Interdisciplinary cleft care outcomes in adults (Van der Straeten et al., 2023)

Purpose: Individuals born with a cleft palate with or without a cleft lip (CP ± L) often experience functional, aesthetic, and psychosocial consequences well into adulthood. This study aimed to investigate outcomes of speech and health-related quality of life (HRQoL) in adults with a CP ± L who received interdisciplinary cleft care at the Ghent University Hospital using valid, reliable, and condition-specific instruments.Method: Thirteen Belgian Dutch-speaking participants with a CP ± L with a mean age of 25.4 years (SD = 5.1, range: 20–33 years) and an age- and gender-matched control group of 13 participants without a CP ± L with a mean age of 25.2 years (SD = 4.8, range: 20–32 years) were included in this study. Speech characteristics were evaluated perceptually and instrumentally. HRQoL was assessed through standardized patient-reported outcome measures. Outcomes were compared with those of the control group and to normative data where available.Results: Participants with a CP ± L in this sample demonstrated significantly lower speech acceptability (p < .001) and higher rates of hypernasality (p = .015) and nasal turbulence (p = .005) than the control group. They showed significantly higher satisfaction with appearance of the cleft scar compared with norms of adults with a CP ± L (p = .047). No other differences in speech characteristics, sociodemographics, or HRQoL were found between participants with and without a CP ± L.Conclusions: The reduced speech acceptability and the presence of resonance and nasal airflow disorders may indicate the need for standardized long-term outcome measurement and interdisciplinary follow-up for speech characteristics and velopharyngeal insufficiency in young and middle adulthood in future clinical practice. Additional research is necessary to further substantiate these findings and to determine predictors for these continuing complications in adults with a CP ± L.Supplemental Material S1. Post-hoc power analysis for t-tests (means), Wilcoxon-Mann-Whitney test (two groups), using G*Power (Faul et al., 2007).Van der Straeten, C., Verbeke, J., Alighieri, C., Bettens, K., Van Beveren, E., Bruneel, L., & Van Lierde, K. (2023). Treatment outcomes of interdisciplinary care on speech and health-related quality of life outcomes in adults with cleft palate. American Journal of Speech-Language Pathology, 32(6), 2654–2675. https://doi.org/10.1044/2023_AJSLP-23-00024

研究背景与目的：伴或不伴唇裂的腭裂（cleft palate with or without a cleft lip，CP ± L）患者往往在成年后仍会面临功能、美观及社会心理层面的诸多不良影响。本研究旨在借助经过验证、信效度良好且针对特定病症的评估工具，对在根特大学医院接受跨学科腭裂诊疗的CP ± L成年患者的言语功能结局与健康相关生活质量（health-related quality of life，HRQoL）进行探究。
研究方法：本研究共纳入13名比利时荷兰语使用者，均为CP ± L患者，平均年龄25.4岁（标准差SD=5.1，年龄范围20~33岁）；同时设置年龄与性别匹配的对照组，纳入13名无CP ± L的受试者，平均年龄25.2岁（SD=4.8，年龄范围20~32岁）。研究从感知层面与仪器检测层面评估受试者的言语特征，并通过标准化患者报告结局量表评估其HRQoL。将受试者的结局指标与对照组及现有常模数据进行对比。
研究结果：本样本中的CP ± L患者言语可接受度显著低于对照组（p<0.001），且高鼻音（p=0.015）与鼻腔气流紊乱（p=0.005）的发生率更高。与CP ± L成年患者的常模数据相比，该组患者对腭裂瘢痕外观的满意度显著更高（p=0.047）。其余言语特征、社会人口学特征及HRQoL在CP ± L患者与对照组之间均未发现显著差异。
研究结论：言语可接受度降低以及共振与鼻腔气流异常，提示未来临床实践中需针对年轻及中年成年CP ± L患者的言语特征与腭咽功能不全，开展标准化的长期结局评估与跨学科随访。还需开展更多研究以进一步验证本研究结论，并明确成年CP ± L患者持续出现此类并发症的预测因素。
补充材料S1：基于G*Power软件（Faul等，2007）完成的均值比较t检验、双组威尔科克森-曼-惠特尼检验的事后功效分析。
参考文献：Van der Straeten, C., Verbeke, J., Alighieri, C., Bettens, K., Van Beveren, E., Bruneel, L., & Van Lierde, K. (2023). 成人腭裂跨学科诊疗对言语功能与健康相关生活质量的结局影响. 《美国言语语言病理学杂志》, 32(6), 2654–2675. https://doi.org/10.1044/2023_AJSLP-23-00024