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Van Stan JH, Roy N, Stemple J, Gartner-Schmidt J, Gillespie AI, Whyte J, Duffy J, Turkstra L. Rehabilitation Treatment Specification System: Content and Criterion Validity Across Evidence-Based Voice Therapies for Muscle Tension Dysphonia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1774-1791. [PMID: 38597797 PMCID: PMC11253635 DOI: 10.1044/2024_ajslp-23-00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 02/20/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Systematically improving voice therapy outcomes is challenging as the clinician actions (i.e., active ingredients) responsible for improved patient functioning (i.e., targets) are relatively unknown. The theory-driven Rehabilitation Treatment Specification System (RTSS) and standard, voice-specific terminology based on the RTSS (RTSS-Voice) may help address this problem. This qualitative study evaluated if the RTSS and RTSS-Voice can describe four evidence-based voice therapies for muscle tension dysphonia without missing critical aspects (content validity) and identify commonalities and differences across them (criterion validity). METHOD Qualitative interviews were completed between the clinicians (protocol experts) who developed and/or popularized the vocal function exercises, laryngeal reposturing, circumlaryngeal massage, and conversation training therapies as well as RTSS experts to produce RTSS specifications that met two consensus criteria: (a) The protocol expert agreed that the specification represented their treatment theory, and (b) the RTSS experts agreed that the specifications correctly adhered to both the RTSS framework and the RTSS-Voice's standard terminology. RESULTS The RTSS and RTSS-Voice comprehensively described voice therapy variations across and within the four diverse treatment programs, needing only the addition of one new target: overall auditory-perceptual severity. CONCLUSIONS The RTSS and RTSS-Voice exhibited strong content validity. The standard RTSS-Voice terminology helped identify, for the first time, commonalities and differences in treatment ingredients, targets, and mechanisms of action across four treatments developed for the same patient population. In the long term, the RTSS and RTSS-Voice could provide the framework for an ever-growing collection of clinically meaningful and evidence-based therapy algorithms with potential to improve research, education, and clinical care. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25537624.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | | | | | | | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
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Wolfberg J, Whyte J, Doyle P, Gherson S, Muise J, Petty B, Tolejano CJ, Hillman RE, Stadelman-Cohen T, Van Stan JH. Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:814-830. [PMID: 38101322 PMCID: PMC11001165 DOI: 10.1044/2023_ajslp-23-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/15/2023] [Accepted: 11/04/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice. METHOD Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification. RESULTS All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice. CONCLUSIONS The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research-practice gap. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24796875.
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Affiliation(s)
- Jeremy Wolfberg
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | - Patricia Doyle
- University of Connecticut School of Medicine, Farmington
| | | | - Jason Muise
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | | | | | - Robert E. Hillman
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tara Stadelman-Cohen
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Jarrad H. Van Stan
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
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Slavych BK, Zraick RI, Ruleman A. A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults. J Voice 2024; 38:544.e1-544.e14. [PMID: 34782227 DOI: 10.1016/j.jvoice.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language. METHOD A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols. RESULTS Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale. CONCLUSION The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use.
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Affiliation(s)
- Bonnie K Slavych
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA.
| | - Richard I Zraick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida, USA
| | - Alice Ruleman
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA
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Tsai MJ, Wang CT, Fu S, Lin FC. Effect of intensive water resistance phonation therapy for people with presbyphonia: A pilot study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-9. [PMID: 37908078 DOI: 10.1080/17549507.2023.2261660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Purpose: The aim of this pilot study was to explore the efficacy of an intensive 3 week water resistance phonation (WRP) therapy program for people with presbyphonia.Method: Participants included 13 people with presbyphonia who received intensive WRP therapy. All participants completed eight sessions of therapy over 3 weeks. Auditory perceptual ratings, and acoustic and aerodynamic assessments were performed before and after treatment. Participants also completed the voice-related quality of life questionnaire before and after the treatment.Result: After 3 weeks of intensive voice therapy, significant improvements were demonstrated in acoustic, aerodynamic, and auditory perceptual parameters, as well as patient perceptions of voice-related quality of life. Acoustically, it was found there were significant decreases in shimmer (p = 0.019), noise-to-harmonic ratio (p = 0.016), and smoothed cepstral peak prominence (p = 0.001). Perceptually, the clients with presbyphonia showed significant reductions in the ratings of the overall grade, roughness, asthenia, and strain. Moreover, there was a significant increase in the total score of the Mandarin version of the Voice-Related Quality of Life measure post-therapy.Conclusion: The investigation provides preliminary evidence that people with presbyphonia can improve their vocal function and voice-related quality of life through intensive WRP therapy within a short period of time.
