Research Article| Volume 27, ISSUE 5, P617-621, September 2013

Relationship Between Adherence to Speech Therapy in Patients With Dysphonia and Quality of Life



      The present study analyzed if aspects of voice-related quality of life (VRQOL) were associated with adherence to voice therapy in teachers.

      Study Design

      Retrospective survey in which the medical records of 179 dysphonic teachers (62, abandonment group and 114, discharge group) who underwent speech therapy at the Speech Therapy Clinic at the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AV-HCUFMG) were analyzed.


      Female teachers with dysphonia referred by Gerência de Saúde e Perícia Médica (Department of Health and Medical Analysis) of Belo Horizonte City Hall were included. The variables of interest were: age, number of voice therapy sessions attended (attendance), number of sessions missed (absence), type of dysphonia, and Vocal Activity and Protocol Profile (VAPP) scores administered during the first therapy session as a component of voice assessment. The chi-square test was used to assess categorical variables. For continuous variables, the Mann-Whitney test, a nonparametric test for independent samples, was used.


      The groups differed with regard to the type of dysphonia as well as the several parameters of the VAPP: vocal self-perception, effects at work, effects on daily communication, effects on emotion, and the total VAPP score.


      Individuals with less favorable VRQOL scores were less adherent to voice therapy compared with subjects with more favorable VRQOL.

      Key Words

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        • World Health Organization
        Measuring Quality of Life—The World Health Organization Quality of Life Instruments.
        WHO/MSA/MNH/PSF, Geneva, Switzerland1997 (1–15)
        • Behlau M.
        • Hogikyan N.D.
        • Gasparini G.
        Quality of life and voice: study of a Brazilian population using the voice-related quality of life measure.
        Folia Phoniatr Logop. 2007; 59: 286-296
        • Gasparini G.
        • Behlau M.
        Quality of life: validation of the Brazilian version of the voice-related quality of life (V-RQOL) measure.
        J Voice. 2009; 23: 76-81
        • Hogikyan N.D.
        • Rosen C.A.
        A review of outcome measurements for voice disorders.
        Otolaryngol Head Neck Surg. 2002; 126: 562-572
        • Krischke S.
        • Weigelt S.
        • Hoppe U.
        • Köllner V.
        • Klotz M.
        • Eysholdt U.
        • Rosanowski F.
        Quality of life in dysphonic patients.
        J Voice. 2005; 19: 132-137
        • Bassi I.B.
        • Assunção A.A.
        • Medeiros A.M.
        • Menezes L.N.
        • Teixeira L.C.
        • Gama A.C.C.
        Quality of life, self-perceived dysphonia, and diagnosed dysphonia through clinical tests in teachers.
        J Voice. 2011; 25: 192-201
        • Horne R.
        • Weinman J.
        Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness.
        J Psychosom Res. 1999; 47: 555-567
        • van Leer E.
        • Connor N.P.
        Patient perceptions of voice therapy adherence.
        J Voice. 2010; 24: 458-469
        • Hapner E.
        • Portone-Maira C.
        • Johns M.M.
        A study of voice therapy dropout.
        J Voice. 2009; 23: 337-340
        • Leite S.N.
        • Vasconcellos M.P.C.
        Adherence to prescribed therapy: points for concepts and presuppositions discussion.
        Ciênc Saúde coletiva. 2003; 8: 775-782
        • Miller N.H.
        Compliance with treatment regimens in chronic asymptomatic diseases.
        J Med. 1997; 102: 43-48
      1. World Health Organization. Adherence to long-term therapies: evidence for action. Switzerland. WHO/MNC;2003:1–209.

