{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T15:35:13Z","timestamp":1793201713108,"version":"4.5.0"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2025,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Cleft lip and palate (CLP) treatment in Norway is centralized and multidisciplinary, with long\u2010term follow\u2010up from birth to adulthood. The Norwegian Registry of Cleft Lip and Palate was established to ensure high\u2010quality care and enable systematic data collection. Speech data are a key component, assessed by speech\u2013language therapists (SLTs) using standardized tools. Ensuring the validity and reliability of these data is essential for clinical decision\u2010making and quality assurance.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n The study aimed to (1) assess the validity of speech data obtained from routine assessments recorded in the Norwegian Registry of Cleft Lip and Palate and (2) propose and evaluate speech\u2010related quality indicators for use in the Norwegian Registry of Cleft Lip and Palate.<\/jats:p>\n <\/jats:sec>\n \n Methods and Procedures<\/jats:title>\n To assess the validity of speech data obtained from routine assessments, comparisons were made between registry entries and blinded re\u2010assessments. The registry data consisted of speech data from 143 children born in 2011\u20132012 with cleft palate \u00b1 lip. For the re\u2010assessments, four experienced SLTs independently re\u2010assessed anonymized audio recordings. Inter\u2010 and intra\u2010rater reliability were analysed using Gwet's agreement coefficients and intra\u2010class correlation coefficients (ICCs). Variables assessed included hypernasality, hyponasality, audible nasal air emission, weak pressure consonants, perceived velopharyngeal competence (VPC), intelligibility of speech, percent non\u2010oral articulation errors, percent consonants correct (PCC) and percent oral articulation errors. Three speech\u2010related quality indicators were proposed and evaluated as follows: (1) proportion of children without non\u2010oral articulation errors, (2) proportion of children with competent or marginally incompetent VPC and (3) proportion of children with good intelligibility of speech.<\/jats:p>\n <\/jats:sec>\n \n Outcomes and Results<\/jats:title>\n Participants: 143 children (47% with cleft palate only, 36% unilateral, 17% bilateral cleft lip), mean age 6 years. Comparisons between registry entries and blinded re\u2010assessments revealed almost perfect agreement (\u22650.81) for hypernasality, hyponasality, audible nasal air emission, weak pressure consonants and perceived VPC. Agreement ranged from substantial (0.80) to almost perfect (\u22650.81) for intelligibility of speech. Agreement was\u00a0substantial\u00a0(0.61\u20130.75) for percent non\u2010oral articulation errors and mainly also for PCC (0.58\u20130.71). Agreement for percent oral articulation errors ranged from fair to moderate (0.25\u20130.50). The quality indicators, proportion of children without non\u2010oral articulation errors and proportion of children with competent or marginally incompetent VPC, revealed substantial to almost perfect agreement (0.80\u20130.91). For good intelligibility of speech, agreement ranged from moderate to almost perfect (0.60\u20130.81). Inter\u2010rater agreement was\u00a0almost perfect\u00a0(\u22650.81) for hypernasality, hyponasality, audible nasal air emission, weak pressure consonants, perceived VPC and intelligibility of speech.\u00a0Agreement was\u00a0substantial\u00a0for percent non\u2010oral articulation errors (0.61\u20130.75), moderate to substantial for PCC (0.58\u20130.71), but only\u00a0fair to moderate\u00a0for percent oral articulation errors (0.25\u20130.50). The quality indicators proportion of children without non\u2010oral articulation errors and the proportion of children with competent or marginally incompetent VPC showed almost perfect agreement (0.82, 0.92). Agreement was substantial (0.67) for the proportion of children with good intelligibility of speech. SLTs showed almost perfect intra\u2010rater agreement (\u22650.81) for most speech characteristics, including hypernasality, hyponasality, audible nasal air emission, weak pressure consonants, perceived VPC and intelligibility of speech. For percent non\u2010oral articulation errors, agreement was almost perfect for three SLTs and substantial for one. For PCC, three SLTs had almost perfect agreement, while one had substantial agreement. Percent oral articulation errors showed more variation, ranging from fair to almost perfect across SLTs. Agreement ranged from substantial to almost perfect for the speech\u2010related quality indicators.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Implications<\/jats:title>\n The speech data in the Norwegian Registry of Cleft Lip and Palate can be considered valid, as the degree of coverage and reporting is high, and the variables are assessed for reliability.<\/jats:p>\n The reliability of the speech data is generally strong, both between registry data and blinded assessments, and in terms of inter\u2010 and intra\u2010rater agreement among assessors. However, lower reliability in the rating of articulation errors, particularly oral errors, indicates a need for regular calibration among SLTs to ensure the validity of the registry's speech data. The three proposed quality indicators are reliable and suitable for inclusion in national reporting.