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Affiliation(s)
- Ming-Jhen Tsai
- Department of Otorhinolaryngology - Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electric Engineering, Yuan-Ze University, Taoyuan, Taiwan
| | - Sherry Fu
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
- Lower School, Taipei American School, Taipei, Taiwan
| | - Feng-Chuan Lin
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Dacakis G, Erasmus J, Nygren U, Oates J, Quinn S, Södersten M. Development and Initial Psychometric Evaluation of the Self-Efficacy Scale for Voice Modification in Trans Women. J Voice 2022:S0892-1997(22)00078-9. [PMID: 35513936 DOI: 10.1016/j.jvoice.2022.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To develop a self-efficacy questionnaire for voice modification related to gender affirmation and to examine the internal consistency and test-retest reliability of the questionnaire among a cohort of trans women. METHODS This study was undertaken in two phases. In phase I, four Speech- Language Pathologists (SLPs) and four trans women informed the development of the Self-Efficacy Scale for Voice Modification in Trans Women (SES-VMTW). In phase II, using classical test theory, data from 31 Australian and 27 Swedish trans women who completed the SES-VMTW twice with an interim period of 3-6 weeks were analyzed for internal consistency and test-retest reliability. During this second phase, the 19 items of the SES-VMTW were subcategorized by consensus among the authors into like groups. RESULTS Phase I resulted in the 19-item SES-VMTW and four subcategories were identified: 1) Change (items related to changing voice); 2) Perception (items related to the ability to perceive changes in voice; 3) Psychological (items related to engaging in voice practice despite psychological barriers; 4) Logistical (items related to engaging in voice practice despite logistical barriers). In Phase II, initial psychometric analysis was applied to the full questionnaire as well as to the subcategories. The Cronbach's alpha for the full questionnaire (α = 0.86) at both the test and retest timepoints indicates a high level of internal consistency. Item-total correlation analysis indicated that individual items correlated with the questionnaire total score, but that they generally correlated more strongly with the total score for the relevant subcategory. The Cronbach's alpha for the four subcategories of the SES-VMTW were variable but all coefficients exceeded 0.6, thus supporting the reliability of the new scale. Good test-retest reliability was demonstrated for the full questionnaire (intraclass correlation coefficient = 0.84; 95% confidence interval, 0.73-0.90, P < 0.001) and was moderate to good for the four subcategories. CONCLUSION The findings of the current study are promising, suggesting that both the full SES-VMTW and the four subcategories can provide consistent and reliable insight into self-efficacy for trans women aiming to modify their voice as part of their gender affirmation.
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Affiliation(s)
- Georgia Dacakis
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Jaco Erasmus
- Gender Clinic, Monash Health, Clayton, Victoria, Australia
| | - Ulrika Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Sterling Quinn
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Maria Södersten
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
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Rao SJ, Nickel JC, Kiell EP, Madden LL. Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology. Laryngoscope 2021; 132:1069-1074. [PMID: 34498753 DOI: 10.1002/lary.29849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare. METHODS This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. RESULTS All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76). CONCLUSION Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Eleanor P Kiell
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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Gartner-Schmidt J, Gillespie AI. Conversation Training Therapy: Let's Talk It Through. Semin Speech Lang 2021; 42:32-40. [PMID: 33596602 DOI: 10.1055/s-0040-1722751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article introduces a novel approach to voice therapy called conversation training therapy (CTT). CTT is the first voice therapy approach to remove the therapeutic hierarchy common in most treatment programs. Rather, CTT uses patient-driven conversation as the sole stimuli in therapy to increase perceptual awareness of voice production in conversational speech. The genesis as to why CTT was developed, as well as the conceptual, theoretical, and component parts of CTT, will be explained. In addition, this article will offer examples of the language of therapy, as it applies to CTT and how to trouble-shoot if problems arise. Medical documentation relevant to CTT will also be outlined. Last, results from a recent efficacy study on CTT will be reported.