        • Fumaz C.R.
        • Tuldra A.
        • Ferrer M.J.
        • et al.
        Quality of life, emotional status, and adherence of HIV-1-infected patients treated with efavirenz versus protease inhibitor-containing regimens.
        J Acquir Immune Defic Syndr. 2002; 29: 244-253
        • Gama A.C.C.
        • Menezes L.N.
        • Maia A.A.
        • Rezende A.L.N.
        • Oliveira J.B.
        Voice related quality of life after botulinum toxin injection for spasmodic dysphonia.
        Rev Laryngol Otol Rhinol. 2010; 131: 39-44
        • Geocze L.
        • Mucci S.
        • Marco M.A.
        • Nogueira-Martins L.A.
        • Citero V.A.
        Quality of life and adherence to HAART in HIV-infected patients.
        Rev Saúde Pública. 2010; 44: 743-749
        • Hommel K.A.
        • Davis C.M.
        • Baldassano R.N.
        Medication adherence and quality of life in pediatric inflammatory bowel disease.
        J Pediatr Psychol. 2008; 33: 867-874
        • Chen S.-L.
        • Tsai J.-C.
        • Lee W.-L.
        The impact of illness perception on adherence to therapeutic regimens of patients with hypertension in Taiwan.
        J Clin Nurs. 2009; 18: 2234-2244
        • Horne R.
        • Weinman J.
        Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication.
        Psychol Health. 2002; 17: 17-32
        • Mannheimer S.B.
        • Matts J.
        • Telzak E.
        • Chesne M.
        • Child C.
        • Wu A.W.
        • Friedland G.
        Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence.
        AIDS Care. 2005; 17: 10-22
        • Roy N.
        • Merrill R.M.
        • Gray S.T.S.D.
        • Smith E.M.
        Effects of voice disorders on teachers and the general population.
        J Speech Lang Hear Res. 2004; 47: 542-545
        • Behlau M.
        • Oliveira G.
        • Santos L.M.A.
        • Ricarte A.
        Validation in Brazil of self-assessment protocols for dysphonia impact.
        Pró-Fono Revista de Atualização Científica. 2009; 21: 326-332
        • Portone-Maira C.
        • Wise J.C.
        • Johns M.M.
        • Hapner E.E.
        Differences in temporal variables between voice therapy completers and dropouts.
        J Voice. 2011; 25: 62-66
        • Bragion T.A.A.
        • Foltran T.R.F.
        • Penteado R.Z.
        Relations between voice, work and health: perceptions of teachers.
        Distúrb Comum. 2008; 20: 319-325
      2. Penteado RZ, Pereira IMTB. Quality of life and vocal health of teachers. 2007;41:236–243

        • Araújo T.M.
        • Reis E.J.F.B.
        • Carvalho F.M.
        • Porto L.A.
        • Reis I.C.
        • Andrade J.M.
        Factors associated with vocal fold pathologies in teachers.
        Cad Saúde Pública. 2008; 24: 1229-1238
        • Jardim R.
        • Barreto S.M.
        • Assunção A.A.
        Work conditions, quality of life, and voice disorders in teachers.
        Cad Saúde Pública. 2007; 23: 2439-2461
        • Medeiros A.M.
        • Barreto S.M.
        • Assunção A.A.
        Voice disorders (dysphonia) in public school female teachers working in Belo Horizonte: prevalence and associated factors.
        J Voice. 2008; 22: 676-687
        • Colombrini M.R.C.
        • Coleta M.F.D.
        • Lopes M.H.B.M.
        Risk factors for non-compliance to treatment with highly effective antiretroviral therapy.
        Rev Esc Enferm. 2008; 42: 490-495
        • Portone C.
        • Johns M.M.
        • Hapner E.R.
        A review of patient adherence to the recommendation for voice therapy.
        J Voice. 2008; 22: 192-196
        • Hill J.
        • Bird H.
        • Johnson S.
        Effect of patient education on adherence to drug treatment for rheumatoid arthritis: a randomized controlled trial.
        Ann Rheum Dis. 2001; 60: 869-875
        • Luz T.C.B.
        • Filho A.I.L.
        • Lima-Costa M.F.
        Perceptions of social capital and cost-related non-adherence to medication among the elderly.
        Cad Saúde Pública. 2011; 27: 269-276
        • Nascimento M.C.
        • Silva O.M.P.
        • Saggioratto C.M.L.
        • Vargas K.C.
        • Schopf K.
        • Klunk J.
        The challenge of physical exercise adherence among the elderly from Palmitos/sc (Brazil): reasons for engagement and abandon.
        Rev bras ativ fis saúde. 2010; : 140-144
        • Miller W.R.
        Motivational interviewing with problem drinkers.
        Behav Psychother. 1983; 11: 147-172
        • Behrman A.
        Facilitating behavioral change in voice therapy: the relevance of motivational interviewing.
        Am J Speech Lang Pathol. 2006; 15: 215-225