Reliability of auditory-perceptual analysis in the study of speech function in patients with unilateral cleft and palate

Abstract

Background/Objectives: Multidisciplinary outcome studies are carried out to evaluate long-term treatment in patients with cleft lip and palate. Speech function as one of the key outcomes of the treatment is examined by means of an auditory-perceptual analysis. For scientific and global studies it is essential to reduce the risk of bias as much as possible. The aim of the present study was the examination of auditory-perceptive analyses on the basis of an outcome study. Reliability was evaluated. Methods: Twenty patients were examined to evaluate their speech function. The speech sample was obtained via the online tool Zoom™. The speech sample consisted of single words (picture supported), a version of the German “Great Ormond Street Speech Assessment” (GOS.SP.ASS) sentences and spontaneous speech. The analysis was carried out by three experienced examiners, all using the German version of the Universal Reporting Parameters at two different times. The intrarater and interrater reliability were calculated. Results: Twenty participants with unilateral cleft and palate and a minimum age of 18 years (ø 20.1) were enrolled in the analysis of the speech function. None of the participants had undergone a secondary operation due to velopharyngeal incompetence. The examination happened at a point in time before an osteotomy might be needed. The multidisciplinary treatment of the 20 participants regarding their speech function was successful. There were only marginal abnormalities. The listeners showed a very good intrarater and moderate interrater reliability (ICC/Fleiss’ kappa). An overall percentual agreement of 88.3% was achieved. Conclusions: These positive results cannot be compared with outcome studies on a national or international level, since the construction of the speech sample as well as the structure and the implementation of the auditing process reveal considerable deficiencies in methodological rigor. The small number of examiners and patients as well as the patients’ minor residual impairments influence the significance of the statistical calculation by kappa and ICC. The auditory-perceptual analysis should be validated for German-speaking countries.