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Affiliation(s)
- Jackie Gartner-Schmidt
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amanda I Gillespie
- Emory Voice Center, Department of Otolaryngology, Emory University School of Medicine, Emory University Hospital Midtown, Atlanta, Georgia
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Helou LB, Gartner-Schmidt JL, Hapner ER, Schneider SL, Van Stan JH. Mapping Meta-Therapy in Voice Interventions onto the Rehabilitation Treatment Specification System. Semin Speech Lang 2021; 42:5-18. [PMID: 33596600 PMCID: PMC7935442 DOI: 10.1055/s-0040-1722756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Meta-therapy refers to the clinical dialogue via which direct and indirect voice treatments are introduced and discussed, and which helps build a useful conceptual framework for voice therapy. Meta-therapy was idiosyncratically defined in previous work. However, the current colloquial narrative of meta-therapy is not standardized or specific enough to be reliably taught, rigorously studied, or clinically delivered with high fidelity. Therefore, this article uses a standard framework (the Rehabilitation Treatment Specification System or RTSS) to further articulate and operationalize meta-therapy in vocal rehabilitation. Meta-therapy's conceptual framework generally aligns with the RTSS's treatment theory and associated concepts; e.g., the treatment component and its underlying ingredients, mechanisms of action, and target. Because the treatment theories in meta-therapy most frequently involve mechanisms of action related to information processing, they primarily map onto the RTSS's Representations treatment components. The treatment targets in meta-therapy are often focused on changes in the patient's cognitions, knowledge, beliefs, attitudes, intentions, and/or awareness regarding voice-related modifications. The ingredients in meta-therapy are frequently clinician actions conveying information with the goal of appropriately shaping the patient's mental representations, and are delivered with verbal cues, stories, analogies, etc. This manuscript provides specific examples of how meta-therapy is applied in clinical voice practice. Considerations for future investigation of meta-therapy are proposed.
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Affiliation(s)
- Leah B. Helou
- Department of Communication Science & Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacqueline L. Gartner-Schmidt
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edie R. Hapner
- Department of Otolaryngology, UAB Voice Center, University of Alabama, Birmingham, Birmingham, Alabama
| | - Sarah L. Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco
| | - Jarrad H. Van Stan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Center for Laryngeal Surgery and Voice Rehabilitation, Boston, Massachusetts
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts
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Baylor C, Darling-White M. Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1335-1360. [PMID: 32463702 PMCID: PMC7893522 DOI: 10.1044/2020_ajslp-19-00043] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/20/2019] [Accepted: 02/10/2020] [Indexed: 05/08/2023]
Abstract
Introduction The World Health Organization's International Classification of Functioning, Disability and Health calls on speech-language pathologists (SLPs) to provide care that impacts all aspects of an individual's experience with a communication disorder, including their participation in valued life situations. However, SLPs often report feeling unprepared to implement and document interventions that target life participation. The purpose of this article is to propose a framework to guide participation-focused intervention practices. This age- and disorder-generic framework is designed to be applicable with clients across the variety of settings in which SLPs work. Method In this clinical focus article, we draw on past research and clinical experience to propose a restructuring of World Health Organization's International Classification of Functioning, Disability and Health components such that participation is the primary focus and outcomes indicator for intervention. In this framework, a specific communicative participation situation is identified and assessed quantitatively, and a corresponding participation-focused goal is established through shared decision making. Following that, assessments are conducted and goals are established in the areas of communication skills, physical and social environments, and personal perspectives. Results The proposed framework provides a concrete organizational structure as well as assessment, goal-writing, and intervention examples to assist SLPs in translating theoretical biopsychosocial frameworks into clinical practices. Conclusions SLPs can and do provide holistic communication services to clients to help them achieve their life participation goals. This article provides an example as to how we can document the need for, as well as the value and impact of our important work, meeting the diverse life participation needs of clients. Supplemental Material https://doi.org/10.23641/asha.12360758.
