Psychosocial outcomes of velopharyngeal insufficiency treatment in patients with cleft palate: A systematic review.

Abstract

Velopharyngeal insufficiency (VPI) after cleft palate repair can cause persistent communication deficits and psychosocial impairment, but; however, patient-reported psychosocial outcomes have not been consolidated across studies using VPI-specific instruments. To synthesize pediatric cleft-related VPI quality-of-life (QoL) outcomes measured using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) instrument and Pediatric Quality of Life Inventory (PedsQL), including preoperative burden, postoperative scores, pre- to postoperative change when available, and patterns of VELO utilization/reporting. For this systematic review, a comprehensive strategy was designed to search the PubMed, EMBASE, Google Scholar, Cochrane Library, and ProQuest databases from inception through April 21, 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Included studies evaluated psychosocial outcomes in patients with VPI secondary to cleft palate and reported pre- and/or postoperative VELO and/or PedsQL scores; non-VPI-focused studies, non-primary reports (e.g., conference abstracts), and incompletely reported outcomes were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale. Thirteen studies were included (10 VELO only, 2 VELO+PedsQL, and 1 PedsQL only). Across the cohorts, 597 patients contributed VELO data and 109 contributed PedsQL data; 89 patients completed both instruments (617 patients contributing 1126 total reports). VELO preoperative pooled means were 71.7 (SD 23.1) for child self-report (n=376) and 67.3 (SD 22.5) for parent proxy (n=524). Postoperative VELO totals were reported only by parents (pooled mean 73.4; n=57), with postoperative child self-report being insufficient for pooling; only 3 studies reported postoperative VELO. Pooled parent-proxy pre- to postoperative VELO change was +46.3. For PedsQL, pooled preoperative totals were 64.4 (SD 17.4) for child report (n=69) and 66.9 (SD 13.3) for parent proxy (n=80); one study reported postoperative PedsQL (mean 77.0 [SD 6.7]; n=20), with pooled total change of +10.1. Children with cleft-related VPI demonstrate substantial preoperative psychosocial burden on disease-specific (VELO) and generic (PedsQL) instruments, and available evidence suggests postoperative improvement-particularly on VELO-though inference is limited by sparse longitudinal data and inconsistent reporting (notably the lack of postoperative child self-reports). Standardized reporting with paired child- and parent-reported outcomes across defined time points is needed to strengthen clinical applicability.