SUMMARY
Objectives
To investigate the noninferiority of intensive voice therapy and compare its effects
with weekly voice therapy on multidimensional outcomes of voice and well-being, satisfaction,
and attendance in people with muscle tension dysphonia (MTD). The study further aimed
to explore clinician's perceptions of barriers and enablers to implementation of intensive
therapy.
Study Design
Noninferiority randomised controlled trial with nested focus group.
Methods
Twenty adults with MTD were randomised to receive either weekly voice therapy (1 hour
per week for 8 weeks) or intensive voice therapy (1 hour, 4 days per week for 2 weeks).
Participants were assessed by a blinded assessor twice before treatment, once post
treatment and once at 4 weeks follow up on the primary outcome measure VHI and a range
of secondary auditory-perceptual, acoustic, and patient (i.e., VoiSS, satisfaction)
and clinician reported outcome measures (i.e., AusTOMs, attendance rates). Five Speech
Language Pathologists also participated in a focus group to explore barriers and enablers
to implementing intensive therapy, with questions and analyses guided by the Theoretical
Domains Framework.
Results
While noninferiority for the primary outcome measure VHI was not confirmed, secondary
outcome measures revealed comparable within group clinically important improvements
for VoiSS and the AusTOMs, as well as selected acoustic and auditory-perceptual measures
for both groups. A trend of more improvements being maintained in the intensive group
was identified. Comparably high satisfaction and attendance was also found between
groups. Clinicians reported more enablers than barriers to providing intensive therapy
which included beliefs that it led to greater progression and consolidation of patient
learning, was supported by the local context and was associated with positive emotions.
Barriers related to difficulties with booking and scheduling and the belief that intensive
therapy was not for all patients.
Conclusions
While the current study was likely underpowered to establish non-inferiority of intensive
therapy, secondary outcomes suggested that intensive therapy may produce comparable
benefits to voice, wellbeing, satisfaction and attendance compared to weekly therapy
and may be a viable therapy option for individuals with MTD. When implementing intensive
therapy, clinicians should consider patient's preferences and availability, as well
as systems which allow for flexible booking and therapy provision for patients. Clear
recommendations for future research including the use of a larger sample and telehealth
are also provided.
KEY WORDS
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Article info
Publication history
Published online: March 17, 2021
Accepted:
February 9,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of The Voice Foundation.