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Affiliation(s)
- Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Meghan Darling-White
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
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Fulton NM, Drake K, Childes JM, Ziegler A, Schindler JS, Graville DJ, Palmer AD. The Association between Paradoxical Vocal Fold Motion and Dysphonia in Adolescents. Folia Phoniatr Logop 2020; 72:378-388. [PMID: 31896115 DOI: 10.1159/000502543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Associations between dysphonia and paradoxical vocal fold motion (PVFM) have been previously reported in adults, but it is unclear whether similar associations exist for adolescents. The goals of this study were to identify the prevalence and severity of voice disorders in adolescent patients with PVFM, identify differences between those with and without clinician-identified dysphonia, and investigate what factors were associated with voice handicap in this population. METHODS A retrospective review of eligible adolescent patients diagnosed with PVFM over a 1-year period at a single institution was undertaken. Data collected from the medical record included demographic background, medical history and workup, patient- and family-reported symptoms, and findings from the laryngeal examination. The presence or absence of clinician-diagnosed dysphonia was used to subdivide the sample for analysis. RESULTS Forty-eight patients with PVFM were included. The sample was primarily female (73%) with a median age of 15 years. Few patients had voice complaints (5%), but clinician-diagnosed dysphonia was common (52%) and ranged from mild to moderate. Vocal hyperfunction was frequently observed (55%), but anatomic abnormalities associated with dysphonia were rare (6%). Adolescents with dysphonia were significantly older, more likely to have vocal hyperfunction on laryngoscopy, and more likely to return for therapy than those without dysphonia. No notable differences existed in the number of behavioral therapy sessions or in the likelihood of completing treatment between the two groups. The majority of participants (79%) had at least one "confounding factor" (i.e., were currently taking a medication for asthma, allergies, or reflux, or had a laryngeal abnormality) but this did not differ significantly between those with and without dysphonia. A minority of individuals (28%) had abnormal scores on the Voice Handicap Index (VHI). Age was positively correlated with dysphonia severity but no other significant associations were observed. CONCLUSION Although voice complaints are rare, dysphonia among adolescents with PVFM is common and can occur in the absence of laryngeal abnormalities and medical comorbidities, typically as a result of vocal hyperfunction. Dysphonia does not appear to be a barrier to PVFM treatment and may be a useful target in therapy.
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Affiliation(s)
- Nicole M Fulton
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Karen Drake
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jana M Childes
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Aaron Ziegler
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joshua S Schindler
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Donna J Graville
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrew D Palmer
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA,
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Measurement properties of self-report questionnaires on health-related quality of life and functional health status in dysphonia: a systematic review using the COSMIN taxonomy. Qual Life Res 2018; 28:283-296. [DOI: 10.1007/s11136-018-2001-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/14/2022]
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12
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Mansuri B, Tohidast SA, Soltaninejad N, Kamali M, Ghelichi L, Azimi H. Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review. J Voice 2018; 32:609-620. [DOI: 10.1016/j.jvoice.2017.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/11/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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Hu A, Hillel A, Zhao W, Meyer T. Anxiety and depression in spasmodic dysphonia patients. World J Otorhinolaryngol Head Neck Surg 2018; 4:110-116. [PMID: 30101219 PMCID: PMC6074012 DOI: 10.1016/j.wjorl.2018.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 12/01/2022] Open
Abstract