<\/jats:p>\n <\/jats:sec>\n \n WHAT THIS PAPER ADDS<\/jats:title>\n \n What is already known on this subject<\/jats:italic>\n \n \n Quality registries for cleft patients have been established in several countries and are recognized as valuable tools for systematic data collection. The use of standardized protocols and national benchmarks for speech outcomes enhances the meaningfulness of reporting and facilitates comparisons across treatment centres. Previous studies on the validity and reliability of speech data indicate variability across different parameters, underscoring the importance of careful interpretation of registry data to ensure optimal patient care. These findings highlight the need for ongoing efforts to improve consistency in assessment procedures and to strengthen the quality of data used in clinical decision\u2010making and research.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n What this paper adds to existing knowledge<\/jats:italic>\n \n \n The Norwegian Registry of Cleft Lip and Palate has systematically collected data since 2011, maintaining a high inclusion rate. Speech data are gathered in accordance with a national protocol and assessed by an individual speech\u2013language therapist (SLT). To ensure the validity and reliability of these data, achieving consistent inter\u2010 and intra\u2010rater agreement among SLTs nationwide is essential.<\/jats:p>\n <\/jats:list-item>\n \n This study investigates the validity of speech data obtained from routine assessments recorded in the Norwegian Registry of Cleft Lip and Palate. The study also proposes and evaluates speech\u2010related quality indicators for use in the Norwegian Registry of Cleft Lip and Palate.<\/jats:p>\n <\/jats:list-item>\n \n The study adds a significant contribution to research on quality registries and the development of national standards for speech outcomes in cleft care.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n What are the potential or actual clinical implications of this work?<\/jats:italic>\n \n \n The speech data in the Norwegian Registry of Cleft Lip and Palate can be considered valid, as the degree of coverage and reporting is high, and the variables are assessed for reliability.<\/jats:p>\n <\/jats:list-item>\n \n The reliability of the speech data is generally strong, both between registry data and blinded assessments, and in terms of inter\u2010 and intra\u2010rater agreement among assessors.<\/jats:p>\n <\/jats:list-item>\n \n However, findings related to articulation variables underscore the need for systematic calibration among SLTs within the cleft teams. Three proposed speech\u2010related quality indicators have shown high reliability and can be implemented as clear, accessible and meaningful measures within the Norwegian Registry of Cleft Lip and Palate.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1460-6984.70151","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T02:48:27Z","timestamp":1761274107000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Validity and Reliability of Speech Data in the Norwegian Registry of Cleft Lip and Palate"],"prefix":"10.1111","volume":"60","author":[{"given":"\u00d8ydis","family":"Hide","sequence":"first","affiliation":[{"name":"Department of Speech and Language Disorders Statped \u2013 National Service for Special Needs Education Holmestrand Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dagrun Sletteb\u00f8","family":"Daltveit","sequence":"additional","affiliation":[{"name":"Norwegian Registry of Cleft Lip and Palate Haukeland University Hospital Bergen Norway"},{"name":"Department of Global Public Health and Primary Care University of Bergen Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Katherine","family":"Hvistendahl","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Disorders Statped \u2013 National Service for Special Needs Education Holmestrand Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randi Lovise","family":"Kjerstad","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Disorders Statped \u2013 National Service for Special Needs Education Holmestrand Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit Berntsen","family":"Kvinnsland","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Disorders Statped \u2013 National Service for Special Needs Education Holmestrand Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina Helen","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Disorders Statped \u2013 National Service for Special Needs Education Holmestrand Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Disorders Statped \u2013 National Service for Special Needs Education Holmestrand Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c5se","family":"Sivertsen","sequence":"additional","affiliation":[{"name":"Norwegian Registry of Cleft Lip and Palate Haukeland University Hospital Bergen Norway"},{"name":"Department of Plastic and Reconstructive Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.1925"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2015.05.003"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162196"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1597\/02-119.2.1"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1597\/13\u2010121"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2022.111145"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619894497"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1597\/14-027"},{"key":"e_1_2_11_10_1","unstructured":"CRANE \u2013 The Cleft Registry and Audit Network.https:\/\/www.crane-database.org.uk\/Falk.hemit.org."},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(90)90158-L"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215162"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1348\/000711006X126600"},{"key":"e_1_2_11_14_1","volume-title":"Handbook of Inter\u2010Rater Reliability: The Definitive Guide to Measuring the Extent of Agreement Among Raters","author":"Gwet K. 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