controls (-3.0; p=0.02). Three RCTs assessed interventions for three different types of speech-sound disorders and reported on various measures of speech-sound; results were generally inconsistent across different measures of speech. Two RCTs that evaluated treatment for children newly referred from primary care for any speech or language problem found inconsistent results, with improvement on some domains of speech and language but not others and no consistent benefit for a similar outcome domain. Eight RCTs (N= 1,239) reported on one or more outcomes specific to school performance or early literacy, health-related quality of life, function, behavior, or socialization. No studies assessing the same type of intervention among similar groups of children reported on similar outcomes, and most studies found no difference between groups for measures of early literacy, function, and quality of life. No RCTs reported on the harms of interventions. Limitations: No studies reported on the benefits and harms of screening vs. no screening, or on the potential harms of interventions. Studies of screening test accuracy and interventions for children with speech and language problems were heterogeneous in terms of the enrolled population and specific type of speech or language disorders targeted. Very few studies of screening test accuracy evaluated the same instrument. Similarly, few studies of interventions for speech and language delay or disorder enrolled similar populations and evaluated similar types of interventions. Two RCTs of treatment enrolled children who were newly referred from primary care; however, it is not clear whether children were identified via routine screening and if the studies differed in terms of setting, mean age of enrolled children, and other factors. Conclusions: We found no eligible studies that reported on benefits directly arising from screening when compared with usual care or no screening. Parent-reported screening tools of emerging expressive language skills had reasonable accuracy for detecting expressive language delay; however, the accuracy of global language instruments based on parent reports was inconsistent. Accuracy of examiner-administered instruments was also variable, especially for examiner-administered instruments of specific language skills. Existing evidence supports the benefit of group parent training programs for speech delay that provide at least 11 parental training sessions for improving receptive language skills, as well as the Lidcombe Program of Early Stuttering Intervention delivered by SLPs for reducing stuttering frequency.
Published on November 29, 2023
Screening for Hypertensive Disorders of Pregnancy: An Evidence Update for the U.S. Preventive Services Task Force
6 Citations • 670 Key Questions • 6 Extraction Forms
Project created on September 29, 2023
Last updated on November 29, 2023
Objectives: Objective: We conducted this comparative effectiveness review to support the U.S. Preventive Services Task Force in updating its recommendation on Preeclampsia Screening. The review aim was to compare different approaches to screening for hypertensive disorders of pregnancy including preeclampsia. Data Sources: We performed comprehensive searches of MEDLINE, PubMed (publisher-supplied only), Embase, and the Cochrane Collaboration Registry of Controlled Trials for studies published between January 1st, 2014 and January 4th, 2022. A research librarian developed and executed the search strategy. Studies included in the prior review to support the 2015 recommendation and studies referenced in recently published reviews were also considered for inclusion. Study Selection: We reviewed 6,316 abstracts and assessed 82 full-text articles against predefined inclusion and exclusion criteria. Studies considered for inclusion were randomized controlled trials and non-randomized studies of interventions (NRSI) comparing screening interventions conducted with pregnant and postpartum people, including those at increased risk for hypertensive disorders of pregnancy. Interventions and comparisons of interest included: blood pressure measurement setting (office or home), interval, frequency, or timing; proteinuria assessment setting, interval, or sequence of testing; and personalization of screening based on risk assessment. Data Analysis: We conducted dual independent critical appraisal of all included studies and extracted all important study details and outcomes from fair- and good-quality studies. We narratively synthesized results by key question and type of screening intervention. We graded the overall strength of evidence as high, moderate, low, or insufficient based on criteria adapted from the Evidence-based Practice Center program. Results: Five fair-quality randomized controlled trials and one fair-quality NRSI with a historical control were included. Three types of screening strategies were compared with usual screening programs: screening programs that incorporated self-measurement of blood pressure (2 studies, N= 2,521), a reduced prenatal visit schedule for people at low risk for complications of hypertensive disorders of pregnancy (3 studies, N= 5,203), and protein urine screening provided only when indicated rather than at every prenatal visit (1 study, N = 2,441). No studies were designed to test screening interventions focused on populations with the highest