Objective/Hypothesis Experts used to believe that spasmodic dysphonia (SD) was a psychogenic disorder. Although SD is now established as a neurological disorder, the rates of co-morbid anxiety and depression range from 7.1% to 62%. Our objective was to study the prevalence and risk factors associated with these mood disorders in SD patients. Study design Retrospective. Methods SD patients who presented for botulinum toxin injections were recruited. Demographic data, Hospital Anxiety and Depression Scale (HADS), Voice Handicap Index-10 (VHI-10), General Self-Efficacy scale (GSES), Disease Specific Self-Efficacy in Spasmodic Dysphonia scale (DSSE), and Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) were collected. Results One hundred and forty two patients (age (59.2 ± 13.6) years, 25.4% male) had VHI-10 of 26.3 ± 6.9 (mean ± standard deviation), GSES 33.2 ± 5.8, CAPE-V 43.9 ± 20.9, HADS anxiety 6.7 ± 3.7, and HADS depression 3.6 ± 2.8. About 19 (13.4%) and 4 (2.8%) had symptoms of anxiety and depression respectively. Final linear regression model for HADS anxiety (R2 = 32.90%) showed that patients who were less likely to have anxiety symptoms were older age (p < 0.001), male (p = 0.002), have higher GSES (p < 0.001) and lower VHI-10 (p = 0.004). Final linear regression model for HADS depression score (R2 = 34.42%) showed that patients who were less likely to have depressive symptoms had high DSSES (p < 0.001). Conclusions Prevalence of anxiety (13.4%) and depression (2.8%) in SD were lower than previously reported in the literature. Risk factors for anxiety were: younger age, female gender, lower general self-efficacy, and higher perceived vocal handicap. The main risk factor for depression was lower disease specific self-efficacy.
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Affiliation(s)
- Amanda Hu
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Al Hillel
- Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, WA, USA
| | - Wei Zhao
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tanya Meyer
- Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, WA, USA
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Affiliation(s)
- Maia Braden
- University of Wisconsin Voice and Swallow Clinics
Madison, WI
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15
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Smith AG, Sandage MJ, Pascoe DD, Plexico LW, Lima IR, Cao G. Elementary School Teachers' Vocal Dose: Muscle Bioenergetics and Training Implications. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1831-1842. [PMID: 28614843 DOI: 10.1044/2016_jslhr-s-16-0193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/29/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE Translating exercise-science methodology for determination of muscle bioenergetics, we hypothesized that the temporal voice-use patterns for classroom and music teachers would indicate a reliance on the immediate energy system for laryngeal skeletal-muscle metabolism. It was hypothesized that the music-teacher group would produce longer voiced segments than the classroom teachers. METHOD Using a between- and within-group multivariate analysis-of-variance design (5 classroom teachers; 7 music teachers), we analyzed fundamental-frequency data-collected via an ambulatory phonation monitor-for length (seconds) of voiced and nonvoiced intervals. Data were collected for 7.5 hr during the workday, over the course of several workdays for each teacher. RESULTS Descriptive analyses of voiced and nonvoiced intervals indicated that over 99% of voiced segments for both groups were no longer than 3.15 s, supporting the hypothesis of reliance on the immediate energy system for muscle bioenergetics. Significant differences were identified between and within the classroom- and music-teacher groups, with the music-teacher group producing longer voiced segments overall. CONCLUSIONS Knowledge of probable intrinsic laryngeal skeletal-muscle bioenergetics requirements could inform new interdisciplinary considerations for voice habilitation and rehabilitation.
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Francis DO, Daniero JJ, Hovis KL, Sathe N, Jacobson B, Penson DF, Feurer ID, McPheeters ML. Voice-Related Patient-Reported Outcome Measures: A Systematic Review of Instrument Development and Validation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:62-88. [PMID: 28030869 PMCID: PMC5533561 DOI: 10.1044/2016_jslhr-s-16-0022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/28/2016] [Accepted: 07/20/2016] [Indexed: 05/24/2023]
Abstract
PURPOSE The purpose of this study was to perform a comprehensive systematic review of the literature on voice-related patient-reported outcome (PRO) measures in adults and to evaluate each instrument for the presence of important measurement properties. METHOD MEDLINE, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument databases were searched using relevant vocabulary terms and key terms related to PRO measures and voice. Inclusion and exclusion criteria were developed in consultation with an expert panel. Three independent investigators assessed study methodology using criteria developed a priori. Measurement properties were examined and entered into evidence tables. RESULTS A total of 3,744 studies assessing voice-related constructs were identified. This list was narrowed to 32 PRO measures on the basis of predetermined inclusion and exclusion criteria. Questionnaire measurement properties varied widely. Important thematic deficiencies were apparent: (a) lack of patient involvement in the item development process, (b) lack of robust construct validity, and (c) lack of clear interpretability and scaling. CONCLUSIONS PRO measures are a principal means of evaluating treatment effectiveness in voice-related conditions. Despite their prominence, available PRO measures have disparate methodological rigor. Care must be taken to understand the psychometric and measurement properties and the applicability of PRO measures before advocating for their use in clinical or research applications.
