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. 2018 Nov 14;2018(11):CD009115. doi: 10.1002/14651858.CD009115.pub3

McArthur 2015a.

Methods Quasi‐randomised controlled trial
3 treatment groups (phonics, sight words (not relevant), mixed (not relevant)) and 3 control groups (no‐training double‐baseline period for phonics group, sight words (not relevant), mixed (not relevant))
Participants Location/setting: Sydney, Australia
Criteria: scored below the mean range for their age (i.e. had a Z score lower than –1) on the CC2 irregular‐word reading test or non‐word reading test. No history of neurological or sensory impairment as indicated on a background questionnaire. Used English as their primary language at school and at home.
Recruits: full study included 141 dyslexic children recruited from schools, clinics, and newspaper advertisements. This review included the 39 participants who completed 8 weeks of no training (control) and then 8 weeks of pure phonics training (intervention).
Sex: 63.8% male; 36.2% female
Mean age: 9.42 years (SD 1.71; range 7–12 years)
Ethnicity: not reported
Sample size: 39 dyslexic children
Allocation: quasi‐randomised allocation procedure. Full study had 3 recruitment periods. 3 groups were recruited in each recruitment period. The children included in this review were recruited in the first recruitment period (months 1–6). The other children, recruited for the 2nd and 3rd groups in 2nd and 3rd periods, were not included in this review since they did a mixture of phonics + sight word training). A between‐groups ANOVA established that the groups did not differ in reading ability or age prior to training.
Intervention groups:
  1. phonics: n = 39 (sex, mean age, SD, and range not reported)

  2. sight words: n = 40 (sex, mean age, SD, and range not reported)

  3. mixed: n = 38 (sex, mean age, SD, and range not reported)


Control groups:
  1. phonics T1: n = 39 (sex, mean age, SD, and range not reported)

  2. sight words: n = 40 (sex, mean age, SD, and range not reported)

  3. mixed: n = 38 (sex, mean age, SD, and range not reported)

Interventions Interventions:
  1. phonics: children were instructed to do the phonics training at home for 30 minutes/day, 5 days/week, for 8 weeks. All training was done on a computer using a modified version of the Lexia® Strategies for Older Students, which uses a wide variety of games and exercises to teach the pairing of written stimuli (i.e. letters, letter clusters, syllables, morphemes, whole words, phrases, and sentences) to the spoken versions of those stimuli. The modified programme thus focused on training GPCs either alone, within parts of words (i.e. syllables), or within regular words. Phonics training focused on accuracy rather than fluency.

  2. sight words: children were taught to read irregular words by sight using the DingoBingo game.

  3. mixed: children did both phonics and sight word training, alternating from day to day.


Controls:
  1. phonics T1: prior to training, children completed a double‐baseline period with outcome measures tested before and after 8 weeks of no training.

  2. sight words: prior to training, children completed a double‐baseline period with outcome measures tested before and after 8 weeks of no training.

  3. mixed: prior to training, children completed a double‐baseline period with outcome measures tested before and after 8 weeks of no training.

Outcomes Time of post‐test: immediately after no‐training period (control) and then immediately after 8 weeks of phonics training (experimental)
Primary outcomes: trained and untrained irregular word reading accuracy and non‐word reading accuracy
Secondary outcomes: word and non‐word reading fluency and reading comprehension
Relevant measures: non‐word accuracy (experimental: 20 untrained non‐words printed on flashcards), irregular words (trained) accuracy (experimental: 30 flashcards), irregular words (untrained) accuracy (experimental: 30 flashcards), non‐word fluency (TOWRE: Non‐word subtest), mixed/regular word fluency (TOWRE: Sight Word subtest), reading comprehension (Test of Everyday Reading Comprehension)
Notes
  1. In addition to the phonics groups, 2 groups in this study did phonics + sight word training. Since "this review was focused on phonics training, we included data on the "purest" example of this – i.e. gains in outcome measures in Group 1 before and after they did 8 weeks of phonics, and the we compared those gains to control data from the same group of children – i.e. gains in the same outcomes measures in Group 1 before and after an 8‐week no training period" (quote from personal communication with author).

  2. It is noteworthy that although all children were tested for their non‐verbal intelligence, children with non‐verbal IQ scores below the mean range were not excluded from the study since intelligence does not appear to predict reading ability or response to treatment.

  3. Contacted author for the numbers for sex of participants.


Study start and end dates: not reported
Funding: "This research was funded by NHMRC Project 488518 and ARC DP0879556" (quote, p 406).
Declared/potential conflict of interest: "no potential conflicts of interest with respect to the research, authorship, and/or publication of this article" (quote, p 406).
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Comment: as noted in the study, this was a quasi‐randomised controlled trial.
Quote from publication: "There is good evidence that this quasi‐randomised allocation procedure did not bias the outcomes of this study. First, the groups were very well matched prior to training (see Table 1). Second, for all bar one outcome, groups made similar gains after 16 weeks of training, indicating that allocation did not produce any group that was unusually responsive or unresponsive to treatment. Third, for the exceptional outcome, the group difference was in the predicted direction, indicating that superior group performance was a result of a genuine experimental effect rather than a group allocation effect. Fourth, this study was designed so that there could be no possible bias between allocation to intervention and control groups since each individual participated in both control and intervention periods, and any gains in the control period were controlled for in the intervention period statistically (i.e. we used a double‐baseline design that gauged the effect of no training in each and every participant before they did training)" (p 398).
Allocation concealment (selection bias) Low risk Quote from publication: "Each recruitment period had a fixed start date and an end date. Children were allocated to their group according to when they were recruited for the study. Since children could be allocated to only one group, it is highly unlikely that lack of allocation concealment introduced bias into the study" (pp 398–9).
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Quotes from publication: "Unlike drug trials, cognitive treatment trials find it difficult to guarantee double blinding because the type of training cannot be completely concealed from a volunteer. However, neither parents nor children were told their group allocation, and it is highly unlikely that they had the expertise to ascertain the type of training that they were receiving (i.e. they were blind to group allocation). Furthermore, all children received exactly the same type of training in this study. The only difference was the order in which they did the training. This would further obscure group allocation to children and their parents" (p 399).
"...we employed four casual testers to help two principal testers. With careful planning, we ensured that no tester assessed the same child twice, and no tester was aware of the child's group allocation (i.e. the tester was blind to group allocation)" (p 399).
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Quote from publication: "...we employed four casual testers to help two principal testers. With careful planning, we ensured that no tester assessed the same child twice, and no tester was aware of the child's group allocation (i.e. the tester was blind to group allocation)" (p 399).
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Comment: 37 participants dropped out in total (26%). There were similar numbers in each group, and reasons for dropout were random. This is similar to McArthur 2015b, which used almost identical methods. This suggests that attrition was not unusual for reading training studies of this type, and is similar to mean attrition rates for cognitive behavioural interventions done with children with clinical problems (Karlson 2009).
Selective reporting (reporting bias) Unclear risk Comment: data reported for all outcome measures outlined in methods; adequate detail for data to be included in analysis.
Other bias Low risk Comment: none apparent