Fields 2003.

Methods	Quasi‐randomised controlled trial comparing 1 intervention group (oral motor therapy and articulation or phonological therapy) and 1 control group (articulation or phonological therapy only). Conducted in 2002
Participants	8 children (4 boys and 4 girls) aged between 3 and 6 years; mean age was 4.63 years. All participants had not received oral motor therapy before the study. All had a current IEP with speech and language assessment no more than 1 year old, and all had been receiving articulation therapy for at least 3 months. Receptive vocabulary score on the PPVT‐III was within normal limits, and the standard score on SPAT‐D fell within 1.5 and 2 standard deviations below the mean. All participants were diagnosed as having moderate to severe articulation disorder. In the intervention group, participants 1, 2 and 3 showed "cluster reduction /s/ errors" and participant 4 had "stridency deletion" (p 18); it was not reported whether additional speech errors were observed in these participants. Investigators did not report speech errors shown by participants in the control group
Interventions	8 children were placed first into 4 groups (2 in each group) according to age, disorder and IEP goals by the speech‐language pathologist at the school the children were attending. Groups were then randomly assigned to 1 of 2 conditions Intervention group (n = 4) 9 × 20‐minute therapy sessions with the first 10 minutes on oral motor therapy and the following 10 minutes on articulation or phonological therapy Oral motor exercises for speech clarity, as developed by Sara Rosenfeld‐Johnson (Rosenfeld‐Johnson 2001), were used for oral motor therapy. This treatment protocol includes exercises for the jaw, lips and tongue. Exercises used in the intervention were selected on the basis of oral motor weakness identified in individual participants and the phoneme(s) that were misarticulated. Hence, tongue exercises were administered to participants 1 and 2, whereas jaw exercises were given to participants 3 and 4. Participant 1 completed the 4 steps in the first exercise ‐ "tongue‐tip lateralisation midline to either side" ‐ and the first 2 steps (6 steps altogether) of the second exercise ‐ "tongue‐tip lateralisation across midline". Participant 2 completed the 4 steps of the first tongue exercise and the first step of the second tongue exercise. Participants 3 and 4 completed the first 2 of the 3 steps of the "Bite Block #2" exercise. The phonological processes shown by participants (see above) were targeted in the articulation or phonological therapy Control group (n = 4) 9 × 20‐minute therapy sessions using articulation or phonological therapy depending on the diagnoses of individual children The phoneme(s) targeted in therapy were not reported 10 therapy sessions were planned; however, only 9 were administered because the "researcher did not implement therapy one day due to personal reasons" (p 23). The frequency of therapy sessions was the same for both intervention and control groups: 2 therapy sessions per week, over 5 weeks. Total therapy time was 3 hours for each participant. All therapy sessions, for both conditions, were carried out in groups of 2 children
Outcomes	SPAT‐D was conducted pre‐intervention and post intervention to measure treatment effect
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	The method used to generate the random sequence was not described
Allocation concealment (selection bias)	Unclear risk	The method used to conceal allocation was not described
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding of participants and personnel was not possible
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Outcome assessor was not identified
Incomplete outcome data (attrition bias) All outcomes	Low risk	All participants completed the 9 therapy sessions
Selective reporting (reporting bias)	Low risk	The study appears to be free of selective reporting bias
Other bias	High risk	Query the possibility of unequal baseline characteristics of the 2 groups ‐ the intervention group had a mean score of 27 and an SD of 14.6 for SPAT‐D pre‐treatment, whereas the control group had a mean score of 40.5 and an SD of 20.5 for SPAT‐D. The intervention group appeared to have fewer speech errors than the control group at the start of the study