{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T04:25:11Z","timestamp":1783311911760,"version":"3.54.6"},"reference-count":61,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T00:00:00Z","timestamp":1498694400000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Orthod Craniofacial Res"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Structured Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate centre\u2010level variation in speech intervention and outcome and factors associated with a speech disorder in children in Cleft Care <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">CCUK<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and Sample Population<\/jats:title><jats:p>Two hundred and sixty\u2010eight 5\u2010year\u2010old British children with non\u2010syndromic unilateral cleft lip and palate recruited to <jats:styled-content style=\"fixed-case\">CCUK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Centre\u2010based therapists undertook audio\u2010video recordings. Perceptual analysis was undertaken using the <jats:styled-content style=\"fixed-case\">CAPS<\/jats:styled-content>\u2010A tool. Speech outcomes were based on structural and articulation scores, and intelligibility\/distinctiveness. Between\u2010centre variation in treatment and outcomes were examined using multilevel models. These models were extended to estimate the association between a range of factors (hearing loss, speech intervention, fistula, secondary speech surgery for velopharyngeal insufficiency, socio\u2010economic status, gender, and parental happiness with speech) and speech outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was centre\u2010level variation in secondary speech surgery, speech intervention, structure and intelligibility outcomes. Children with a history of speech intervention had a lower odds of poor intelligibility\/distinctiveness, 0.1 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.0\u20100.4). Parental concern was associated with a higher odds of poor intelligibility\/distinctiveness, 13.2 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 4.9\u201035.1). Poor speech outcomes were associated with a fistula, secondary speech surgery and history of hearing loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Within the centralized service there is centre\u2010level variation in secondary speech surgery, intervention and speech outcomes. These findings support the importance of early management of fistulae, effective management of velopharyngeal insufficiency and hearing impairment, and most importantly speech intervention in the preschool years. Parental concern about speech is a good indicator of speech status.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ocr.12186","type":"journal-article","created":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T09:15:12Z","timestamp":1498727712000},"page":"27-39","source":"Crossref","is-referenced-by-count":42,"title":["Centre\u2010level variation in speech outcome and interventions, and factors associated with poor speech outcomes in 5\u2010year\u2010old children with non\u2010syndromic unilateral cleft lip and\u00a0palate: The Cleft Care <scp>UK<\/scp> study. Part 4"],"prefix":"10.1111","volume":"20","author":[{"given":"D.","family":"Sell","sequence":"first","affiliation":[{"name":"North Thames Regional Cleft Service Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health Illness and Disability (ORCHID) Great Ormond Street Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Southby","sequence":"additional","affiliation":[{"name":"School of Social and Community Medicine University of Bristol  Clifton Bristol UK"},{"name":"Cleft.NET.East Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Wren","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"},{"name":"Bristol Speech &amp; Language Therapy Research Unit North Bristol NHS Trust Southmead Hospital  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. K.","family":"Wills","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"},{"name":"National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Hall","sequence":"additional","affiliation":[{"name":"Life and Health Sciences Aston University  Birmingham UK"},{"name":"Children's Hearing Centre St Michael's Hospital  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"School of Social and Community Medicine University of Bristol  Clifton Bristol UK"},{"name":"Department of Applied Statistics Helwan University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Waylen","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. R.","family":"Sandy","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. R.","family":"Ness","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"},{"name":"National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,6,29]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"327","volume-title":"Cleft Palate Speech Management: A Multidisciplinary Approach","author":"Golding\u2010Kushner KJ","year":"1995"},{"key":"e_1_2_7_3_1","unstructured":"HallC.Golding\u2010Kushner KJ. Long\u2010term follow\u2010up of 500 patients with palate repair performed prior to 18\u00a0months of age. 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