risks for hypertensive disorders of pregnancy and adverse pregnancy-related health outcomes. One trial (N = 2,441) incorporated home blood pressure measurement into prenatal care and reported health outcomes. Similar proportions of maternal complications related to hypertensive disorders of pregnancy were seen in the home measurement group (15/1209; 1.2%) as in the usual care group (19/1209; 1.6%). The confidence interval for the relative risk spanned null (RR 0.79 [95% CI, 0.40 to 1.55]). Similar proportions of intrauterine growth restriction occurred in the intervention group (104/1249, 8.3%) compared with the control group (87/1235, 7.0%), and the confidence interval again spanned null (adjusted RR 1.15 [95% CI, 0.87 to 1.53]). The trial also did not report a difference in the timing of detection of high blood pressure. Increased anxiety, a potential harm of home blood pressure measurement, was assessed in two trials and was not associated with the intervention. Three trials published in 1996 and 1997 compared reduced prenatal visit schedules, which result in fewer antenatal blood pressure assessments, to usual care in populations at low risk for complications. Although the power to detect differences was limited for most outcomes, overall having fewer prenatal visits was not associated with better or worse pregnancy outcomes based on two trials. A large US trial (N= 2,328) including mostly White participants (81%) and a similarly sized UK trial (N= 2,794) where approximately one-third of participants belonged to an “ethnic minority” reported no evidence of differences in preeclampsia diagnoses (RR 0.94 [95% CI, 0.78 to 1.14] and RR 0.85 [95% CI, 0.35 to 2.04], respectively) or in maternal or perinatal health outcomes associated with a reduced visit schedule, although many of the outcomes were uncommon, which limited precision and the ability to rule out differences in serious outcomes. A small US trial (N = 81) was very underpowered for assessing differences between groups for serious health outcomes; few harms outcomes were reported. The UK trial and the small US trial assessed rates of anxiety or depression during and after pregnancy but did not find differences associated with the visit schedule. A fair-quality non-randomized study with a historical control (N = 2,441) evaluated the effect of implementing indicated instead of routine urine screening in a setting predominantly serving Hispanic/Latino people with public health insurance reported. Indicated urine screening was associated with increased risk of preterm birth compared to routine screening (RR 0.64 [95% CI, 0.45 to 0.90]), and diagnoses of hypertensive disorders of pregnancy did not differ following implementation. Limitations: There is very little evidence available to assess potential changes to clinical screening practices that could improve clinical outcomes related to hypertensive disorders of pregnancy. Only one fair-quality randomized study provided evidence on the effects of incorporating home-based blood pressure measurement to screen for hypertensive disorders of pregnancy on patient health outcomes. The included studies of reduced visit schedules provide potentially confounded tests of the effects of fewer office-based blood pressure measurements over the course of pregnancy, as a change in frequency of other tests and counseling received during visits could also influence the results. The evidence on an indicated urine screening strategy is very limited given the risks of bias inherent to historically controlled studies; reported findings may be due to factors other than the screening program. Black and American Indian/Alaska Native people, who experience the highest risks for adverse pregnancy-related health outcomes, were very underrepresented in the included studies. Conclusions: Screening for hypertensive disorders of pregnancy with standard of care office-based blood pressure measurement can identify individuals requiring further surveillance and evidence-based clinical management to decrease risks for related adverse pregnancy outcomes. Research is needed to develop and strengthen clinical screening and management, possibly incorporating telehealth, home-based blood pressure measurement, and postpartum screening. Addressing troubling and persistent health inequities related to hypertensive disorders of pregnancy among specific populations in the US – especially Black and American Indian/Alaska Native people – will require interventions at multiple levels, including policies, health systems, and clinical practices.
Published on November 21, 2023
SGS 2022 POP PROM
67 Citations • 1 Key Questions • 94 Extraction Forms
Project created on December 17, 2021
Last updated on November 22, 2023
Objectives: Evaluation of validity etc. of patient-reported outcome measures for pelvic organ prolapse
Published on November 21, 2023
SGS 2021 Fibroids PFD
54 Citations • 1 Key Questions • 41 Extraction Forms
Project created on September 29, 2021
Last updated on November 22, 2023
Objectives: • Women with uterine leiomyoma(ta) and symptoms of pelvic floor dysfunction undergoing procedural management for uterine leiomyomata • Procedural intervention(s) for uterine leiomyoma(ta) via the abdominal, vaginal, laparoscopic, robotic, radiologic or intravascular routes • Urinary, bowel, and pelvic floor symptoms; QoL, satisfaction, improvement