Innovations, Watersheds and Gold Standards: Concluding Symposium Reflections

What caused the problem?

So what might explain this unusual state of affairs with our discipline’s efforts with stuttering treatments? Speech pathology, physiotherapy and occupational therapy seem to have in common that they do not have the extensive resources of the medical profession. For example, a search of the same database reveals 837 RCTs for hypertension. The disparity there is understandable. Professional preparation in the three disciplines in Table 18.1 is focused more or less exclusively on attaining a qualification for professional practice. There is little funding or infrastructure available to induce graduates to contemplate a research career in preference to a practitioner career. There is, for example, no career infrastructure in those professions that resemble the network of government funded Australian independent health and medical research institutes, at which medical graduates may train for a research career. Many of the presenters in this volume remarked that they are located at clinics and do not have funding for research. Yet in that regard, speech pathology appears to be in the same position to physiotherapy and occupational therapy. Neither can an explanation be that the speech pathology profession considers stuttering to be an inconsequential speech disorder in terms of the research attention it generates. Using the topic search terms speech therapy or speech pathology or speech-language pathology or speech-language therapy, a total of 5714 publications emerged. Using the data in Column Four of Table 18.1, this means that around 27% of our discipline’s publications are about stuttering. Similar analyses for physiotherapy and occupational therapy reveal results of 12% and 1.6%, respectively, so uninterest in the topic cannot be an explanation. Considering that, neither can the often documented poor quality of professional clinical training with stuttering (for an overview, see Block, 2012). Regardless of that poor training, many of our graduates find their way to research locations, but not many of them conduct clinical trials. At least for now, it seems, that might be not only a bewildering fact but an inexplicable one. Certainly, it is not clear how to fix this problem, but somehow, somewhere, someone needs to put their minds to it or we may find ourselves in another 30 years from now, again, no further advanced.

So, many issues have been raised by our symposium, and it is uncertain whether they will be resolved, or even whether they will be taken account of. However, what is certain is that, regardless of whatever transpires, our discipline will be accountable for the future health care of those who stutter. After another three decades we may know wondrous scientific things about how to treat chronic stuttering. We may find a way to stop the development of early stuttering in its tracks. We may fail on both accounts. But whatever the outcome may be, our part in it is documented for an eternity as the proceedings of this symposium.

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1 http://www.consort-statement.org

2 http://www.cebm.net/index.aspx?o=1025

3 http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment/HealthProfessional/page1

4 http://www.joannabriggs.edu.au/

5 http://nccam.nih.gov/research/clinicaltrials/factsheet/

6 The body of clinical trials literature in this volume tangentially skirts this issue on one occasion, which is the comparison not of two different speech restructuring techniques, but of different ways of presenting them to clients (Carey et al., 2010).

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