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Affiliation(s)
- David O. Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN
- Center for Surgical Quality and Outcomes Research, Nashville, TN
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
| | - James J. Daniero
- Center for Voice and Swallowing, University of Virginia, Charlottesville
| | | | - Nila Sathe
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
- Vanderbilt University Medical Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Barbara Jacobson
- Department of Hearing and Speech Sciences, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN
| | - David F. Penson
- Center for Surgical Quality and Outcomes Research, Nashville, TN
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Departments of Urology and Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research and Education Coordination Center, Veteran's Administration Tennessee Valley Health System, Geriatric Research and Education Coordination Center, Nashville, TN
| | - Irene D. Feurer
- Center for Surgical Quality and Outcomes Research, Nashville, TN
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa L. McPheeters
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
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Forero M. LA, Kohler M, Vellasco MM, Cataldo E. Analysis and Classification of Voice Pathologies Using Glottal Signal Parameters. J Voice 2016; 30:549-56. [DOI: 10.1016/j.jvoice.2015.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/12/2015] [Indexed: 12/01/2022]
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Correlation of VHI-10 to Voice Laboratory Measurements Across Five Common Voice Disorders. J Voice 2014; 28:440-8. [DOI: 10.1016/j.jvoice.2013.10.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/30/2013] [Indexed: 11/24/2022]
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Hu A, Isetti D, Hillel AD, Waugh P, Comstock B, Meyer TK. Disease-specific self-efficacy in spasmodic dysphonia patients. Otolaryngol Head Neck Surg 2013; 148:450-5. [PMID: 23300221 DOI: 10.1177/0194599812472319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Self-efficacy (SE) is an optimistic self-belief that one can perform a novel task. This concept involves empowerment, self-esteem, and adaptation to a stressful situation. SE is a strong predictor of health behaviors. Our objectives were to study SE in spasmodic dysphonia (SD) and to develop a disease-specific SE-SD scale. STUDY DESIGN Prospective study. SETTING Academic hospital. SUBJECT AND METHODS Disease-specific SE-SD items were developed with laryngologists, speech pathologists, and SD patients. These items, General SE Scale, Voice Handicap Index-10 (VHI-10), Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), and Hospital Anxiety and Depression Scale (HADS), were administered to SD patients who presented for botulinum toxin injections. RESULTS One hundred forty-five SD patients (mean age 59.5 ± 13.6 years) had a general SE score (Cronbach's α = 0.894) of 33.4 ± 5.2 out of 40. This was negatively correlated with HADS-A (r = -0.42, P < 0.001) and HADS-D (r = -0.42, P < .001), but not correlated with VHI-10 (r = -0.098, P = .243) and CAPE-V (r = -0.047, P = .57). Factor analysis selected 8 items from the general SE scale and 5 disease-specific SE-SD items to generate a 13-item disease-specific SE-SD scale (Cronbach's α = 0.907). Disease-specific SE-SD score was 42.1 ± 6.9 out of 52 and was negatively correlated with VHI-10 (r = -0.19, P = .005), HADS-A (r = -0.43, P < .001), and HADS-D (r = -0.57, P < .001), but not correlated with CAPE-V (r = -0.024, P = .60). CONCLUSION SD patients established on botulinum toxin injections have high degrees of general and disease-specific SE. Patients with higher SE-SD demonstrate lower vocal handicap and lower levels of anxiety and depression. A 13-item disease-specific SE-SD scale has been developed.
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Affiliation(s)
- Amanda Hu
- Department of Otolaryngology-Head & Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.
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